BACKGROUND: Neuroanatomical staging of sporadic amyotrophic lateral sclerosis (ALS) indicates that neurodegeneration may spread corticofugally.
METHODS: We conducted an observational study to define the initial sites of disease onset and the clinical progression (\'spreading patterns\') of motor deficits in a cohort of 910 ALS patients in Germany.
RESULTS: Mean age of ALS onset was 59.0 ± 12.6 years for males and 61.2 ± 10.5 years for females, the mean ALSFRS-R was 35.1 ± 9.2, and 7.7% of the cohort reported a family history. Onset of motor symptoms was bulbar/upper limb in 26.8%/35.9%, the right arm initially being slightly more often affected than the left (18.5% vs.16.3%). Testing on concordance of handedness and onset in the dominant arm did not reach significance. Lower limb onset was observed in 37.3%. Unilateral limb onset patients reported horizontal spreading about three times more often than vertical spreading. 71/244 bulbar onset patients reported spreading pattern to the legs, and 17/339 lumbar onset patients reported spreading secondarily to the bulbar region.
CONCLUSIONS: Our results indicate that, although the phenotype of so-called \'spinal\' or \'intraspinal\' spreading predominated, we also observed an additional clinical spreading pattern: 29.1% of patients with bulbar onset experienced spreading clinically to the legs (vice versa in 5.0% of lumbar onset patients). For obvious neuroanatomical reasons, this pattern hardly can be explained solely by a \'spinal\' or an \'intraspinal\' pattern of spreading. Instead, these findings complement insights from previous clinical and clinicopathological studies supporting a cortical initiation of ALS.

OBJECTIVE: The question of why aqueous solutions of some surfactants demonstrate a rapid spreading (superspreading) over hydrophobic solid substrates, while solutions of other similar surfactants do not, has no definitive explanation despite numerous previous studies. The suggested hypothesis for this study assumes that once the spreading coefficient of surfactant is positive, there is a concentration range for solutions of any surfactant which demonstrates rapid spreading. As it is impossible to calculate spreading coefficients for solid substrates, we compare the spreading performance of known superspreaders and non-superspreaders on liquid (oil) substrate.
METHODS: The kinetics of spreading of aqueous solutions of a series of branched ionic surfactants and non-ionic trisiloxane surfactants on two liquid substrates was studied and compared with the spreading of a surfactant-free liquid, silicone oil. Both dynamic and equilibrium spreading coefficients were calculated using measured surface and interfacial tensions.
RESULTS: There is no difference in spreading rate on liquid substrate between solutions of surfactants proven as superspreaders (while spreading on solid substrate) or non-superspreaders. A rapid spreading (superspreading) with the characteristic rate of spreading O(102-103) mm2/s occurs if the dynamic spreading coefficients exceeds the positive threshold value. If the dynamic spreading coefficient is negative or slightly positive, complete wetting still occurs, but the spreading is slow with the spreading rate is O(1) mm2/s. Spreading exponents for surfactant solutions in the rapid spreading regime are considerably larger than for the surfactant-free liquid. A number of spreading and dewetting patterns were observed depending on the surfactant type, its concentration and substrate.

Understanding different gender roles forms part of the efforts to reduce gender inequality. This paper analyses COVID-19 family clusters outside Hubei Province in mainland China during the 2020 outbreak, revealing significant differences in spreading patterns across gender and family roles. Results show that men are more likely to be the imported cases of a family cluster, and women are more likely to be infected within the family. This finding provides new supportive evidence of the \'men as breadwinner and women as homemaker\' (MBWH) gender roles in China. Further analyses reveal that the MBWH pattern is stronger in eastern than in western China, stronger for younger than for elder people. This paper offers not only valuable references for formulating gender-differentiated epidemic prevention policies but also an exemplification for studying group differences in similar scenarios.

OBJECTIVE: Necrotizing external otitis (NEO) is a serious complication of external otitis. NEO can be classified according to-anterior, medial, posterior, intracranial, and contralateral-extension patterns. Currently there is no consensus on the optimal imaging modality for the identification of disease extension. This study compares NEO extension patterns on MR and CT to evaluate diagnostic comparability.
METHODS: Patients who received a CT and MR within a 3-month interval were retrospectively examined. Involvement of subsites and subsequent spreading patterns were assessed on both modalities by a radiologist in training and by a senior head and neck radiologist. The prevalence of extension patterns on CT and MR were calculated and compared.
RESULTS: All 21 included NEO cases showed an anterior extension pattern on CT and MR. Contrary to MR, medial extension was not recognized on CT in two out of six patients, and intracranial extension in five out of eight patients. The posterior extension pattern was not recognized on MR. Overall, single anterior extension pattern (62%) is more prevalent than multiple extension patterns (38%).
CONCLUSIONS: All anterior NEO extension pattern were identified on CT as well as MR. However, the medial and intracranial spreading patterns as seen on MR could only be identified on CT in a small number of patients. The posterior spreading pattern can be overlooked on MR. Thus, CT and MR are complimentary for the initial diagnosis and work-up of NEO as to correctly delineate disease extent through the skull base.