![]() ![]() I was afraid that the Ep-7S would block some of the buttons and functions of my X-Pro1 but on the contrary, it still offers me full access to my buttons, and it actually helps by preventing me from moving the sometimes annoying EV dial by accident. I never had a problem with how the Fuji X-Pro1 feels without the EP-7S but seriously, I was really surprised at how comfortable the camera was with the Thumbs Up thumb rest. In terms of shooting with it, the EP-7S feels fantastic. ↑ The Thumbs Up EP-7S comes is packaged very nicely, and it comes with a charm. The EP-7S also has two silicone rubber inserts on the inner part of it that provide stable contact with the camera, and protects the camera from marks and scratches. It’s tight but in no way does it feel like it doesn’t belong in there. It slides into the hot shoe surprisingly very smoothly, and it’s an absolutely perfect fit. It’s an extremely well-made, solid piece of brass that matches perfectly with the Fuji X-Pro1. The EP-7S feels exactly how it looks in the photos. ![]() It doesn’t look like a cheap aftermarket part nor does it feel like one at all. ![]() The great thing about the EP-7S is that it looks like an OEM product on my X-Pro1. I figured, why not? Who am I to say no to trying out new gear, right? Match Technical Thumbs Up EP-7S Build Quality: As they say, “If it ain’t broke, why fix it?” So, why am I writing a post about the Thumbs Up EP-7S for the X-Pro1? Well, one of my friends, who’s visiting from California, recently bought an EP-7S for his X-Pro1, and told me I need to try it out. I’ve heard of only great things about Match Technical’s Thumbs Up devices but never used them because I was content with how my cameras felt in my hands. One popular accessory for rangefinder and mirrorless cameras are the Thumbs Up devices made by Match Technical. Nowadays, there’s a huge market for little trinkets, such as, neck straps, hand grips and even soft release buttons. This customization goes further than just picking what kind of lenses or film you prefer (if you shoot with film). Like almost everything else in the world these days, camera equipment can be customized to suit one’s needs. ![]()
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![]() One thing I do take exception to is that all of this gets old after a few missions. Do you have the navigator give his dying comrade first aid or man the now vacant gun turret? All while repairing damage, lining up bombing runs and wondering if one of the engines is going to explode (yes, yes it is.) All this while designating targets for the gunners and having the pilot maintain a proper course. Wait? Fuel? Planes like fuel… I’m going to need that. To make matters worse, opening the bay doors too soon causes drag, slowing down your aircraft and wasting fuel. For example, you can’t drop your bombs without having your bombardier open the bomb bay doors, but he is doubling as the radio operator and will stop that function to take on another. You can’t forget anything or delay too long with critical tasks without consequences. It is allowed to slow time, but this costs you reward money you would otherwise be able to use to upgrade your aircraft or equipment. (Pro-tip, keep someone in the pilot’s seat.) Like FTL this can be a lot of balls to keep in the air, not only do you have to make correct decisions, you must do so in real time as you can’t save or pause the game (Mu-ha-ha!) during a mission. It won’t warn you that you forgot to put down the landing gear or moved your pilot out of his seat. Presumably, this is done in the name of accessibility, but my bombardier looks like Gandhi, and I’m reasonably sure the radio operator is Oprah.īomber Crew’s interface is clean and reasonably clear, but it doesn’t cut you any slack. You can even name the cute doomed people who are a typical 21st-century mix of ethnicities and genders. The crew can be injured, killed or captured or just listed as missing during the mission and of course, your aircraft can be destroyed forcing you to start over with a new plane lacking those fancy upgrades you spent ten missions earning and of course brand new cute cartoon people to send to their doom. Failure to properly equip and manage your crew will lead to death or worse, mission failure. ![]() Their gentle persuasion includes cannon armed interceptors, crew-served weapons and if you purchase the Secret Weapons DLC guided missiles. The Germans, of course, think your dropping bombs on them is not the best idea they’ve ever heard and go to some trouble to discourage you. Unsurprisingly, in this case, that of a Royal Air Force Avro Lancaster Bomber taking part in missions against German-occupied Europe during the Second World War. ![]() ![]() Much like the classic FTL: Faster Than Light, you manage the actions of your crew. Are you a fan of aviation? Of history? Of watching cute cartoon people struggle against overwhelming odds and ultimately fail leading to their violent and untimely death? If so, Rudder Duck’s Bomber Crew is just the thing to pass the time while you are waiting for Amazon to deliver that new bone saw you’ve been saving up for. ![]() ![]() They form a set as a whole.Ī permutation, however, puts the elements in a fixed order, one after the other, making it a sequence rather than a set. In essence, we say which ones we pick, but not which is first, second, etc. As we've said in the previous section, the meaning behind a combination is picking a few elements from a bigger collection. We multiply the number of choices: 3 × 2 × 1 = 6, and get the factorial. Note that we can also understand this formula like this: we choose the first element out of three (3 options), the second out of the two remaining (because we've already chosen one – 2 options), and the third out of the one that's left (because we've already chosen two – 1 option). Visit our permutation calculator for a deeper dive. Observe that this agrees with what the factorial tells us: For example, if we have three cute kitten expressions, say □, □, and □, then we can order them in six different ways: A permutation of length n means putting n elements in some order. In combinatorics, it denotes the number of permutations. ![]() In the section above, we've seen what a factorial is. Which is the same as n choose k (since multiplication is commutative). If we take n choose n - k, then we'll get We can get from it a quite interesting symmetric property. So we can choose two elements from a set of four in six different ways and from a set of six in fifteen ways.īefore we move on, let's take one more look at the n choose k formula. The expression n! is the product of the first n natural numbers, i.e., ![]() The exclamation mark is called a factorial. " And how do I calculate it?" Well, easily enough. Is "6 choose 2." In some textbooks, the binomial coefficient is also denoted by C(n,k), making it a function of n and k. The number of combinations of k elements from a set of n elements is denoted by After all, all members of a project team are equal (except those that don't do any work). What is most important here is that the order of the elements we choose doesn't matter. If you'd like to get a bit technical, choosing a combination means picking a subset of a larger set. In this case, a combination of four elements from a twenty-element set, or, if you prefer, of four students from a twenty-person group. If there are twenty people in the group, and the teacher divides you into groups of four, how probable is it that you'll be with your friend?Įvery possible group is an example of a combination. The problem is that there's only one guy that you'd like to work with on the project. Suddenly, the teacher brings you back to earth by saying, " Let's choose the groups for the mid-term projects at random." Well, it looks like you'll have to do some work, after all. ![]() Imagine that you're a college student, taking a casual nap during a lecture. ![]() ![]() PERSONA SUPER LIVE P-SOUND BOMB!!!! 2017 ~Minato no Hankou wo Mokugekiseyo!~ / PERSONA SUPER LIVE P-SOUND BOMB!!!! 2017 ~港の犯行を目撃せよ!~ / PERSONA SUPER LIVE P-SOUND BOMB!!!! 2017 ~Minato no Hankou wo Mokugekiseyo!~ LNCM-1222~3 Main Artist (as Lyn / Lyn) PERSONA5 the Animation Original Soundtrack Vol.1 / PERSONA5 the Animation Original Soundtrack Vol.1 / PERSONA5 the Animation Original Soundtrack Vol.1 ANZX-13576 Performer (as Lyn / Lyn) PERSONA5 the Animation Jika Net Tanaka Special Arrange CD / PERSONA5 the Animation 時価ネットたなか 特製アレンジCD / PERSONA5 the Animation Jika Net Tanaka Special Arrange CD SBCV-80283 Performer (as Lyn / Lyn) PERSONA5 the Animation OPENING & ENDING THEME DISC: BREAK IN TO BREAK OUT/INFINITY / PERSONA5 the Animation OPENING & ENDING THEME DISC: BREAK IN TO BREAK OUT/INFINITY / PERSONA5 the Animation OPENING & ENDING THEME DISC: BREAK IN TO BREAK OUT/INFINITY ANZX-13572 Vocals (as Lyn / Lyn) P3D & P5D FULL SOUNDTRACK / 『P3D』&『P5D』フルサウンドトラック / P3D & P5D FULL SOUNDTRACK 610-9155 Voice (as Lyn / Lyn), Vocals (as Lyn / Lyn) Lupin The Third Part V Si Bon! Si Bon! ORIGINAL SOUNDTRACK / ルパン三世 PART5 オリジナル・サウンドトラック~SIBON! SIBON! / Lupin The Third Part V Si Bon! Si Bon! ORIGINAL SOUNDTRACK VPCG-83526 Chorus, Vocals PERSONA3 DANCING IN MOONLIGHT / PERSONA5 DANCING IN STARLIGHT / PERSONA3 DANCING IN MOONLIGHT / PERSONA5 DANCING IN STARLIGHT / PERSONA3 DANCING IN MOONLIGHT / PERSONA5 DANCING IN STARLIGHT N/A Vocals (as Lyn / Lyn) ![]() GAME SYMPHONY JAPAN 21st CONCERT ATLUS Special ~PERSONA 20th Anniversary~ / GAME SYMPHONY JAPAN 21st CONCERT ATLUS Special ~ペルソナ20周年記念~ / GAME SYMPHONY JAPAN 21st CONCERT ATLUS Special ~PERSONA 20th Anniversary~ LNXM-1219 Performer (as Lyn / Lyn) P5 / P5 / P5 8BIT-8069 Performer (as Lyn / Lyn) Persona 5 Vinyl Soundtrack Essential Edition / Persona 5 Vinyl Soundtrack Essential Edition / Persona 5 Vinyl Soundtrack Essential Edition 8BIT-8069 Performer (as Lyn / Lyn) Let's Fall In Jazz / Let's Fall In Jazz / Let's Fall In Jazz VPCG-83523 Performer (as Lyn / Lyn) PERSONA5 SOUNDS OF REBELLION / PERSONA5 SOUNDS OF REBELLION / PERSONA5 SOUNDS OF REBELLION N/A Performer (as Lyn / Lyn) PERSONA5 ORIGINAL SOUNDTRACK / 『ペルソナ5』 オリジナル・サウンドトラック / PERSONA5 ORIGINAL SOUNDTRACK LNCM-1175~7 Vocals (as Lyn / Lyn), Liner Notes (as Lyn / Lyn) While we wait for Strikers to come out, Persona 5 Royal is out now on PlayStation 4.Masshiro Original Soundtrack / TBS系 火曜ドラマ まっしろ オリジナル・サウンドトラック / Masshiro Original Soundtrack UZCL-2064 Performer (as Lyn / Lyn)Ģ0th ANNIVERSARY OF PERSONA SERIES ALL TIME BEST ALBUM / ペルソナ 20thアニバーサリーオールタイムベストアルバム / 20th ANNIVERSARY OF PERSONA SERIES ALL TIME BEST ALBUM CDP-02879~83 Vocals (as Lyn / Lyn)ĭoctor-X Gekai Daimon Michiko Original Soundtrack 2 / ドクターX~外科医・大門未知子~Original Soundtrack 2 / Doctor-X Gekai Daimon Michiko Original Soundtrack 2 COCP-39794 Performer (as Lyn / Lyn) You can watch the announcement trailer below. The PS4 version can be played on PS5 through backward compatibility. Persona 5 Strikers launches on PlayStation 4 and Nintendo Switch on February 23, 2021. ![]() The Game Awards air on December 10 at 6:30 pm ET/ 3:30 pm PT. Some of the games making an appearance are Dragon Age 4, Fall Guys, and Among Us. Among the presenters is Gal Gadot, Brie Larson, Reggie Fils-Aime, and Josef Fares. You'll get to also play as characters such as Joker, Morgana, Haru, and more.Īs we get closer to The Game Awards, we're getting more details on presenters and potential announcements. Strikers is an action RPG and a sequel to Persona 5 where you can fight hordes of enemies throughout Japan. The game's announcement was leaked last week but we now know it'll come to the PS4, Nintendo Switch, and PC next February. Additionally, the pre-show will also feature five world premieres.Īfter months of speculation, Persona 5 Scramble is coming to America as Persona 5 Strikers. She won't be the only musical guest, with Pearl Jam's Eddie Vedder set to perform. ![]() Her performance ties in well with Persona 5 Strikers likely making an appearance during the show. There's no word on what songs from the game she'll perform or if series Shoji Meguro will be there too. Inaizumi is a Japanese jazz and soul vocalist who has worked on Persona 5 and its spin-offs. ![]() ![]() ![]() “Exasperating Farrago of Distortions, Misrepresentation and Outright lies being broadcast by an unprincipled showman masquerading as a journalist” – Shashi Tharoor’s tweet in response to a scathing TV report. It displays a very welcoming image, the time and also allows for you to set a main focus for the day reminding you of what is to be done. This Chrome extension changes how the home page is. We have gotten used to this and actually don’t understand the appearance to have this problem but it doesn’t take away the fact that it could be a hell of a lot more welcoming. Every day we open the browser we all love and what are we greeted with? A window which is similar to a person giving you a matter of fact distasteful look. What it actually means is that don’t be indifferent to life or the people in it. People often say wake up every day with love in your heart and kindness in your thought. The extension provides options to take screenshots (taking a screenshot of a small portion is also possible), bookmark pages, highlight relevant content, and to copy and clip clutter-lessly and easily. Evernote Clipper is a very powerful tool that allows its users to collect and organize data and share it across devices with a very power synchronization option. While we have always found efficient ways to do just that there are easier ways to do it with Evernote clipper being a prime example. Evernote ClipperĪs avid readers, researchers or as the legendary meme makers we all on a regular basis comes across content that we wish we could easily save and organize. Once the user wants to access it again that tab can be opened and click to reload option can be used to get the content back. This Chrome extension unloads the content from the tab and reduces the memory consumption without having to close the tab. ![]() This is a great tussle to people who can’t afford to close tabs and this is where The Great Suspender comes to the rescue. ![]() This is because of the memory consumption of those 4 idle tabs eating in your RAM. Open 4 tabs in Chrome and leave it idle while doing something else in your laptop, something preferably that consumes a decent amount of memory. To understand the greatness of The Great Suspender let’s do an exercise. Apart from identifying errors it also clearly expresses why the error occurred thereby allowing a user to understand it and never make the same error again. It detects more types of errors than even Word’s advanced error identifying system. Grammarly is an extension primarily for MS Word and Chrome that identifies errors in the documents that are written. Here are some Google chrome extensions for testing and debug analytics set-ups whilst browsing sites.The number of times that web users have come continuously across this ad is only rivalled by the number of times it has saved our neck from making mistakes in important documents. User-Agent Switcher Chrome extensions for Analysts This means you’re able to select only the links you want on a page and open all of them at once in separate tabs. Linkclump allows you to copy all the links you require on a page using a click and drag action. Multilink allows you to open multiple links at once, without manually having to add each link into a new tab The Structured Data Testing Tool extension checks the markup on the page, providing an easy way to check for any markup errors. View Rendered Source allows you to compare how a rendered page differs to the original HTML source and highlights lines of code that have either been added or removed in the fully rendered version.īuiltwith gives you a detailed account of what technologies the web page you’re on has been built with. Scraper allows you to scrape data from websites, either from multiple areas of one page. Scraper is another fantastic tool, but it’s worth noting that this requires an understanding of XPath or Regex to make the most of it. Link Redirect Trace does exactly what its names suggests: it informs you whether the link you’ve just clicked on has gone through a redirect or not and, if so, then it follows the redirect chain to its final destination. Web Developer is a chrome extension developed by Chris Pederick that allows you to make changes to your viewport to impact what you’re seeing on the webpage. ![]() ![]() Get all 3 draft guides for the price of 2 and use promo code BUNDLE10 at checkout to save even more. Dominate your football, baseball and basketball drafts with the Rotoworld Draft Guide Bundle. Who am I too high on? Who am I too low on? In the meantime, be sure to check out Fantasy Football Happy Hour every week wherever you get your podcasts, on the NFL on NBC YouTube page and on Peacock, of course.Įvery season is draft season. One key aspect of dynasty leagues is the rookie draft, where teams. Until then, take a look and tell me what you think. Dynasty fantasy football is a popular format that allows players to build and manage a team of players over multiple seasons. These ranks will continue to be updated as we get closer to August and depth charts change. Like, I wouldn't recommend taking Zach Charbonnet over Jordan Addison just because you need a RB since the gap between those two players in my rankings is much more significant. Get inspired to begin transforming HR at your company. Player value changes all the time which means so do your team needs. ADP is a better way to work for you and your employees, so everyone can reach their full potential. Are you deep at RB but desperate for a TE? Then Mayer is your guy. In that situation, it's likely that your team needs could play a role in which player you choose to draft. I currently have Michael Mayer, Kendre Miller and Marvin Mims Jr. Hosts Rich Dotson (DynastyRich), Matt OHara (DynastyMatt), and Garret Price (DynastyPrice) hone in on Superflex startup drafts, dissecting the ADP with a focus on the 2023 NFL rookie class. Team context (by that I mean YOUR fantasy team) also plays a role in draft strategy. For example, in shallower leagues, it's generally better to focus on upside with early rookie picks whereas in a deeper league, floor becomes more important. There is no uniform or standard way to play dynasty, so as always adjust these rankings as needed to fit your specific league structure and scoring settings. The Wolf updates his Dynasty Fantasy Football Rankings & Big Board for fantasy start ups and dynasty leagues for the first. My positional rankings will be coming out on Thursday. If you would like to see how I rank these players just for the 2023 season, you can check out my Top 100. This is how I would rank this class of rookies for dynasty/keeper purposes coming out of the 2023 NFL Draft. So, below you will find my PPR rookie dynasty rankings for both 1QB and Superflex leagues. The saying “There is no off-season” could not be more true for those of us in dynasty leagues. ![]() ![]() ![]() More languages and a mobile version are planned for 2020. Google News About The Author Manuel Vonau Senior Google Editor (2056 Articles Published) Manuel Vonau joined Android Police as a freelancer in 2019 and has worked his way up to become the. Definitely worth a read for anyone involved in publishing SEO. a law suit against Google for showing pictures and news alerts without consent or. Users can find the feature on the right side of, and it is now available on desktop globally in U.S. The folks at Ahrefs have compiled a very solid guide on optimising for Google Discover, with contributions from excellent SEO specialists Dan Taylor, John Shehata, Suganthan Mohanadasan, and Kevin Indig. In particular, they are concerned that headlines or content of their. ![]() The stories are surfaced and organized using our Google News algorithms. Whether you’re short on time or ready to dive deep into a topic, Beyond the Headlines will help you manage your time with an estimated read-time feature, letting you know how long it takes to read a story. With our tool, you can even preview your titles in Google Search and ensure. Algorithms personalize your news based on your: Google News settings. Our Headline Analyzer tool enables you to write irresistible SEO headlines. Write Headlines to Dominate Google News Report this post Chris Abraham Chris Abraham 30 years of experience in search, marketing, reputation, web, and Internet technologies. Keeping these stories visible beyond the fast daily news cycle, Beyond the Headlines connects readers with in-depth articles exploring important issues such as healthcare, the environment, education and more. Headline news stories, which show up as: In your app: Headlines or 'Headlines' stories in your briefing On Google News: Headlines stories in Top stories In these sections, people who use the same language and region get news for the same subjects. With Beyond the Headlines in Google News, we want to recognize publishers that are investing in diving deeper into the headlines and moving past the who, what and when to explore the why and how. Today, we’re expanding on that mission by surfacing more in-depth content that highlights and explores key issues in our society. Last year, we redesigned Google News with one goal in mind: to help people understand the world through quality, trustworthy and enjoyable news. Google’s new AI chatbot Bard, which launched in Australia on Thursday as a competitor of ChatGPT, can provide information, write code, translate languages and analyse images. ![]() ![]() ![]() Make sure you have properly installed the drivers of your mobile device that you want to use for sending text messages using Bulk SMS Software for Android Mobile Phone. Software Full Name: SMS Deliverer Enterprise Setup File Name: SMSDeliverer2.7. 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Last room in 10/10 dropped a 30m implant. ![]() I once got a world's collide storyline I think as a lvl 1 and then by the time I got to lvl 3's I managed to get the 10/10 gurista something. You can simply buy the Omber on the market, if you're in a popular missioning area chances are someone will have set up sell orders in the storyline agent's station. Mastin Dragonfly Absolutely No Retreat The Red Skull If you are really unlucky with the RNG, you just happen to get the trade stuff all the time. In the table above you have more crappy trade (4x)/courier (3x) missions than the juicy combat mission (1x), so the chance to get a crappy mission (7/10 = 70%) is increased. This number is checked against the mission table. Combat mission 2 (= 10/10 combat mission with gigantic rewards).Trade mission (= sucky materials mission).RNG creates a random mission table looking maybe like that:.My guess is that it isn't a true random number generator, but more of a random number which is checked against a random generated mission table. I seem to get Materials-storyline most of the time, resulting in a really unbalanced quantity of charisma implants in my hangar. Minmatar Ninmu Seijaku Legionnaire Services Ltd. I got that materials for war one out in guristas space and the lass wanted some omber mined, only prob is that omber is the one of the roids that arnt otu there :( Just wait you'll get that sweet 10 or 4 parter like 5 times in a row )Ĭaldari Lords of Maelstrom Phalanx Alliance Very annoying since the standings increase is pretty low.īad luck man. I seem to get that one alot more than any of the others as well. Things are definitely not working correctly. Hell, in all of my storyline missions I have yet to get a single combat mission. ![]() Yeah, I'd say I get that damn storyline at least 4x as often as any other. It's a damned pain because the mission is near insta-completable through sell orders set-up to take advantage of it and therefore yields very little factional standing, which for me was the only point in running the 15/16 missions before hand. If it's supposed to be random it's broken, I hear similar from a lot of people. Nearly every storyline has been materials for war (2 exceptions so far in over 20 storylines). Recently ran a whole load of level 2 missions for thukker mix, brutor tribe, and a mass of Gallente Federation corps. I wouldnt mind but the reward is always a uselss charisma implant :( Wierd, just recently i keep getting that damn mission. Of course I did not keep count when this all started because it wasn't an issue but while my numbers are probably not exact they really are close. I keep thinking well NEXT time it surely must be different. Support fixing the EVE UI | Suggest Jita fixes With as many people playing this game, someone is going to get boned.įile a bug report. One of the best ways to tell if a "random" distribution was done by a human is that humans will not put in enough streaks. Streaks happen in true random distributions too. True random isn't perfectly random, streaks happen. I understand streaks can happen but c'mon.there's gotta be limits. Some combat, some courier, some in different regions as well as on my ALT. You need to find an agent that is closer to a different Storyline agent, that will improve your chances of getting different missions.Īctually I get them from different agents. Your agent will send you to the closest Storyline agent for their faction. Try leaving it up so you get another storyline agent instead.Īlso try switching regions / systems that you are doing missions in. Bad luck (because Materials has crappy rewards) happens. Is this how it should be or should I tap CCP on the shoulder and let them know their random number generator is borked.at least for me? I really am not kidding.I get this one almost exclusively be it form combat agents or courier agents. While that mission is as easy as they come and perhaps I should be glad for it this has gone beyond absurd. Out of the last 15 (or so.didn't think to keep track initially) Storyline missions 13 (cuz I only remember two that weren't) were the mission "Materials for War Preparation". Thought I'd ask here before bothering with a petition (petition that there is a problem with the game.not that I want ISK or something). Thread Statistics | Show CCP posts - 0 post(s) EVE Search - Keep getting "Materials for War Preparation".should I petition it?Ĭhannels Missions & Complexes Keep getting "Materials for War Preparation".should I petition it? » Click here to find additional results for this topic using Google ![]() ![]() Other etiologies that cause focal structural changes are poorly suited to medical treatment, such as neck radiation therapy causing extensor myopathy and anterior scar contracture. In particular, Parkinson disease, inflammatory myositis, and secondary myopathies due to metabolic or endocrine dysfunction are likely to show substantial improvement when treated with appropriate medications. Many of the underlying conditions are medically treatable and in some cases the extent of the deformity may be decreased to an acceptable level without invasive intervention. Optimal management of a patient with DHS requires a comprehensive multidisciplinary workup to establish the primary cause before surgical decision making. ![]() Imaging at follow-up shows the correction and stabilization of the deformity ( Fig 4).ĭropped head syndrome is a complex and challenging condition. She regained full mobility, and at 8 months follow-up she reported increased energy and a significantly improved ability to carry out daily activities. She was managed for 8 weeks postoperatively in a cervico-thoracic orthosis. Computed tomography confirmed good positioning of all hardware, and anatomical alignment with increased space in the spinal canal. Postoperatively she recovered well with no neurological deficits. Intraoperative electromyographic recordings showed transient-spiking activity during the procedure but this resolved fast. The surgical procedure was uncomplicated, with motor and sensory-evoked potentials maintained throughout. Good reduction of the cervical deformity with neutral head alignment was achieved via direct visualization and image intensification. She underwent a C2 to T1 decompressive laminectomy, and occiput to T6 posterior instrumented fixation and fusion. The patient consented to surgical intervention to achieve the goals of decompression of neural structures, and correction of the cervical deformity with stabilization. Evidence also of fat infiltration of the paraspinal muscles in the lower cervical spine region. Subtle progression of spondylosis, now with distinct T2 hyperintensity of the cord at C3–C4. Magnetic resonance imaging (mid-sagittal T2-weighted image) from 2010. Repeated electrodiagnostic assessment showed fibrillation and small amplitude polyphasic potentials in the paraspinal muscles suggesting myopathy as the cause of DHS. 3) showed distinct T2 hyperintensity of the cord at C3–C4 and atrophy with fat infiltration of the paraspinal muscles in the lower cervical spine. Clinical examination showed an increase in hyperreflexia of the left arm but was otherwise unchanged. Over 2 years she became progressively disabled with decline in her functional state such that she could only ambulate short distances while holding her head up with both hands. A muscle biopsy from the trapezius showed no evidence of inflammatory myopathy and nonspecific atrophic changes with fibrosis which were considered nondiagnostic. Initial electrodiagnostic findings were nonspecific. Evidence of spondylosis with cerebrospinal fluid effacement at the mid-cervical levels, although no evidence of cord signal change. Magnetic resonance imaging (mid-sagittal T2-weighted image) from 2007, when the patient initially presented. A preliminary diagnosis of cervical dystonia causing DHS with subtle signs of myelopathy was considered, and further investigations to determine the primary pathology were organized. 2) showed multilevel cervical spondylosis with cerebrospinal fluid effacement at the mid-cervical levels but no evidence of cord signal change. 1) indicated marked cervical kyphosis centered on the mid-cervical spine, and evidence of spondylosis. She had mild global hyperreflexia and positive Hoffmann reflexes bilaterally, but downward Babinski reflexes bilaterally. Muscle bulk, tone, and power were normal in all four limbs. Active cervical flexion and extension were reduced to 50% of normal and painful at extremes. The deformity was completely reducible by the examiner. On examination she was found to have pronounced cervical kyphosis with hypertrophic neck extensors. However, she testified no motor or sensory dysfunction in any extremity. She also described trouble ambulating, primarily due to difficulty holding up her head. Her neck deformity had been slowly progressive over the last 3 to 4 years but had worsened in recent months. ![]() She gave a decade long history of gradually worsening intense tightness around the neck and muscular contractions. A 38-year-old woman presented to the senior author's spinal cord clinic with a history of severe chronic cervical pain and a recent history of cervical deformity and gait abnormalities. ![]() |
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