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Animals : An Open Access Journal From... Dec 2023Limited evidence is available relating gait changes to diagnostic anaesthesia. We investigated associations between specific movement patterns and diagnostic anaesthesia...
Limited evidence is available relating gait changes to diagnostic anaesthesia. We investigated associations between specific movement patterns and diagnostic anaesthesia of different anatomical structures in a retrospective analysis. Referral-level lameness cases were included with the following criteria: presence of diagnostic anaesthesia of a forelimb and/or hind limb; subjective efficacy classified as "negative", "partially positive", or "positive"; quantitative gait data available from inertial measurement units. Gait changes were calculated for three forelimb (palmar digital, abaxial sesamoid, low 4-point nerve block) and five hind limb diagnostic blocks (tarso-metatarsal, metatarsophalangeal joint block, deep branch of lateral plantar, low 6-point, abaxial sesamoid nerve block). Mixed models (random factor "case", fixed factors "diagnostic anaesthesia type" and "efficacy", two-way interaction) assessed the head and pelvic movement ( < 0.05, Bonferroni correction). Four parameters were significantly affected by forelimb anaesthesia (N = 265) (all ≤ 0.031) and six by hind limb anaesthesia (N = 342) efficacy (all ≤ 0.001). All head movement parameters and pelvic push-off asymmetry were significantly affected by the two-way interaction after forelimb anaesthesia (all ≤ 0.023) and two pelvic movement symmetry parameters by the two-way interaction after hind limb anaesthesia (all ≤ 0.020). There are interactions between block efficacy and type resulting in changes in weight-bearing and push-off-associated head and pelvic movement symmetry after diagnostic anaesthesia.
PubMed: 38136806
DOI: 10.3390/ani13243769 -
American Journal of Veterinary Research Feb 2024To describe the feasibility of a novel thread-transecting technique for the tenotomy of the equine deep digital flexor tendon (DDFT).
OBJECTIVE
To describe the feasibility of a novel thread-transecting technique for the tenotomy of the equine deep digital flexor tendon (DDFT).
ANIMALS
39 equine distal limb specimens.
METHODS
Under ultrasonographic guidance, a surgical thread was percutaneously placed around the DDFT through 2 needle punctures (lateral and medial) using a Tuohy needle in equine limbs (22 forelimbs, 17 hindlimbs). The DDFT was transected by a back-and-forth motion of the thread until the loop emerged from the entry puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported.
RESULTS
Complete DDFT transection was achieved in all 39 limbs, taking an average of 8.6 minutes per procedure. Iatrogenic damage to surrounding structures occurred in 17 (44%) limbs, with 6 (15%) limbs having more than 1 structure damaged. Damage to the communicating branch of the palmar or plantar nerves was the most commonly seen.
CLINICAL RELEVANCE
DDFT tenotomy in equine limb specimens was effectively performed using a novel thread-transecting technique. The procedure is quick, and no suturing is needed, but damage to surrounding structures is possible. Further assessment of the procedure and clinical significance of its potential iatrogenic damage in clinical cases is needed.
Topics: Horses; Animals; Tenotomy; Tendons; Foot; Foot Diseases; Iatrogenic Disease; Forelimb; Horse Diseases
PubMed: 38109844
DOI: 10.2460/ajvr.23.09.0215 -
Indian Journal of Dermatology 2023The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This...
BACKGROUND
The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This research was done to estimate the proportion of leprosy patients who had G2D at the time of diagnosis and to identify the clinical and demographic factors that predicted G2D.
MATERIALS AND METHODS
Design -Hospital-based retrospective cross-sectional study. The outcome variable was G2D and the determinants were demographic and clinical characteristics.
RESULTS
G2D was seen in 22.3% and G1D in 17.5%. The M:F ratio of G2D was 5:1. G2D was highest in the hands (62.1%), followed by the feet (59.4%), and the eyes (16.2%). The claw hand was the most common deformity in the hand and the plantar ulcer was the most common deformity in the feet. Age >45 (OR 2.27, 95% CI 1.1-4.8), males (OR 3.3,95% CI 1.3-8.5), multibacillary type (OR 6.95,95% CI 1.6-30.6), pure neuritic type (OR 3.6,95% CI 1.1-12.3), and thickened nerves (OR 14.3, 95% CI 1.9-108.7) were the significant determinants.
CONCLUSION
Being male, being older than 45, having multibacillary leprosy, having pure neuritic leprosy, and having a thicker nerve trunk predicted G2D. Training primary care health workers in recognising the subtle early symptoms and raising community awareness are the need of the hour. Frequent leprosy case detection programmes should be held to identify undiagnosed cases.
PubMed: 38099113
DOI: 10.4103/ijd.ijd_391_23 -
Frontiers in Physiology 2023Bioelectrical impedance analysis (BIA) can noninvasively and quickly assess electrical properties of the body, such as the phase angle. Phase angle is regarded as the...
Bioelectrical impedance analysis (BIA) can noninvasively and quickly assess electrical properties of the body, such as the phase angle. Phase angle is regarded as the quantity and/or quality of skeletal muscle and is associated with exercise performance, such as jump height and walking speed. Although the phase angle derived from BIA is assumed to be a useful way to assess muscle function, the relationship between the phase angle and neuromuscular properties has not been fully investigated. The purpose of this study was to investigate the association of phase angle with voluntary and evoked contractile properties in 60 adults (age, 21-83 years; 30 females and 30 males). The phase angle of the right leg at 50 kHz was evaluated using BIA. The twitch contractile properties (peak twitch torque [PT], rate of twitch torque development [RTD], and time-to-PT [TPT]) of the plantar flexors were measured using tibial nerve electrical stimulation. Maximal voluntary isometric contractions (MVICs) were performed to measure the maximal muscle strength and explosive muscle strength, from which the peak MVIC torque (PT) and rate of torque development (RTD) over a time interval of 0-200 ms were assessed, respectively. The root mean square (RMS) values of electromyographic (EMG) activity during the PT and RTD measurements (EMG-RMS and EMG-RMS, respectively) were calculated. The RTD and EMG-RMS were normalized using PT and EMG-RMS, respectively. Phase angle significantly correlated with twitch contractile properties (|| ≥ 0.444, < 0.001), PT ( = 0.532, < 0.001), and RTD ( = 0.514, < 0.001), but not with normalized RTD ( = 0.242, = 0.065) or normalized EMG-RMS ( = -0.055, = 0.676). When comparing measurement variables between the low- and high-phase angle groups while controlling for sex and age effects, the high-phase angle group showed greater PT, RTD, PT, and RTD ( < 0.001) and shorter TPT ( < 0.001) but not normalized RTD ( = 0.184) or normalized EMG-RMS ( = 0.317). These results suggest that the leg phase angle can be an indicator of voluntary and evoked muscle contractile properties but not the neuromuscular activity of the plantar flexors, irrespective of sex and age.
PubMed: 38074320
DOI: 10.3389/fphys.2023.1292778 -
Archives of Rheumatology Sep 2023The aim of this study was to evaluate possible peripheral and autonomic nerve involvement in familial Mediterranean fever (FMF) patients with nerve conduction studies,...
OBJECTIVES
The aim of this study was to evaluate possible peripheral and autonomic nerve involvement in familial Mediterranean fever (FMF) patients with nerve conduction studies, sympathetic skin response (SSR) and RR interval variability (RRIV).
PATIENTS AND METHODS
The comparative case series was conducted with 76 participants between November 2017 and December 2018. Forty-six FMF patients, [12 with amyloidosis (5 males, 7 females; mean age: 44.7±13.9 years) and 34 without amyloidosis (14 males, 20 females; mean age: 35.9±8.7 years)], and 30 healthy volunteers (11 males, 19 females; mean age: 38.4±10 years) were included in this study. Nerve conduction parameters, SSR latency and amplitude from palmar and plantar responses, and RRIV at rest and deep breathing were studied in all the subjects. Neuropathic symptoms of the patient group were evaluated using the survey of autonomic symptoms scale and the neuropathy disability score.
RESULTS
Nerve conduction studies of the patient group revealed polyneuropathy in seven (15.21%) patients and carpal tunnel syndrome in six (13.04%) patients. The mean amplitudes of SSR measured from the soles were significantly lower than the control group (p=0.041). The mean values of RRIV during rest and hyperventilation were lower in the patient group compared to the control group, but no statistically significant difference was found (p=0.484, p=0.341).
CONCLUSION
We detected that the prevalence of carpal tunnel syndrome in our patient population (13.04%) was higher than in the general population. Most of the changes in the range of parameters of SSR and RRIV determined in the patient group did not reach statistical significance, suggesting subclinical dysautonomia in FMF patients.
PubMed: 38046242
DOI: 10.46497/ArchRheumatol.2023.9695 -
Progress in Rehabilitation Medicine 2023Magnetic stimulation devices can be large because of the need for cooling systems. We developed a compact and lightweight Spinning Permanent Magnet (SPM) device that...
BACKGROUND
Magnetic stimulation devices can be large because of the need for cooling systems. We developed a compact and lightweight Spinning Permanent Magnet (SPM) device that generates magnetic fields with intensities below the motor threshold. In this report, we present the case of a post-stroke patient in which an immediate reduction in spasticity of the ankle plantar flexors was achieved after SPM treatment.
CASE
A 37-year-old man was admitted to our hospital with a right putamen hemorrhage. The patient underwent conservative therapy and exhibited residual left hemiplegia and spasticity. Three months after stroke onset, he was able to walk with supervision while using a left ankle-foot orthosis and a T-cane. The Modified Ashworth Scale (MAS) score of the left ankle plantar flexors was 1+. The plantar flexors were stimulated by SPM treatment. The outcomes were the Hmax/Mmax of the tibial nerve (soleus muscle) and the MAS score. On the first day, SPM stimulation was applied for 30 min. On the second day, a sham stimulation of the same duration was performed. On the third day, the SPM stimulation was repeated. Hmax/Mmax decreased from 41.5% to 37.7% on the first day, and from 46.9% to 31.6% on the third day after SPM stimulation. The MAS score decreased from 1+ to 1 on both days. In contrast, after sham stimulation, Hmax/Mmax increased from 39.2% to 44.2%, whereas the MAS score remained unchanged at 1+.
DISCUSSION
Stimulation below the motor threshold using SPM treatment can effectively reduce spasticity.
PubMed: 38024959
DOI: 10.2490/prm.20230040 -
Cureus Oct 2023Homocysteine is a type of amino acid that isn't genetically encoded by the human body. This amino acid is capable of causing oxidative damage to the endothelial cells,...
Homocysteine is a type of amino acid that isn't genetically encoded by the human body. This amino acid is capable of causing oxidative damage to the endothelial cells, leading to the onset of thrombosis. Moreover, it can also inflict harm to neurons by activating pro-apoptotic factors, causing DNA damage, and inducing oxidative stress, as observed in various animal models and cell cultures. This case report highlights a four-year-old girl who exhibited signs of an ischemic stroke. The neurological examination revealed several symptoms, including anisocoria, decreased tone, decreased power, absent reflexes on the right upper and lower extremity, and hyper extensor plantar response, accompanied by upper motor neuron seventh cranial nerve palsy. An MRI scan further confirmed the presence of an ischemic stroke in the left middle cerebral artery territory. After a thorough evaluation, the probable cause of this condition was identified as severe homocysteine elevation.
PubMed: 38021803
DOI: 10.7759/cureus.46981 -
Cureus Oct 2023Mechanisms of sciatic nerve injury include gunshot injury, sharps injury, injection injury, contusion, femoral fracture injury, and iatrogenic injury due to fracture...
OBJECTIVE
Mechanisms of sciatic nerve injury include gunshot injury, sharps injury, injection injury, contusion, femoral fracture injury, and iatrogenic injury due to fracture surgery. Regardless of the type of injury, patients undergoing sciatic nerve repair have poor motor and sensory outcomes. In this study, we compared the late outcomes of a group of patients in whom the author performed an early end-to-end anastomosis for sciatic nerve sharps injury and another group of patients with a similar injury who were not operated on but left to natural history.
METHODS
The sciatic nerve, comprising two primary divisions with distinct muscle innervations, was subject to separate examinations. Group 1 (n=10, study group) underwent tibial division anastomosis, while Group 2 (n=12, control group) received no surgical intervention involving the tibial division. Similarly, Group 3 (n=11, study group) underwent peroneal division anastomosis, while Group 4 (n=14, control group) encompassed subgroups that did not undergo peroneal division surgery.
RESULTS
In Group 1, the rate of gain in plantar flexion muscle strength was significantly higher (p < 0.05) compared to Group 2. Furthermore, the sensory examination gain level ratio within the tibial domain was significantly greater (p < 0.05) in Group 1 than in Group 2. Additionally, Group 1 exhibited a significantly higher rate (p < 0.05) of detection of regeneration and reinnervation findings in electromyography (EMG) compared to Group 2.
CONCLUSION
When evaluating the long-term outcomes following early end-to-end anastomoses of the sciatic nerve, it becomes evident that while significant improvements are observed when compared to individuals without anastomosis, the positive impact of surgical interventions on motor and sensory gains in daily life remains limited. Nevertheless, we contend that early surgical intervention holds potential advantages in terms of patient management.
PubMed: 38021623
DOI: 10.7759/cureus.47101 -
Scientific Reports Nov 2023Diabetic foot is a common severe complication of diabetes, and its main symptom is diabetic foot ulcer. The production of plantar diabetic foot ulcers is usually...
Diabetic foot is a common severe complication of diabetes, and its main symptom is diabetic foot ulcer. The production of plantar diabetic foot ulcers is usually affected by two factors, namely neuropathy or vascular disease. While previous studies proved that stochastic resonance (SR) could effectively enhance the plantar touch of patients with diabetic feet, the potential impact of SR on neural circuit feedback, especially on the input of the tactile nerves of the lower limbs, is less clear. This study aims to explore the potential impact on the tactile threshold of the human foot when using vibrating insoles. We study a white noise vibration insole based on SR mechanism. We compare and analyze the tactile threshold voltage (TTV) triggered by an electrical stimulation device in three main plantar pressure-bearing areas (the second metatarsal (M2), the fourth metatarsal (M4), and the heel (H) area) of 8 participants using EEG and self-developed vibration insole. Significance found in M2 and M4 areas, white noise signal (WNS) lowered the tactile threshold in these areas, and had a potentially positive impact on patients with diabetic feet, especially in the M4 area. The influence of WNS on the plantar heel area was still controversial. This study showed that WNS applied to the sole could improve the plantar tactile sensing ability of patients with diabetic feet, but it did not cover all areas. The application of WNS showed better benefits for the forefoot area than for the hindfoot area, which was speculated that may be related to the difference in the distribution density of blood vessels in plantar areas. Due to the impaired natural touch in participants with diabetic foot, using artificial evoked sensation WNS intervention, would be a feasible approach to improve plantar sensation.
Topics: Humans; Diabetic Foot; Foot; Sensation; Heel; Foot Orthoses; Shoes; Diabetes Mellitus
PubMed: 38001103
DOI: 10.1038/s41598-023-47263-w -
Healthcare (Basel, Switzerland) Oct 2023Extracorporeal shock waves are high-intensity mechanical waves (500-1000 bar) of a microsecond duration with a morphology characterized by a rapid positive phase... (Review)
Review
UNLABELLED
Extracorporeal shock waves are high-intensity mechanical waves (500-1000 bar) of a microsecond duration with a morphology characterized by a rapid positive phase followed by a negative phase.
BACKGROUND
Extracorporeal shock waves have been used for pain treatment for various sub-acute and chronic musculoskeletal (MSK) problems since 2000. The aim of this article is to update information on the role of extracorporeal shock wave therapy (ESWT) in the treatment of various pathologies that cause MSK pain.
METHODS
Given that in the last two years, articles of interest (including systematic reviews and meta-analyses) have been published on less known indications, such as low back pain, nerve entrapments, osteoarthritis and bone vascular diseases, a literature search was conducted in PubMed, the Cochrane Database, EMBASE, CINAHL and PEDro, with the aim of developing a narrative review of the current literature on this topic. The purposes of the review were to review possible new mechanisms of action, update the level of evidence for known indications and assess possible new indications that have emerged in recent years.
RESULTS
Although extracorporeal shock waves have mechanical effects, their main mechanism of action is biological, through a phenomenon called mechanotransduction. There is solid evidence that supports their use to improve pain in many MSK pathologies, such as different tendinopathies (epicondylar, trochanteric, patellar, Achilles or calcific shoulder), plantar fasciitis, axial pain (myofascial, lumbar or coccygodynia), osteoarthritis and bone lesions (delayed union, osteonecrosis of the femoral head, Kienbock's disease, bone marrow edema syndrome of the hip, pubis osteitis or carpal tunnel syndrome). Of the clinical indications mentioned in this review, five have a level of evidence of 1+, eight have a level of evidence of 1-, one indication has a level of evidence of 2- and two indications have a level of evidence of 3.
CONCLUSIONS
The current literature shows that ESWT is a safe treatment, with hardly any adverse effects reported. Furthermore, it can be used alone or in conjunction with other physical therapies such as eccentric strengthening exercises or static stretching, which can enhance its therapeutic effect.
PubMed: 37957975
DOI: 10.3390/healthcare11212830