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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 -
Journal of Foot and Ankle Research Nov 2023The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main...
BACKGROUND
The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle's medial side and if so, do they have a regular path after emerging from TN.
METHODS
The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon-McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).
RESULTS
The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter's nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001).
CONCLUSIONS
In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.
Topics: Humans; Tarsal Tunnel Syndrome; Ankle; Foot; Calcaneus; Heel
PubMed: 37957735
DOI: 10.1186/s13047-023-00682-4 -
Indian Journal of Pharmacology 2023The goal of the research is to investigate the protocatechuic acid (PCA) potential action, a phenolic acid derivative, on pain induced by neuropathy and to determine its...
OBJECTIVES
The goal of the research is to investigate the protocatechuic acid (PCA) potential action, a phenolic acid derivative, on pain induced by neuropathy and to determine its efficacy on activation of K type channels and A receptors.
MATERIALS AND METHODS
Neuropathic pain by cause of sciatic nerve damage was induced in Sprague-Dawley rats. Anti-allodynic and anti-hyperalgesic effects were evaluated with von Frey apparatus and Hargreave's plantar test apparatus, respectively. The effects of PCA at the doses of 75, 150 and 300 mg/kg, carbamazepine at the doses of 50 and 100 mg/kg, combination of low effective doses of PCA and carbamazepine were tested. Pretreatments 3 μg/kg DPCPX as adenosine A receptor antagonist and 60.7 nmol glibenclamide as K channel blocker were applied for mechanistic studies.
RESULTS
PCA showed anti-allodynic and anti-hyperalgesic effects without impairing locomotor activity. In addition, the combination treatment was found to be more effective than the separate individual treatments of drugs. K channel activation related with A receptor stimulation makes a significant contribution to the anti-allodynia and anti-hyperalgesia induced by PCA.
CONCLUSIONS
It can be said that PCA has similar effects with carbamazepine, which is used in clinical practice, and that PCA can take place as an adjuvant drug in neuropathic pain with the combination group. In addition, it is seen that the undesirable effects that drugs can cause alone can be avoided and a more effective treatment potential can be created with multiple mechanisms.
Topics: Rats; Animals; Rats, Sprague-Dawley; Neuralgia; Hyperalgesia; Carbamazepine; Adenosine Triphosphate
PubMed: 37929410
DOI: 10.4103/ijp.ijp_364_21 -
Acta Neurochirurgica Dec 2023Polyethylene glycol is known to improve recovery following its use in repair of acute peripheral nerve injury. The duration till which PEG works remains a subject of...
PURPOSE
Polyethylene glycol is known to improve recovery following its use in repair of acute peripheral nerve injury. The duration till which PEG works remains a subject of intense research. We studied the effect of PEG with augmentation of 20Htz of electrical stimulation (ES) following neurorrhaphy at 48 h in a rodent sciatic nerve neurotmesis model.
METHOD
Twenty-four Sprague Dawley rats were divided into 4 groups. In group I, the sciatic nerve was transected and repaired immediately. In group II, PEG fusion was done additionally after acute repair. In group III, repair and PEG fusion were done at 48 h. In group IV, ES of 20Htz at 2 mA for 1 h was added to the steps followed for group III. Weekly assessment of sciatic functional index (SFI), pinprick, and cold allodynia tests were done at 3 weeks and euthanized. Sciatic nerve axonal count and muscle weight were done.
RESULTS
Groups II, III, and IV showed significantly better recovery of SFI (II: 70.10 ± 1.24/III: 84.00 ± 2.59/IV: 74.40 ± 1.71 vs I: 90.00 ± 1.38) (p < 0.001) and axonal counts (II: 4040 ± 270/III: 2121 ± 450/IV:2380 ± 158 vs I: 1024 ± 094) (p < 0.001) at 3 weeks. The experimental groups showed earlier recovery of sensation in comparison to the controls as demonstrated by pinprick and cold allodynia tests and improved muscle weights. Addition of electrical stimulation helped in better score with SFI (III: 84.00 ± 2.59 vs IV: 74.40 ± 1.71) (p < 0.001) and muscle weight (plantar flexors) (III: 0.49 ± 0.02 vs IV: 0.55 ± 0.01) (p < 0.001) in delayed repair and PEG fusions.
CONCLUSION
This study shows that PEG fusion of peripheral nerve repair in augmentation with ES results in better outcomes, and this benefit can be demonstrated up to a window period of 48 h after injury.
Topics: Rats; Animals; Rats, Sprague-Dawley; Polyethylene Glycols; Hyperalgesia; Disease Models, Animal; Sciatic Nerve; Trauma, Nervous System; Peripheral Nerve Injuries; Electric Stimulation; Nerve Regeneration; Recovery of Function
PubMed: 37907766
DOI: 10.1007/s00701-023-05854-6