Development of the center of pressure velocity in the healing process after intra-articular calcaneus fractures

BackgroundCalcaneal fractures are among the most common foot injuries and sometimes develop manifold post-surgical complications. Restricted foot movement is one of the main functional limitations which often persists during long-term rehabilitation. Therefore, it is important to quantitatively monitor the biomechanical foot mobility after calcaneal fracture from an early stage in order to achieve an optimal therapeutic treatment.Research questionEvaluation of the Center of Pressure velocity (v_COP) in patients after intrarticular calcaneal fractures during the healing progress from three to 24 months after surgery.MethodsA total of 20 patients with unilateral calcaneal fracture were investigated by means of pedobarography and marker-based gait analysis at three, six, 12 and 24 months after surgery. Data for v_COP [m/s], maximum external dorsal extension moments during stance (DEmoment_stance) and tibiotalar range of motion during mid stance (MS) and terminal stance (TS) were obtained. Functional evaluation was performed using clinical examination (e.g. calf circumference measurements) and patient-reported outcome measures (SF-36).ResultsWhen compared to the healthy side, v_COP of the injured side showed a significant reduction during MS (3 months: 48%, p < 0.001; 6 months: 13%; p = 0.040) and an significant increase during TS (3 months: 110%, p < 0.001; 6 months: 43%, p < 0.001; 12 months: 17%, p = 0.012). DEmoment_stance of the fractured foot, showed a significant increase of 80% (p < 0.001) from three to 24 months after surgery, which correlated with v_COP at three and six months after surgery (p < 0.05; v_{COP MS:} 3 months: r = 0.876, 6 months: r = 0.685; v_{COP TS:} 3 months: r = −0.554, 6 months r = −0.626).Significancev_COP might serve as an indicator for foot mobility and function during the early healing phase after calcaneal fractures. As v_COP can be obtained by pedobarography it is more readily accessible an less costly compared to foot function obtained by marker based gait analysis.     

Polymicrogyria with calcification in Pallister-Killian syndrome detected by microarray analysis

BackgroundPallister-Killian syndrome (PKS) is a rare disorder caused by the mosaic tetrasomy of chromosome 12p, and is characterized by facial dysmorphism, developmental delay, hypotonia and seizures.ResultsWe report a patient with PKS showing unique polymicrogyria with calcification. He had delayed development and dysmorphic facial features including frontal bossing, hypertelorism, and high arched palate at 6 months of age. Neuroimaging revealed unilateral polymicrogyria with spot calcifications, which predominantly affected the right perisylvian region. Chromosome G-banding showed the karyotype 46,XY, however, array-based comparative genomic hybridization analysis showed mosaic duplication of chromosome 12p, in which CCND2, which encodes cyclin D2 and is a downstream mediator of PI3K-AKT pathway, is located. Supernumerary chromosome of 12p was detected in 58% of buccal mucosa cells by the interphase fluorescence in situ hybridization analysis using chromosome 12 centromere-specific D12Z3 probe. The diagnosis of PKS was made based on distinctive clinical features of our patient and the results of cytogenetic analyses.ConclusionThis report is, to our knowledge, the first case of a patient with PKS who clearly demonstrates polymicrogyria colocalized with calcifications, as shown by CT scans and MRI, and suggests that a patient with PKS could show structural brain anomalies with calcification. We assume that somatic mosaicism of tetrasomy could cause asymmetrical polymicrogyria in our patient, and speculate that increased dosages of CCND2 at chromosome 12p might be involved in the abnormal neuronal migration in PKS.     

Complexity of human postural control in subjects with unilateral peripheral vestibular hypofunction

Complexity is a new measure for identifying the adaptability of a complex system to meet possible challenges. For a center of pressure (COP) time series, the complexity measure represents the stability of postural control. In this study, multiscale entropy (MSE) was used to evaluate the complexity of COP time series in six test conditions of sensory organization test (SOT). Complexity index (CI) is defined as the summation of entropies with coarse-graining scales 1–20 by MSE. A total of 51 subjects belonging to 3 groups – healthy-young, healthy-elderly and dizzy – were recruited in this study. The COP signals in both anteroposterior (AP) and mediolateral (ML) directions were analyzed respectively. According to our results, the CI of AP-direction COP time series is significantly correlated to the equilibrium score, which represents the stability of postural control in SOT. The AP-direction sway is significant larger than the ML-direction sway, particularly in the test conditions with sway-surface. In additions, the CI of AP-direction COP for the healthy-elderly and dizzy groups are significantly lower than those for the healthy young group in the test conditions 1–4. The CI of ML-direction COP for the healthy-elderly group is significantly lower than those for the healthy-young and dizzy groups under test conditions 3 and 6. These results show that the complexity loss is a common status of AP-direction COP time series for both healthy-elderly and dizzy groups, and the complexity of ML-direction COP time series for subjects with unilateral vestibular dysfunction is higher than that for the healthy-elderly group specifically under test conditions 3 and 6.     

Atypical Unilateral Posterior Reversible Encephalopathy Syndrome Mimicking a Middle Cerebral Artery Infarction

Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.     

Nonprogressive Unilateral Intracranial Arteriopathy in Children with Arterial Ischemic Stroke

The nonprogressive unilateral intracranial arteriopathy known as transient (focal) cerebral arteriopathy is not a well-recognized arteriopathy among practitioners of Korea and Japan, although it cannot be easily differentiated from early moyamoya disease. This review summarizes the nomenclature, pathophysiology, diagnostic evaluation, clinico-radiological features, and management of nonprogressive (reversible or stable) unilateral arteriopathy based on the relevant literature and our own experiences. Nonprogressive unilateral arteriopathy should be strongly suspected in children presenting with basal ganglia infarction and arterial beading. The early identification of patients likely to have nonprogressive or progressive arteriopathy would ensure proper management and guide further research for secondary stroke prevention.     

Temporomandibular joint fibrocartilage degeneration from unilateral dental splints

Objective

The objective of this study was to determine the extent to which altered loading in the temporomandibular joint (TMJ), as might be associated with a malocclusion, drives degeneration of articulating surfaces in the TMJ. We therefore sought to quantify the effects of altered joint loading on the mechanical properties and biochemical content and distribution of TMJ fibrocartilage in the rabbit.

Design

Altered TMJ loading was induced with a 1 mm splint placed unilaterally over the maxillary and mandibular molars for 6 weeks. At that time, TMJ fibrocartilage was assessed by compression testing, biochemical content (collagen, glycosaminoglycan (GAG), DNA) and distribution (histology), for both the TMJ disc and the condylar fibrocartilage.

Results

There were no changes in the TMJ disc for any of the parameters tested. The condylar fibrocartilage from the splinted animals was significantly stiffer and the DNA content was significantly lower than that in control animals. There was significant remodeling in the condylar fibrocartilage layers as manifested by a change in GAG and collagen II distribution and a loss of defined cell layers.

Conclusions

A connection between the compressive properties of TMJ condylar fibrocartilage after 6 weeks of splinting and the changes in histology was observed. These results suggest a change in joint loading leads to condylar damage, which may contribute to pain associated with at least some forms of TMJ disease.     

单侧通道椎体后凸成形术治疗骨质疏松脊柱压缩性骨折

目的探讨单侧通道椎体后凸成形术治疗骨质疏松脊柱压缩性骨折的临床效果。方法选择2012-01—2012-12间收治的骨质疏松脊柱压缩性骨折患者42例,行单侧通道椎体后凸成形术,观察患者的治疗效果及疼痛评分等指标。结果患者治疗后椎体高度(26.94±12.35)mm,显著优于治疗前(15.23±5.32)mm,差异有统计学意义(P<0.05);治疗后疼痛评分(1.01±0.21)分,明显低于治疗前(7.64±1.34)分,差异有统计学意义(P<0.05)。患者出院后随访6~12个月,平均8.7个月,42例患者未发生感染及血管栓塞等并发症,术后3 d下床活动,7 d后出院。1 a后复查,患者骨水泥充盈良好。结论骨质疏松脊柱压缩性骨折采用单侧通道椎体后凸成形术治疗,疗效可靠,值得临床推广。     

Chronic unilateral locked facet joint with spinal cord injury in a 26-month-old child: A case report

Objectives

This study presents the successful posterior surgical reduction and fusion on a 26-month-old child with chronic unilateral locked facet joint and spinal cord injury (SCI).

Methods

A 26-month-old child with chronic unilateral locked facet joint and SCI treated by posterior surgical reduction and fusion. Plaster external fixation was applied and rehabilitation exercise was trained post-operatively.

Results

Chronic unilateral locked facet joint was reduced successfully and bone fusion of C4/5 was achieved 3 months after surgery. The function of both lower limbs was improved 1 year after surgery, aided with physical rehabilitation.

Conclusion

Unilateral locked facet joint in pediatric population is rare. Few clinical experiences were found in the literature. Non-surgical treatment has advantages of not being invasive and is preferred for acute patients; however, it may not be suitable for chronic unilateral locked facet joint with SCI, in which surgical intervention is needed.     

短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折的疗效比较

目的 探讨短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折的临床疗效.方法 回顾性分析自2009-06-2012-06行手术治疗的胸腰椎骨折245例的相关资料.采用短节段经伤椎单侧置钉固定术131例,行短节段经伤椎单侧置钉固定结合椎体内植骨术114例,测量伤椎及其上、下相邻正常椎体的前缘、中间的高度、伤椎后凸Cobb角,比较两组的椎体压缩率、矫正度丢失、术中出血量、手术时间和患者满意度.结果 术后随访18～24个月,平均21.8个月,随访期间椎体高度均无严重丢失,无钉棒弯曲、松动或断裂.伤椎椎体压缩率由术前的(45.59±5.2)％和(46.48±7.5)％降至术后的(8.76±4.8)％和(9.24±4.6)％;后凸Cobb角由术前的(25.8±3.8)°和(24.6±4.2)°降至术后的(9.8±1.7)°和(8.6±2.7)°,两者无明显变化(P＞0.05).2组伤椎中间高度由术前的(56.74±8.6)％和(55.60±7.3)％升至术后的(85.26±10.52)％和(92.52±8.4)％,差异有统计学意义(P＜0.05).结论 短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折均可取得满意治疗效果.