体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响

目的 分析体感交互技术训练对帕金森病患者平衡功能、足底压力及跌倒发生率的影响。方法 选取2020年2月-2022年4月三二〇一医院收治的115例帕金森患者,按不同训练方案分为常规组（n=56）与体感交互组（n=59）。常规药物治疗期间,常规组实施传统平衡训练,体感交互组接受体感交互技术训练。比较两组训练4周后Berg平衡量表（Berg Balance Scale,BBS）评分,动、静态足底压力分布,跌倒发生率。结果 训练后体感交互组BBS评分高于常规组（P＜0.05）;训练前后比较,常规组BBS评分无统计学意义（P＞0.05）,体感交互组BBS评分有所提升,具有统计学意义（P＜0.05）。训练前两组静态、动态足底压力分布无统计学意义（P＞0.05）,两组静态站立时双脚压力由低到高排序为：2区＜1区＜3区＜6区＜5区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜3区＜5区＜4区＜7区＜8区,右足：2区＜6区＜1区＜3区＜5区＜7区＜8区＜4区。训练后两组站立时双足的3区压力上升,双足压力：2区＜1区＜6区＜5区＜3区＜4区＜7区＜8区;行走时左足：2区＜6区＜1区＜5区＜3区＜4区＜7区＜8区,右足压力分区未变。训练后两组静态跌倒风险指数评分上升,动态跌倒风险指数评分下降,且体感交互组评分优于常规组（P＜0.05）。1个月随访期间,常规组发生11例跌倒,体感交互组发生2例,体感交互组跌倒发生率3.39%低于常规组19.64%（P＜0.05）。结论 体感交互技术训练能有效改善帕金森患者平衡功能康复情况,有助于更好调整动、静态足底压力分布,降低跌倒风险,减少跌倒发生情况。     

Postural stabilization and balance assessment in Charcot–Marie–Tooth 1A subjects

The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot–Marie–Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Y_inf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.     

软组织结节性筋膜炎的细针吸取细胞学诊断

目的 对13例结节性筋膜炎进行细针吸取细胞学检查，并结合病史分析不同时期的细胞学形态特点，以取得诊断与鉴别诊断的经验。方法 13例均有术后病理组织学对照，光镜观察其细胞学特点及形态表现，与组织学对比分析；并与黏液性脂肪肉瘤、恶性纤维组织细胞瘤、皮肤转移腺癌及炎性肌纤维母细胞瘤等的细胞学特点相对照。结果 13例中男性8例，女性5例；发生于上肢6例，胸壁1例，颈部1例，背部2例，下肢3例。在疾病不同的发展阶段可见不同的细胞学构象，但基本图像以从幼稚到较成熟的纤维母细胞增生为主，病变的不同阶段纤维母细胞以不同比例混杂出现，可见核分裂，但无病理性核分裂及凝固性坏死是其与各种肉瘤区分的要点。结论 细胞学穿刺对结节性筋膜炎的中、晚期改变诊断较准确，但在早期病变中误诊率较高，需密切结合病史及部位。     

Facial necrotizing fasciitis secondary to accidental bite of the upper lip

We describe a case with facial wounds over the left upper lip that became contaminated with saliva. A facial necrotizing fasciitis developed 2 days after injury. This produced a serious and almost fatal infection.     

The treatment of intractable plantar fasciitis with platelet-rich plasma injection

BackgroundWhilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems.ObjectiveEvaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis.Patients and methodsPatients with plantar fasciitis not responded to a minimum of 1 year standard conservative management were offered PRP therapy. Injections were performed in theatre as a day case. Roles–Maudsley (RM) scores, Visual Analogue Scores (VAS), AOFAS scores and ‘would have injection again’ were collated pre-operatively, three and six months.ResultsProspective data was collected of 50 heels (44 patients). At six month review, RM score improved from mean 4 to 2 (p < 0.001), VAS improved from 7.7 to 4.2 (p < 0.001) and AOFAS improved from 60.6 to 81.9 (p < 0.001). 28 patients (64%) were very satisfied and would have the injection again.No complications were reported.ConclusionIn these chronic cases, PRP produce an efficacy rate, approaching 2 out of every 3. The procedure was safe with no reported complications. The authors feel PRP may have some role in treatment, and merits further study with a prospective randomised trial.     

An unusual complication of missed appendicitis

A case of necrotizing fasciitis complicating missed appendicitis with perforation and abscess formation in a 63-year-old diabetic is presented. The case emphasizes the importance of thorough, conservative evaluation and management in elderly diabetic patients. The ED management of patients with necrotizing fasciitis is also briefly reviewed.     

Long-term remission by cyclosporine in a patient with eosinophilic fasciitis associated with primary biliary cirrhosis

A 70-year-old man was admitted to the hospital in June 1994 because of cutaneous induration of the extremities. Eosinophilic fasciitis was diagnosed on the basis of the course and distribution of the cutaneous lesions. Cyclosporine (100 mg/day) was given. After 4 weeks of treatment, cutaneous induration and limited joint mobility improved. Liver dysfunction had been diagnosed 5 years before the onset of eosinophilic fasciitis. Primary biliary cirrhosis (PBC) was diagnosed on the basis of the elevated serum biliary-enzyme levels, strongly positive antimitochondrial antibody titer, and histologic features of the liver-biopsy specimens showed stage-3 PBC. These findings suggested that eosinophilic fasciitis developed in association with PBC. PBC is often accompanied by autoimmune diseases, such as Sjögren’s syndrome and Hashimoto’s disease. To our knowledge, eosinophilic fasciitis associated with PBC has not been reported previously. We believe this is the first time a case of eosinophilic fasciitis occurring in a patient with PBC is documented.     

Plantar fasciitis and impaired vision: A case report

We report a case of acute bilateral central serous chorioretinopathy in a patient who received a local injection of triamcinolone for the treatment of plantar fasciitis. Central serous chorioretinopathy is a serious, though rare, ocular complication of steroid treatment and it may occur even when the steroid is administered at a site as remote from the eye as the foot. This case report highlights the need for greater awareness of this complication amongst all medical personnel who prescribe steroids. It is advisable that patients, undergoing steroid treatment for any cause, be alerted to the risk of sudden visual impairment.     

Effect of reduced cutaneous cues on motion perception and postural control

To investigate whether the sensory perception could be a more direct assessment of sensory deficit as oppose to the postural performance, we examined the effect of reduced cutaneous cues on motion perception and motion control. The subject was translated in a mediolateral direction with a single sinusoidal acceleration at a stimulus frequency of 0.25 Hz with a peak acceleration magnitude ranging from 0.25 to 8 mG in the dark. Two different plantar cutaneous conditions were provided: the control condition (barefoot) and the reduced cutaneous condition (foot on a spongy surface). For each foot-sole sensory condition, the subject completed six sets of 33 randomly ordered translation stimuli. After each translational stimulus, the subject reported their perceived direction of motion by pressing a hand-held button. The center of pressure (COP) and joint kinematics of the quiet stance were also measured. The results showed a significant increase in perception threshold as well as COP variation in the anteroposterior direction in the reduced cutaneous cue trials. However, a non-significant increase in COP in the mediolateral direction was shown. Multivariate covariance analysis of joint kinematics showed changes in postural coordination, such as increased reliance on hip strategy under reduced cutaneous cues condition, that have not been differentiated by univariate measures. The observed discrepancy in the significance of the contribution of plantar cutaneous cues to the detection threshold and the COP variation implies that the ‘perception’ could provide more direct and sensitive assessment of the sensory degradation than the ‘action’.