Parkinson's disease may reduce sensitivity to visual-tactile asynchrony irrespective of dopaminergic treatment: Evidence from the rubber hand illusion

BackgroundThe feeling of body ownership relies on the binding of multisensory body-related signals. Various sensory abnormalities have been described in Parkinson's disease (PD).ObjectiveTo assess the rubber hand illusion (RHI) in patients with PD (PwPD) and age-matched healthy controls (CTRL). To evaluate the influence of the dopaminergic system in a PwPD subgroup OFF medication.MethodsThe RHI paradigm was applied to 42 PwPD and 48 CTRL. In this experimental setup, stroking a visible plastic hand simultaneously with the covered real hand elicits the feeling of ownership over the seen hand. Asynchronous stroking served as a control condition. Proprioceptive bias and an illusion score based on a questionnaire were used as measures of the RHI. Seventeen PwPD additionally underwent the experiments “OFF medication”.ResultsCompared to CTRL, PwPD showed higher proprioceptive bias independent of the stroking condition (p = 0.015), and had higher illusion scores in the asynchronous condition (p < 0.05). In PwPD, there were no significant differences between ON- and OFF-medication state.ConclusionIn PwPD, responses to the RHI are less specific with respect to the degree of synchronicity of brushstrokes. This might be attributed to a less stable body representation, internal “noise” during multisensory integration, or a blur of temporal discrimination in PD. The fact that RHI measures did not differ between ON- and OFF-medication states indicates an involvement of non-dopaminergic transmitter systems in this finding.     

Post-operative management after total ankle arthroplasty: A systematic review of the literature

BackgroundCurrently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences.MethodsA systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme.ResultsEighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols.ConclusionDue to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.     

Role of pulsed electromagnetic fields after joint replacements

Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients' satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient's functional recovery.     

右美托咪定对老年性全髋关节置换术患者小剂量布比卡因腰麻的影响

目的将右美托咪定(DEX)应用于小剂量布比卡因腰麻的老年性全髋关节置换术中,探讨其影响及可行性。方法 60例实施全髋关节置换术的老年患者,ASAⅡ~Ⅲ级,采用随机数字表法分为对照组(C组,n=30)和DEX组(D组,n=30),两组分别采用布比卡因6 mg或布比卡因6 mg与DEX 3μg混合液进行腰麻。结果 D组术中的心率较术前下降明显(P<0.05);术中两组出现心动过缓概率无统计学差异(P>0.05);手术医师满意度D组显著高于C组(P<0.05),术后寒战C组较D组明显(P<0.05);感觉及运动阻滞方面,D组优于C组(P<0.05);镇静评分上,D组较C组效果好,两者有统计学差异(P<0.01);比较两组术后镇痛药的应用,无论是对乙酰氨基酚,还是双氯芬酸、曲马朵,D组应用的人数都明显少于C组(P<0.01)。结论 DEX应用于小剂量布比卡因腰麻的老年患者全髋置换术中,可以延长麻醉时间,具有一定镇痛效应,不良反应少,术者满意度更高。