Upper limb function and activity in people with facioscapulohumeral muscular dystrophy: a web-based survey

Purpose To investigate the upper extremity (UE) at the level of impairments and related activity limitations and participation restrictions in people with facioscapulohumeral muscular dystrophy (FSHD). Methods The study was conducted using web-based questionnaires that were distributed amongst people with FSHD in the Netherlands. Eighty-eight respondents started the survey, and 71 completed it. The questionnaires covered the following dimensions: Function, Activity and Participation of the International Classification of Functioning Disability and Health. Results More than 40% of the respondents experienced pain in one arm or both the arms. Increased pain and stiffness scores and longer disease duration were associated with increased limitation scores. For basic activities, lifting the arm above shoulder-level was most frequently reported as most limited, coherent with the clinical picture of FSHD. Among the respondents, 50% indicated restrictions at school, 78% indicated restrictions at work and more than 80% indicated restrictions whilst participating in sports, hobbies, household activities and romantic relationships. Conclusions This study has shown that alongside the well-known problem of lifting the arms above shoulder-level, UE activities below shoulder height during vocational and occupational activities are also problematic in patients with FSHD. Alongside disease duration, pain and stiffness are associated with UE activity limitations.

• Implications for Rehabilitation

• Attention is needed for pain and experienced stiffness in the upper extremity as it is frequently present in patients with FSHD.

• Rehabilitation professionals need to be aware that patients with FSHD not only experience problems with activities above shoulder height, but also with activities below shoulder height.

• At least 50% of the patients with FSHD experience restrictions in participation as a result of limitations in their UE.

     

The relationship of body mass index,age and triceps-surae musculotendinous stiffness with the foot arch structure of postmenopausal women

Background

Low- or high-arched feet and insufficient or excessive muscle–tendon stiffness have been identified as risk factors for lower extremity injuries. Additionally, increased body mass index and age may be responsible for structural changes of the foot, which might adversely affect the functional capacity of the longitudinal arch. Therefore, the aim of this study was to investigate the relationship of body mass, age and triceps-surae musculotendinous stiffness with the foot arch structure of postmenopausal women.

Methods

81 post menopausal women (58.0 (SD 6.0) years) participated. An in vivo free oscillation technique was used to assess musculotendinous stiffness of the ankle. The two-step protocol was used to acquire gait plantar pressure data. Dynamic arch index was calculated as the ratio of the midfoot area to the area of the entire foot excluding the toes. Three groups were formed (cavus, normal and planus).

Findings

Significant differences (P < 0.05) between the groups cavus and planus were found for age using the ANOVA test. Using Kruskal–Wallis tests significant differences were found for body mass index between the cavus–normal groups and cavus–planus (P < 0.001) but no significant differences were found for triceps-surae musculotendinous stiffness between foot-type groups.

Interpretation

Since obese subjects present greater downward vertical forces, they might be more prone to overload foot structures leading to the collapse of the medial longitudinal arch affecting adversely the functional capacity of the foot. Deterioration of the musculoskeletal system, due to age, may also affect foot arch structure. No relationship between musculotendinous stiffness and foot arch structure appears to exist.     

核苷（酸）类药物治疗对乙型肝炎失代偿期肝硬化患者肝功能及肝硬度指标的影响

核苷（酸）类药物治疗慢性乙型肝炎及早期肝硬化具有明显的临床疗效及组织学改善,但失代期肝硬化患者长期应用核苷（酸）类药物是否会取得明显的组织学改善尚不明确。本文通过检测乙型肝炎肝硬化失代偿期患者治疗前后HBVDNA、肝脏功能相关指标以及应用Fibroscan检测此类患者长期核苷（酸）类药物治疗后的肝硬度值,探讨核苷（酸）类药物对失代偿期肝硬化肝功能和组织学的影响。     

小切口辅助手法松解治疗TKA术后关节僵硬

目的探讨髌外侧小切口辅助麻醉下手法松解治疗初次全膝关节置换术后早期膝关节僵硬的临床疗效。方法对10例初次全膝关节置换术后早期（6周内）发生膝关节僵硬的患者行髌外侧小切口辅助麻醉下手法松解。其中男性3例,女性7例;术前膝关节平均活动度为（74.4±9.44）°（60°～85°）,平均年龄（72.8±7.18）岁（59～81岁）。排除因感染、假体松动、假体位置不良等明确原因导致术后关节僵硬的患者。术中给予蛛网膜下腔麻醉,反复、柔和、持续地对膝关节进行手法松解,结合髌外侧小切口,使其达到最大的活动度。采用KSS评分对膝关节术前及术后功能进行评价。结果平均随访（2.6±1.04）年（1～4年）,术中能达到的平均活动度为（112.5±9.20）°（100°～125°）,末次随访时平均活动度为（105±6.97）°（95°～115°）。KSS评分从术前平均69分提高到末次随访时平均82分。术前术后KSS评分差异有统计学意义（t=14.40,P〈0.01）。结论髌外侧小切口辅助麻醉下手法松解是治疗初次全膝关节置换术后早期发生膝关节僵硬安全、有效的治疗手段,通过早期治疗,能显著改善膝关节功能。     

Biomechanical performance of powder-free examination gloves

Biomechanical performance studies were undertaken for powder-free, latex and nitrile examination gloves. Using standardized tests, examination glove performance was judged by measuring glove thickness, glove puncture force, glove tape adhesion force, glove donning force, glove stiffness, and immediate unrecovered stretch. Even though the nitrile examination gloves were thinner than the latex examination gloves, they exhibited a greater puncture resistance. In addition, tape adherence to the N-Dex nitrile glove was the lowest. Moreover, measurements of the handling characteristics of the nitrile examination gloves demonstrated that they are an acceptable alternative to latex examination gloves. While these biomechanical studies demonstrate the superiority of the nitrile examination gloves, clinical glove evaluation is still needed to determine their performance in the health care setting.     

Effects of short-term exposure to fine and ultrafine particles from indoor sources on arterial stiffness – A randomized sham-controlled exposure study

ObjectivesParticulate air pollution is linked to adverse cardiovascular effects, including arterial stiffness. The aim of the study was to investigate the effect of short-term exposure to indoor fine and ultrafine particles on augmentation index (AIx), augmentation pressure (AP), and pulse wave velocity (PWV), early signs of vascular damage.MethodsWe analyzed the association of particle emissions from typical indoor sources (candle burning - CB, toasting bread - TB, and frying sausages - FS) with changes in pulse wave analysis indices in 55 healthy adults in a randomized cross-over controlled exposure study. Particle mass concentration (PMC), size-specific particle number concentration (PNC) and lung-deposited particle surface area concentration (PSC) were measured during the 2 h exposure. AIx and AP were measured before, directly, 2, 4 and 24 h after exposure. PWV was measured directly and 24 h after exposure. We performed multiple mixed linear regression analyses of different particle metrics and AIx, AP and PWV.ResultsThe highest mean PMC was observed during FS reaching a maximum of 210 μg/m³ PM₁₀. The maximal PNC for UFP <100 nm was reached during CB with 2.3 million particles/cm³. PSC was similar across all three exposures (about 3000 μm²/cm³). Strongest associations between different particles metrics and arterial stiffness indices could be observed for UFP from CB and FS and for PMC from TB. The highest mean increase could be observed for the UFP fraction <10 nm, measured during CB, and AIx with an increase of 9.5%-points (95%-CI: 3.1; 15.9). PSC seemed to follow the pattern of PNC. PM₁₀ and PM_2.5 from TB led to clear changes in AIx with biggest increases for PM₁₀ of 5.8%-points (95%-CI: 3.2; 8.4) 2 h after exposure and for PM_2.5 of 8.1%-points (95%-CI: 2.5; 13.7) directly after exposure.ConclusionsOur study indicates effects of indoor exposure to fine and ultrafine particles on systemic arterial stiffness indices that depend on the indoor source as well as on particle metric. Differences in size-specific physical characteristics of source-specific particles might account for these differential effects. We did not observe clear and stable associations of indoor particle exposure and PWV.     

Arterial-wave reflections are increased in heart failure patients with a left-ventricular assist device

BACKGROUND: Chronic heart failure (HF) is associated with increased central arterial pulse-wave reflections, which may contribute to increased myocardial oxygen demand. Although the treatment of HF via left-ventricular assist device (LVAD) placement has recently become widespread, the effects of LVAD therapy on central arterial pulse-wave reflections are unknown. METHODS: Central aortic pulse-wave analysis was performed on patients with end-stage HF awaiting cardiac transplantation and on healthy age-matched controls using the SphygmoCor (Akor Medical, Sydney, Australia) system. Arterial pulse-wave data were compared between patients receiving LVAD support versus those receiving intravenous inotropic drugs and healthy control patients. RESULTS: Five patients on LVAD support were compared with 10 patients on inotropic drugs and 10 healthy control patients. Aortic augmented pressure and the aortic augmentation index (AI(a)) were higher in LVAD patients compared with inotrope and control patients, despite similar brachial and aortic blood pressures between groups. The AI(a) was significantly higher in LVAD patients than in patients on inotropic drugs (28.2% +/- 10% v 7.9% +/- 9%, P < or = .01). Additionally, there was a significantly higher aortic systolic tension time index, an index of left-ventricular myocardial oxygen demand, in the LVAD group compared with the inotrope group (2655 +/- 298 mm Hg/sec/min v 1748 +/- 303 mm Hg/sec/min, P < .01). CONCLUSIONS: Central arterial pressure-wave reflection is increased in end-stage HF patients on LVAD support compared with those on inotropic drugs, leading to an increase in aortic augmented pressure, AI(a), and systolic tension time index. The AI(a) is also higher in LVAD patients than in healthy controls. This increased central arterial-wave reflection places an additional hemodynamic load on the LVAD device and may have relevance to the medical management of patients after LVAD placement and to the longevity of the LVAD device itself.     

Expert consensus document on arterial stiffness: methodological issues and clinical applications.

In recent years, great emphasis has been placed on the role of arterial stiffness in the development of cardiovascular diseases. Indeed, the assessment of arterial stiffness is increasingly used in the clinical assessment of patients. Although several papers have previously addressed the methodological issues concerning the various indices of arterial stiffness currently available, and their clinical applications, clinicians and researchers still report difficulties in selecting the most appropriate methodology for their specific use. This paper summarizes the proceedings of several meetings of the European Network for Non-invasive Investigation of Large Arteries and is aimed at providing an updated and practical overview of the most relevant methodological aspects and clinical applications in this area.