超声引导下辅助诊断和治疗冻结肩的研究进展

冻结肩是常见的肩部疾病,传统非可视化治疗冻结肩效果欠佳。近年来,超声引导具有动态实时定位、无辐射、便携性、低成本等优点在辅助诊断和治疗冻结肩患者中得到成功应用,不仅能提供精确的诊断,也提高了患者中长期的疗效。本文就超声引导辅助诊断和治疗冻结肩的研究进展进行综述。     

Cytokine and LL-37 gene expression levels in Bartonella spp. seropositive and seronegative patients of a rheumatology clinic

PurposeThe variation in the immune response to Bartonella spp. infection in humans remains unclear. The present study compares the expression of selected interleukins, cytokines and cathelicidin (LL-37) in rheumatology clinic patients suffering from musculoskeletal symptoms with healthy blood donors. The patients had previously been tested for the presence of Bartonella henselae antibodies.MethodsGene expression of LL-37, interleukin (IL)-2, IL-4, IL-6, IL-12, interferon-(IFN)-γ, and tumor necrosis factor (TNF-α)-α was determined in blood samples using quantitative Polymerase Chain Reaction (qPCR). Statistical analysis was prepared with STATISTICA.ResultsStatistically significant differences in the mRNA levels of the tested cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-12; p<0.0001) were observed between the healthy controls and patients; however, no difference was observed for LL37 mRNA (p ?= ?0.1974). No significant differences in mRNA expression were observed between IgG in anti-Bartonella seropositive and seronegative individuals (p>0.05). The only significant differences between the Bartonella spp. DNA positive and negative patients, indicated by PCR, were observed for TNF-α and IL-12 mRNA (p ?= ?0.0045 and p ?= ?0.0255, respectively).ConclusionA broadly similar immune response to the tested cytokines was observed among the participants irrespective of anti-Bartonella spp. IgG seropositivity. However, the Bartonella DNA-positive participants demonstrated significantly lower expression of IL-12 and TNF-α mRNA; this may indicate that these bacteria have a suppressive influence on the immune system.     

The association between sport-related concussion and musculoskeletal injury in university rugby athletes

ObjectivesThe study aimed to analyse the association between Sports-Related Concussion (SRC) and Subsequent Musculoskeletal Injury (MSK) in United Kingdom university-aged rugby union players whilst considering the effects of sex, athlete playing position and injury location.DesignRetrospective cohort study. A period of 365 days with 0–90, 91–180 and 181–365 days sub-periods was analysed for the following variables; MSK injury incidence, occurrence, severity, injury location, playing position and sex.SettingInjury data was collected from the Sports Development Centre database at Loughborough University.ParticipantsA total of 408 injuries in 181 athletes (55 females and 126 males) were included.ResultsThe MSK injury incidence of SRC group was significantly higher than control and higher post-SRC than pre-SRC period over a 365-day period (p=0.012 and p=0.034, respectively). The odds ratios of MSK injury incidence between groups and between periods were 1.62 (95% CI, 1.10–2.25) and 1.57 (95% CI ,1.08–2.29). A SRC was not associated with a greater time loss from a subsequent MSK injury or a specific MSK injury location.ConclusionsAthletes with a second recorded injury were more likely to sustain a MSK injury if they had experienced SRC, however, there was no indication a SRC resulted in greater time loss from a MSK injury.     

A Coupled FEM-BEM Approach for the Solution of the Free-Boundary Axi-Symmetric Plasma Equilibrium Problem

In this paper we present a coupled Finite Element Method – Boundary Element Method (FEM-BEM) approach for the solution of the free-boundary axi-symmetric plasma equilibrium problem. The proposed method, obtained from an improvement of the Hagenow-Lackner coupling method, allows to efficiently model the equilibrium problem in unbounded domains by discretizing only the plasma region; the external conductors can be modelled either as 2D or 3D models, according to the problem of interest. The paper explores different iterative methods for the solution of the nonlinear Grad-Shafranov equation, such as Picard, Newton-Raphson and Newton-Krylov, in order to provide a robust and reliable tool, able to handle large-scale problems (e.g. high resolution equilibria). This method has been implemented in the FRIDA code (FRee-boundary Integro-Differential Axisimmetric – https://github. om/matteobonotto/ FRIDA), together with a suitable Adaptive Integration Technique (AIT) for the computation of the source term. FRIDA has been successfully tested and validated against experimental data from RFX-mod device, and numerical equilibria of an ITER-like device.     

Smartphone-based inertial sensors technology – Validation of a new application to measure spatiotemporal gait metrics

BackgroundSmartphones are increasingly recognized as the future technology for clinical gait assessment.ResearchQuestion: To determine the concurrent validity of gait parameters obtained using the smartphone technology and application in a group of patients with musculoskeletal pathologies.MethodsPatients with knee, lower back, hip, or ankle pain were included in the study (n = 72). Spatiotemporal outcomes were derived from the walkway and the smartphone simultaneously. Pearson’s correlations and limits of agreement (LoA) determined the association between the two methods.ResultsCadence and gait cycle time showed excellent correlation and agreement between the smartphone and the walkway (cadence: r = 0.997, LoA=1.4%, gait cycle time: r = 0.996, LoA = 1.6%). Gait speed, double-limb support and left and right step length demonstrated strong correlations and moderate agreement between methods (gait speed: r = 0.914, LoA=15.4%, left step length: r = 0.842, LoA = 17.0%, right step length: r = 0.800, LoA=16.4%). The left and right measures of single-limb support and stance percent showed a consistent 4% bias across instruments, yielding moderate correlation and very good agreement between the smartphone and the walkway (r = 0.532, LoA = 9% and r = 0.460, LoA=9.8% for left and right single-limb support; r = 0.463, LoA = 5.1% and r = 0.533, LoA = 4.4% for left and right stance).Significance: The examined application appears to be a valid tool for gait analysis, providing clinically significant metrics for the assessment of patients with musculoskeletal pathologies. However, additional studies should examine the technology amongst patients with severe gait abnormalities.     

Assessment of family physicians' knowledge about fibromyalgia in Egypt

Aim of the workTo assess knowledge of Egyptian family physicians about the diagnostic criteria and treatment modalities of fibromyalgia.Subjects and methodsA questionnaire and an informed consent were sent by email to family physicians working in primary health care centers in Egypt. The questionnaire assessed 3 areas: sociodemographic and professional data; knowledge about diagnosis; and knowledge about treatment modalities. Scoring system was used to categorize levels of knowledge into very low, low, moderate, high and very high.ResultsA total of 108 family physicians responded, with a response rate of 60%.The respondents were 27 consultants, 54 specialists and 27 residents, with a median age of 33 years and a median experience of 12 years. Very low, low and moderate levels of familiarity with fibromyalgia were perceived by 28.7%, 30.6% and 28% respectively. Close to half of participants (46.2%) gained their knowledge about fibromyalgia through self-study. According to the scoring system, 39.8% had low level of knowledge about clinical presentation and 37% had the same level of knowledge about treatment modalities. About three quarters (76%) of participants agreed that patients with fibromyalgia should be referred to rheumatologists. The most common selected clinical presentations were widespread pain (94.4%) and excessive fatigue (91.7%), while the most selected treatment modalities were non-steroidal anti-inflammatory drugs (89.8%) and selective serotonin reuptake inhibitors (47.2%).ConclusionKnowledge about clinical presentation and treatment modalities of fibromyalgia among Egyptian family physicians is low. Continuing medical education about fibromyalgia is needed to improve quality of health care.     

Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review

ObjectiveThe aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020).Eligibility criteriaTwo authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing.Results13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions.ConclusionThere was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.