五禽戏—猿提改良动作在咽期吞咽障碍康复中的应用研究

目的:验证猿提动作对于脑卒中和脑外伤后咽期吞咽障碍的治疗效果。方法:将符合纳入标准的38名咽期吞咽障碍患者随机分入研究组和对照组,每组19人,2组均接受常规训练,研究组另外接受猿提改良动作训练,对照组另外采用Shaker训练法、门德尔松手法并结合低头转头法,每周5次,共治疗20次。2组患者治疗前后均分别采用功能性经口摄食量表(FOIS)评级和电视荧光吞咽造影检查(VFSS)进行吞咽功能评定。结果:治疗后,2组的FOIS均明显上升(均P<0.05),2组治疗前后稀钡及稠钡的会厌谷及梨状窝滞留、渗透量、喉上抬、喉前移的距离差异均有统计学意义(均P<0.05),治疗后2组FOIS及VFSS参数比较差异均无统计学意义。结论:五禽戏——猿提改良动作能改善脑卒中和脑外伤后咽期吞咽障碍患者的吞咽功能,且能增加吞咽时喉上抬及喉前移的距离,减少渗透与误吸,并能减少梨状窝滞留。     

Determining the Efficacy of the Chin-Down Maneuver Following Esophagectomy With Fiberoptic Endoscopic Evaluation of Swallowing

ObjectivesTo clarify the reliability of fiberoptic endoscopic evaluation of swallowing (FEES) compared to videofluoroscopic swallowing studies (VFSSs). Second, we explored the effect of the chin-down maneuver in the presence or absence of vocal fold paralysis (VFP) using FEES in patients with 3-field lymphadenectomy (3FL) postesophagectomy.DesignRetrospective data collection from FEES and VFSS.SettingDysphagic clinics in the ear, nose, and throat department.ParticipantsPatients (N=15) underwent esophagectomy with 3FL at the Department of Gastroenterologic Surgery, during a period of 12 months.InterventionsThe patients underwent FEES and VFSS with neutral and chin-down maneuvers 2 weeks postoperatively. Two raters of speech pathology blindly scored aspiration, penetration, delayed initiation, and pharyngeal clearance in the pyriform sinus and vallecula, respectively, from recorded movie clips of both examinations, using the penetration aspiration scale (PAS) and modified Hyodo FEES rating scale.Main Outcome MeasuresThe intrarater and interrater correlation coefficients of each parameter examined with FEES. Statistical comparison of each parameter between FEES and VFSS and of each parameter evaluated using FEES between 2 maneuvers with or without VFP.ResultsThe intrarater and interrater correlation coefficients of the PAS and pyriform sinus examined with FEES were both statistically consistent between the 2 raters. The PAS and pyriform sinus evaluated using FEES were significantly correlated with those evaluated in a VFSS (P<.05). The 2 parameters evaluated using FEES were significantly (P<.05) improved with the chin-down maneuver compared to the neutral maneuver, especially in VFP patients.ConclusionFEES performed postesophagectomy with 3FL for evaluation of aspiration is as reliable statistically as VFSSs. The chin-down maneuver is especially useful for reducing the PAS score and pyriform sinus in VFP patients.     

脑卒中急性期吞咽障碍的临床影像评价

目的:探讨脑卒中急性期吞咽障碍的临床及影像学检查的表现,分析脑卒中部位与吞咽障碍发生类型的关系。方法:首次发病的急性脑卒中患者62例,根据不同病变部位分为单侧大脑半球组、双侧大脑半球组、脑干与小脑组及多发性卒中组。入院后3d内完成临床吞咽功能评估;入院7d进行吞咽X线荧光透视检查(VFSS);记录分析吞咽障碍的类型和脑卒中的病变部位。结果:入院3d内临床吞咽评定4组患者中有29例(46.8%)存在吞咽困难,其中脑干及小脑组发生吞咽困难的百分率明显高于其他组(P0.05);于7d时VFSS检测11例能完成,其中单侧大脑半球组3例、双侧大脑半球组2例,多出现口腔期困难;脑干及小脑组2例,多出现咽期困难;多发卒中组4例,口腔期和咽期均受影响。吞咽异常表现类型为唇闭合无力、舌运动减弱、误吸及环咽肌功能不全、吞咽反射延迟、喉上抬差、会厌谷和/或梨状窝滞留、喉渗透等。结论:脑卒中后吞咽障碍的临床评定可明确吞咽口阶段的生理状态,VFSS可明确咽阶段及有无误吸。为避免吞咽困难所致的并发症及预防或治疗吞咽困难,需尽早完成吞咽评定,且可以节省患者总体费用及加快改善预后。     

经颅直流电刺激治疗脑干卒中后吞咽障碍的疗效观察

目的:探讨经颅直流电刺激(tDCS)治疗脑干卒中后吞咽障碍的疗效。方法:将47例吞咽功能障碍的脑卒中患者随机分为观察组23例和对照组24例。2组患者均进行脑卒中基础治疗、吞咽康复训练和针刺治疗,观察组再给予tDCS阳极交替刺激双侧口咽部皮层感觉区域,对照组以tDCS阳极假刺激同一区域。治疗前及治疗3周后,采用标准吞咽功能评估(SSA)、电视荧光透视检查(VFSS)及渗透-误吸指数(PAS)对2组患者进行评估。结果:治疗3周后,2组SSA评分各阶段较组内治疗前的同一阶段比较均明显降低(均P<0.05),且治疗后总分较治疗前明显降低(P<0.05);观察组咽期、误吸情况评分及总分较治疗前及对照组均明显提高(均P<0.05),且观察组PAS分级情况明显优于对照组(P<0.05)。结论:经颅直流电刺激双侧口咽部感觉皮层能更好地改善吞咽功能,对治疗脑干卒中后吞咽障碍有一定的疗效。     

Application of ultrasonography in assessing oropharyngeal Dysphagia in stroke patients

This study applied submental ultrasonography (SUS) to measure changes in dysphagic stroke patients' tongue thickness and hyoid bone displacement when swallowing 5 mL of water and correlated the results with the severity of clinical dysphagia. We included 60 stroke patients (30 tube-feeding-dependent and 30 on regular oral intake) and 30 healthy controls. An additional 10 healthy people were recruited to assess the reliability of SUS. Measurements of hyoid bone displacement using videofluoroscopic swallowing study (VFSS) and SUS were compared for 12 stroke patients to assess the correlation between the two methods. Changes in tongue thickness and hyoid bone displacement were significantly less in the tube-feeding group. Those with a tongue thickness change of less than 1.0 cm and hyoid bone displacement of less than 1.5 cm were likely to be tube-feeding. SUS showed good intra-rater/inter-rater reliability and correlated well with VFSS measurement. SUS can be an adjunct assessment tool of swallowing.     

不同稠度和容积吞咽任务对卒中后吞咽障碍患者吞咽生理成分表现及渗漏误吸的影响

目的 探讨不同稠度和容积吞咽任务对卒中后吞咽障碍患者吞咽生理成分表现及渗漏误吸的影响。 方法 选取在我院康复科治疗的59例脑卒中后吞咽障碍患者作为研究对象,参照中国改良容积粘度测试程序,按2、1、0、3号（分别对应中稠度、低稠度、硫酸钦原液及高稠度）顺序分别对每种稠度食物进行3、5、10 ml的吞咽造影检查。使用标准化吞钡造影功能障碍评价量表（MBSImP）和Rosenbek渗漏/误吸量表进行量化分析。记录患者在执行不同稠度及容积吞咽任务时其各个吞咽生理成分评分和渗漏误吸分级。 结果 入选患者舌控制、咽期吞咽启动及喉关闭均在吞咽0号食物时表现较差,口腔残留在执行大容积吞咽任务时表现较差,咽蠕动在执行较小容积吞咽任务时表现较差。入选患者在执行低稠度、大容积吞咽任务时发生渗漏误吸的风险较高;其渗漏误吸分级与咽期总分间具有明显正相关性（r=0.365,P<0.01）,并以喉关闭与渗漏误吸分级间的相关性尤为显著（r=0.772,P<0.01）。 结论 脑卒中吞咽障碍患者口咽期各吞咽生理成分的表现与进食食物稠度及容积密切相关,患者在执行较低稠度、较大容积吞咽任务时发生渗漏误吸的风险较高。     

球囊扩张术对脑卒中后吞咽障碍康复疗效及不良并发症研究

目的:研究球囊扩张术对脑卒中后吞咽障碍的康复疗效及不良并发症的影响。方法:选取我院经吞咽造影检查确诊为脑卒中后环咽肌失弛缓导致的吞咽障碍患者50例,随机分为2组各25例。对照组接受常规吞咽功能训练、Vitalstim神经肌肉低频电刺激,观察组另外给予球囊扩张术治疗。比较2组患者的总有效率、吞咽功能、并发症发生率,同时比较治疗前和治疗后的咽通过时间、吞咽造影检查(VFSS)评分及功能性经口摄食评估(FOIS)评分。结果:观察组的可进水、可进食流质物、可进食糊状物、可进食固体食物比例均明显高于对照组(均P0.01);观察组的吸入性肺炎发生率明显低于对照组(P0.05);治疗后,观察组的咽通过时间明显低于对照组(P0.01),VFSS和FOIS评分均明显高于对照组(均P0.01);观察组的康复总有效率明显高于对照组(96.0%,72.0%,P0.05)。结论:球囊扩张术对脑卒中后吞咽障碍具有显著疗效,缩短患者康复时间,降低误吸等并发症的发生。     

Effects of neck exercises on swallowing function of patients with stroke

[Purpose] This study examined the effects of neck exercises using PNF on the swallowing function of stroke patients with dysphasia. [Subjects and Methods] A total of 26 study subjects were selected and randomly divided into an experimental group of 13 subjects, who received the PNF-based short neck flexion exercises, and a control group of 13 subjects, who received the Shaker exercise. [Results] The experimental group showed statistically significant improvements in premature bolus loss, residue in the valleculae, laryngeal elevation, epiglottic closure, residue in the pyriform sinuses, and coating of the pharyngeal wall after swallowing, and improvements in pharyngeal transit time, and aspiration on both the new VFSS scale and the ASHA NOMS scale. [Conclusion] PNF-based short neck flexion exercises appear to be effective at improving swallowing function of stroke patients with dysphagia.Key words: Proprioceptive neuromuscular facilitation, Dysphagia, Stroke     

Alterations in methionine to homocysteine ratio in individuals with first-episode psychosis and those with at-risk mental state

BackgroundDisturbance of the methionine (Met) cycle, which produces Met from homocysteine (Hcy), is suggested to be involved in several diseases, including psychiatric disorders. This study was aimed to investigate both levels of Met and Hcy in serum from individuals with first-episode psychosis (FEP) and individuals with at-risk mental state (ARMS).MethodWe measured serum Met and Hcy levels in individuals with FEP (n = 13) and ARMS (n = 30) using HPLC with fluorescence detection and LC-ESI-MS/MS. Met and Hcy levels in healthy controls (n = 41) were also measured. Differences between the 3 groups were analyzed by one-way analysis of variance (ANOVA) with Bonferroni correction.ResultsSerum Met levels were decreased (p = 0.038) and Hcy levels were increased (p = 0.017) in the FEP group. Hcy levels were also significantly increased compared to the ARMS group (p = 0.016), while Met levels were not significantly different between the FEP and ARMS groups. A significant decrease in the Met to Hcy ratio (Met/Hcy) was observed in the FEP group compared to both the control (p = 4.58 × 10⁻⁴) and ARMS (p = 8.07 × 10⁻³) groups. Furthermore, Met/Hcy ratio was correlated with Positive and Negative Syndrome Scale, especially positive scores (p = 5.90 × 10⁻⁵).ConclusionTaken together, these data indicate that a decrease in the serum Met/Hcy ratio may be a risk factor for developing psychosis during the transition from ARMS to FEP, and may prove to be a useful marker of the phase between ARMS and FEP.     

Visual and haptic verticality misperception and trunk control within 72 h after stroke

IntroductionStroke patients often exhibit an altered perception of verticality, but there are no studies evaluating verticality perception in the first 72 h after stroke and its relationship with trunk control. Therefore, this study aimed to analyze visual and haptic verticality in the acute phase of stroke.MethodsThis was a cross-sectional study conducted with two groups: (a) 13 individuals with stroke and (b) 12 healthy participants. We assessed verticality via the subjective visual vertical (SVV) and the subjective haptic vertical (SHV); and we measured trunk control with the Trunk Impairment Scale (TIS). We performed t-tests to compare the SVV and SHV between groups. Pearson correlation was performed between verticality tests with National Institutes of Health Stroke Scale (NIHSS) and the TIS.ResultsParticipants with recent stroke presented higher true and absolute SVV deviation values than did the control group. There was significant negative correlation between absolute (r = −0.57; p = 0.02) and true SVV (r = −0.54; p = 0.01) with TIS scores There was also significant positive correlation between absolute (r = 0.63; p = 0.009) and true SVV (r = 0.61; p = 0.003) with NIHSS. A significant negative correlation between NIHSS and TIS scores also was found (r = −0.80; p = 0.005).ConclusionIndividuals with acute stroke presented larger variability in their perceptions of visual verticality than did healthy controls, and verticality perceptions were positively correlated with trunk impairment.     

Effect of external and internal focus of attention on acquisition,retention, and transfer phase of motor learning in Parkinson's disease

The purpose of this study was to evaluate the effectiveness of external focus of attention and internal focus of attention in different phases of motor learning in people with Parkinson's disease (PD). Twenty-four patients (17 men and 7 women) with idiopathic PD participated in the study. The participants were randomly assigned to either the internal focus of attention group (n = 12) or the external focus of attention group (n = 12). The task was to throw darts at the centre of a target. The attention of the patients in the internal focus group was directed at the movements of upper extremity joints, whereas the attention of the patients in the external focus group was directed at the target, dart, and dart course. The results showed that the external focus group had significantly less mean radial error for the acquisition phase (fifth block, p = 0.005) and the transfer phase (p = 0.005). In summary, an external focus of attention enhanced learning in the last block of the acquisition phase and the whole transfer phase, whereas an internal focus of attention resulted in no improvement. External focus of attention may be the preferred method for facilitating the learning of motor skills in patients with PD.     

Chemokine CXC Ligand 16 serum concentration but not A181V genotype is associated with atherosclerotic stroke

BackgroundSerum chemokine CXC Ligand 16 (CXCL16) concentration is associated with atherosclerosis and CXCL16 expression may be influenced by the polymorphism, A181V. We established whether serum CXCL16 concentration or the A181V genotype is more strongly associated with atherosclerotic stroke and its associated risk factor, carotid atherosclerosis.MethodsPCR–RFLP was used to genotype 244 atherosclerotic stroke patients (AS group), 153 stroke-free controls (patient controls) and 167 healthy controls. Serum CXCL16 concentration was determined for a subset of patients (n = 135) and all controls. The same subset of patients was then examined using ultrasound to evaluate their carotid atherosclerotic lesions, including intima-media thickness (IMT), plaque stability and carotid plaque area (CPA).ResultsCompared with the patient controls and healthy controls, serum CXCL16 concentration was significantly increased in the AS group (P < 0.05, and 0.01). It was also strongly associated with increased IMT, vulnerable plaque and increased CPA (P < 0.05, < 0.001, and < 0.01). However, the CXCL16 A181V genotype distribution and allele frequencies showed no differences between AS and control groups, nor did it influence serum CXCL16 concentration.ConclusionSerum CXCL16 concentration is significantly associated with atherosclerotic stroke and carotid atherosclerosis, suggesting that this biochemical test may be useful to identify patients at increased risk of atherosclerosis.     

鼻咽癌放疗后误吸患者的咽部生物力学特点研究

目的探讨鼻咽癌（NPC）放疗后误吸患者咽部生物力学特点。 方法回顾性收集本科室自2011年7月至2015年6月期间连续收治的NPC放疗后吞咽困难患者临床资料,其中有23例患者完成了视频吞咽造影检查（VFSS）,并采用高分辨率固态测压系统对其咽腔压力和食道上括约肌（UES）松弛功能进行检测。根据VFSS有无误吸将入选患者分为误吸组和无误吸组,比较两组患者进食不同性状食物时其咽部生物力学差异。 结果进食浓流质或糊状食物发生误吸的患者其UES松弛残余压［进食浓流质时为（20.1±14.3）mmHg,进食糊状食物时为（18.0±14.3）mmHg］较无误吸患者［进食浓流质时为（9.3±9.2）mmHg,进食糊状食物时为（7.2±8.9）mmHg］明显增高（P<0.05）,而两组患者咽腔压力组间差异无统计学意义（P>0.05）。 结论NPC放疗后误吸可能与UES松弛残余压增高有关。     

Hyperferritinemia in neonatal and infantile human parechovirus-3 infection in comparison with other infectious diseases

Human parechovirus-3 (HPeV-3) has been associated with severe clinical manifestations in neonates and infants in the form of sepsis or hemophagocytic lymphohistiocytosis (HLH)-like illness. To clarify the clinical features of HPeV-3 infection, we compared clinical signs and laboratory findings among enteroviruses (EVs), HPeV-3, and other infections. Participants were 26 febrile infants in whom EVs (n = 20) or HPeV-3 (n = 6) were isolated from throat swab or fecal specimens. Clinical and laboratory data were compared among EVs, HPeV-3, respiratory syncytial virus (RSV) infection (n = 15), and bacterial meningitis (n = 8) groups. Apnea was frequently seen in the HPeV-3 group although there were no significant differences in other clinical symptoms. Leukocyte count was significantly lower in the HPeV-3 group than in the EV and RSV group. Platelet count was significantly lower in the HPeV-3 group than in the RSV group. Serum ferritin levels in the HPeV-3 group (mean, 2437 ng/ml) and EV group (mean, 552 ng/ml) were significantly higher than in the RSV group (mean 237 ng/ml; P = 0.008 and P = 0.002, respectively). The frequency of patients with clearly high ferritin levels ≥1000 ng/ml was comparatively higher in the HPeV-3 group (4/6) than the EV group (3/20) (P = 0.03). In the HPeV-3 group, ferritin levels were high on Days 4–5. Elevated ferritin levels, decreased leukocyte and platelet counts could offer diagnostic clues to HPeV-3 infection in infant. These laboratory findings might be associated with aberrant immune response to HPeV-3, which could contribute to the development of sepsis or HLH-like illness in neonates.     

Motions and functional performance after supervised physical therapy program versus home-based program after arthroscopic anterior shoulder stabilization: A randomized clinical trial

ObjectiveTo compare the effects of a standardized supervised physical therapy versus a controlled home-based programs on the rate of shoulder motion and functional recovery after arthroscopic anterior shoulder stabilization.MethodsTwenty-seven patients (18–35 years) underwent arthroscopic anterior shoulder stabilization. Patients were randomized into two groups. A supervised group (n = 14) received a rehabilitation program, 3 sessions/week for 24 weeks and a controlled home treated group (n = 13) who followed a home-based program for same period. Range of motion (ROM) of the shoulder was assessed 4 times after each phase of rehabilitation and function was assessed after the 3rd and 4th phase of rehabilitation.ResultsBoth groups achieved a significant progressive increase in all shoulder motions throughout the study period. Patients in the supervised group achieved 92.6% and 94.2% of the contralateral side in abduction and forward elevation respectively. The controlled home-based group achieved 87.1% and 94.7% of abduction and forward elevation respectively. For external rotation, the percentage ROM achieved was 81.1% for the supervised group and 76.4% for the controlled home-based group. For function assessment, the two groups showed a significant improvement. However, the two groups were not significantly different from each other in all measured variables.ConclusionA controlled home-based physical therapy program is as effective as a supervised program in increasing shoulder range of motion and function after arthroscopic anterior shoulder stabilization.     

Tissue Doppler Imaging and Tissue Strain Imaging for the Evaluation of Hepatic Fibrosis in Patients with Chronic Hepatitis B

We studied the feasibility of evaluating the stages of liver fibrosis with tissue Doppler imaging (TDI) and tissue strain imaging (TSI) for patients with chronic hepatitis B virus infection. One hundred ten patients were divided into two groups: normal adult group (n = 38) and chronic liver disease group (n = 72, patients infected with HBVs). The chronic liver disease group was divided into three subgroups on the basis of the Scheuer scoring system and clinical evidence: mild fibrosis (S0 and S1, n = 11), moderate fibrosis (S2 and S3, n = 27) and cirrhosis (S4 and clinically typical cirrhosis, n = 34) groups. TDI was performed for a chosen oblique section. Four regions of interest (ROIs), A–D, were chosen in the hepatic parenchyma based on the direction of propagation from the heart to the liver. Strain rate curves were obtained on the basis of TDI and TSI findings. Strain peak rates (SPRs) of all ROIs and the differences in times to SPRs for the four ROIs (T_A-B, T_B-C and T_C-D) in the hepatic parenchyma were measured with TDI and TSI. Strain rate curves were analyzed for each ROI. The strain rate curves for the normal adult group were synchronous, whereas those for the chronic liver disease group were asynchronous. SPRs of the ROIs gradually decreased with the progression of liver fibrosis. The SPRs of ROI B significantly correlated with chronic liver disease severity (r = 0.991, p < 0.05). Areas under the curve (AUCs) of the ROI A and ROI B SPRs at the moderate fibrosis and cirrhosis stages were 0.86 ± 0.06, 0.81 ± 0.56 and 0.90 ± 0.65, 0.92 ± 0.04, respectively. The AUC of the SPRs of ROIs A and B correlated better than the platelet/age/phosphatase/α-fetoprotein/aspartate aminotransferase (PAPAS) index for advanced fibrosis. The differences in time to SPRs among the peaks of the four ROIs (T_A-B, T_B-C and T_C-D) gradually increased with the progression of liver fibrosis. TDI and TSI with quantitative measurements using tissue Doppler analysis software (TDIQ, GE Medical Systems, Horten, Norway) provided reliable information for evaluating non-invasive liver fibrosis in patients with chronic hepatitis B.     

综合康复疗法对脑卒中患者吞咽功能重建及吸入性肺炎的影响

目的:探讨综合康复疗法对脑卒中后吞咽功能重建及吸入性肺炎的影响。方法:将82例脑卒中后吞咽功能障碍患者随机分为观察组(42例)和对照组(40例)。两组患者均接受常规康复治疗,观察组患者同时加用项针疗法和电刺激。对两组患者于治疗前和治疗4周后进行洼田饮水试验和吞咽X线电视透视检查,并统计治疗期间两组患者出现吸入性肺炎情况。结果:两组患者治疗后洼田饮水试验和吞咽X线电视透视检查评分均明显高于治疗前,且治疗4周后,两组患者之间评分差异存在统计学意义(P<0.01),观察组高于对照组。治疗期间两组患者吸入性肺炎发生情况比较,存在统计学意义(P<0.05)。结论:综合康复疗法能够促进脑卒中后吞咽功能重建和减少吸入性肺炎的发生。     

Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study

BackgroundPhysical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions.ObjectivesWe examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L).MethodsThis observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes.ResultsWe included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1–4, P < 0.001) and moderate (NIHSS score 5–10, P = 0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (P < 0.001) and was associated with mRS score (P = 0.001) and weakly correlated with EQ-5D-3L score at 6 months (P = 0.032, r = 0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable.ConclusionAA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures.Trial registrationClinicalTrials.gov (NCT00924638).     

Association of toe-extension movement pattern magnitude and variability during three functional tasks with diabetic foot complications

BackgroundA toe-extension movement pattern may contribute to metatarsophalangeal joint deformity and ulceration in people with diabetes. We sought to quantify the relationship between toe extension magnitude and variability during three functional tasks (ankle range of motion, sit to stand, walking) with metatarsophalangeal joint deformity, and identify potential mechanisms associated with a toe-extension movement pattern.MethodsIndividuals with diabetes and peripheral neuropathy were included (n = 60). Metatarsophalangeal joint deformity was assessed using computed tomography (CT). Toe-extension movement was quantified using 3-dimensional motion capture. Linear regression was used to investigate the role of toe-extension movement pattern on metatarsophalangeal joint deformity. Regression analysis was used to identify mechanisms (neuropathy severity, foot intrinsic muscle deterioration ratio, ankle dorsiflexion range of motion) contributing to toe-extension movement pattern.FindingsToe extension with each functional task as well as the mean and coefficient of variation across all tasks were significantly related to metatarsophalangeal joint deformity (range of correlation coefficients = (−0.386, 0.692), p ≤ 0.001). Ankle dorsiflexion range of motion was associated with mean toe extension across all tasks (r_sp = −0.282, p = 0.029). Neuropathy severity and foot intrinsic muscle deterioration ratio were associated with toe extension variability (r_sp = −0.373, p = 0.003 and r_sp = −0.266, p = 0.043; respectively).InterpretationGreater magnitude and lower variability of a toe-extension movement pattern was found to be associated with metatarsophalangeal joint deformity. These findings may support clinical assessment and treatment of movement across more than one task.     

ARFI elastography in patients with chronic autoimmune liver diseases: A preliminary study

ObjectiveAcoustic radiation force impulse (ARFI) is a new software-based technique that evaluates liver stiffness during B-mode ultrasonography. The purpose of this study was to evaluate the accuracy of ARFI in distinguishing patients with chronic autoimmune liver disease from healthy subjects.Material and methodsWe enrolled 9 adult patients (8 women, 1 man; age 48.1 ± 12.8 years) with chronic autoimmune disease (primary biliary cirrhosis (PBC, n = 3), autoimmune hepatitis (AIH, n = 2), primary sclerosing cholangitis (PSC, n = 1) and overlap syndromes, (n = 3) who underwent a liver biopsy and 11 healthy volunteers (age 34.7 ± 10.4 years; 7 women, 4 men). Liver stiffness was evaluated and expressed as the shear wave velocity (SWV) in m/sec. We used a US scanner Siemens-Acuson S2000, evaluating the right liver lobe and the left liver lobe.ResultsThe SWV was significantly higher in cases (right lobe: 1.51 ± 0.44; left lobe: 1.57 ± 0.40) than in controls (right lobe: 1.08 ± 0.10; left lobe: 1.12 ± 0.13) (right lobe: P = 0.002; left lobe: P = 0.013). We found no significant correlation between right and left lobe SWVs in cases (P = 0.779) or controls (P = 0.385). The SWV cut-off that best distinguished cases from controls was 1.25 m/sec (accuracy: AUC=0.885; sensitivity: 70.6%; specificity: 95.5%).ConclusionsARFI elastography is a noninvasive ultrasonographic technique that can differentiate healthy subjects from patients with fibrotic stages of chronic liver disease.