Small fibre impairment predicts neuropathic pain in Guillain-Barré syndrome

The mechanisms of neuropathic pain (NP) in Guillain Barré syndrome (GBS) are currently unknown. It has recently been shown that acute neuropathy of GBS not only affects large myelinated fibres but also small nociceptive fibres. In this prospective longitudinal 18 months study, we investigated the role of small fibre impairment in NP in GBS (n = 30). Small fibres were assessed by quantifying cold and warm detection and pain thresholds and responses to suprathreshold painful thermal and mechanical stimuli. Nerve conduction velocities and mechanical detection thresholds assessed large myelinated fibres. Detection thresholds particularly at the lower limbs were significantly impaired in patients with GBS compared to 15 healthy controls. GBS patients with NP (n = 13) had more severe impairment of cold detection thresholds (p = 0.04), heat pain thresholds (p = 0.03) and responses to suprathreshold heat stimuli (p = 0.017) in the foot compared with those without pain or with non-neuropathic pain (n = 17). Large fibre dysfunction and motor disability were similar between groups. Small fibre sensory impairment at the acute stage was correlated with the intensity of burning pain (Rho: −0.72; p = 0.01 for cold detection; Rho: 0.72; p = 0.02 for heat pain) and predicted residual NP (odds 4.1 p = 0.04 for heat pain). These findings emphasize the importance of nociceptive fibre impairment in NP in GBS at both acute and chronic stages and suggest similarities between the mechanisms of NP in GBS and those of small fibre painful sensory polyneuropathies.     

Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets

Aim of the study

To investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension.

Methods

One-day-old piglets were left in apnoea until heart rate and mean arterial pressure were less than 50 min⁻¹ and 25 mmHg, respectively. They randomly received adrenaline, 10 μg kg⁻¹ (n = 16) or placebo (n = 15) and were resuscitated with air ventilation and, when needed, closed-chest cardiac massage (CCCM). Eight not asphyxiated animals served as time controls.

Results

CCCM was required in 13 piglets given adrenaline and in 13 given placebo. Time to return of spontaneous circulation was: 72 (66–85) s vs. 77 (64–178) s [median (quartile range)] (p = 0.35). Time until cerebral regional oxygen saturation (CrSO₂) had increased to 30% was 86 (79–152) s vs. 126 (88–309) s (p = 0.30). The two groups did not differ significantly in CrSO₂, heart rate, arterial pressure, right common carotid artery blood flow, or number of survivors: 13 vs. 11 animals. Plasma concentration of adrenaline, 2.5 min after resuming ventilation, was 498 (268–868) nmol l⁻¹vs. 114 (80–306) nmol l⁻¹ (p = 0.01). Corresponding noradrenaline concentrations were 1799 (1058–4182) nmol l⁻¹vs. 1385 (696–3118) nmol l⁻¹ (ns). In the time controls, the concentrations were 0.4 (0.2–0.6) nmol l⁻¹ of adrenaline and 1.8 (1.3–2.4) nmol l⁻¹ of noradrenaline.

Conclusion

The high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome.     

Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy

A length-dependent neuropathy with pain in the feet is a common complication of diabetes (painful diabetic neuropathy). It was hypothesized that pain may arise from sensitized-hyperactive cutaneous nociceptors, and that this abnormal signaling may be reduced by topical administration of the α₂-adrenergic agonist, clonidine, to the painful area. This was a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Nociceptor function was measured by determining the painfulness of 0.1% topical capsaicin applied to the pretibial area of each subject for 30 minutes during screening. Subjects were then randomized to receive 0.1% topical clonidine gel (n = 89) or placebo gel (n = 90) applied 3 times a day to their feet for 12 weeks. The difference in foot pain at week 12 in relation to baseline, rated on a 0–10 numerical pain rating scale (NPRS), was compared between groups. Baseline NPRS was imputed for missing data for subjects who terminated the study early. The subjects treated with clonidine showed a trend toward decreased foot pain compared to the placebo-treated group (the primary endpoint; P = 0.07). In subjects who felt any level of pain to capsaicin, clonidine was superior to placebo (P < 0.05). In subjects with a capsaicin pain rating ?2 (0–10, NPRS), the mean decrease in foot pain was 2.6 for active compared to 1.4 for placebo (P = 0.01). Topical clonidine gel significantly reduces the level of foot pain in painful diabetic neuropathy subjects with functional (and possibly sensitized) nociceptors in the affected skin as revealed by testing with topical capsaicin. Screening for cutaneous nociceptor function may help distinguish candidates for topical therapy for neuropathic pain.     

Greater Q angle may not be a risk factor of patellofemoral pain syndrome

Background

A greater Q-angle has been suggested as a risk factor for Patellofemoral Pain Syndrome. Greater frontal plane knee moment and impulse have been found to play a functional role in the onset of Patellofemoral Pain Syndrome in a running population. Therefore, the purpose of this investigation was to determine the relationship between Q-angle and the magnitude of knee abduction moment and impulse during running.

Methods

Q-angle was statically measured, using a goniometer from three markers on the anterior superior iliac spine, the midpoint of the patella and the tibial tuberosity. Thirty-one recreational runners (21 males and 10 females) performed 8–10 trials running at 4 m/s (SD 0.2) on a 30 m-runway. Absolute and normalized knee moment and impulse were calculated and correlated with Q-angle.

Findings

Negative correlations between Q-angle and the magnitude of peak knee abduction moment (R² = 0.2444, R = − 0.4944, P = 0.005) and impulse (R² = 0.2563, R = − 0.5063, P = 0.004) were found. Additionally, negative correlations between Q-angle and the magnitude of weight normalized knee abduction moment (R² = 0.1842, R = − 0.4292, P = 0.016) and impulse (R² = 0.2304, R = − 0.4801, P = 0.006) were found.

Interpretation

The findings indicate that greater Q-angle, which is actually associated with decreased frontal plane knee abduction moment and impulse during running, may not be a risk factor of Patellofemoral Pain Syndrome.     

The contribution of quasi-joint stiffness of the ankle joint to gait in patients with hemiparesis

Background

The role of ankle joint stiffness during gait in patients with hemiparesis has not been clarified. The purpose of this study was to determine the contribution of quasi-joint stiffness of the ankle joint to spatiotemporal and kinetic parameters regarding gait in patients with hemiparesis due to brain tumor or stroke and healthy individuals.

Methods

Spatiotemporal and kinetic parameters regarding gait in twelve patients with hemiparesis due to brain tumor or stroke and nine healthy individuals were measured with a 3-dimensional motion analysis system. Quasi-joint stiffness was calculated from the slope of the linear regression of the moment–angle curve of the ankle joint during the second rocker.

Findings

There was no significant difference in quasi-joint stiffness among both sides of patients and the right side of controls. Quasi-joint stiffness on the paretic side of patients with hemiparesis positively correlated with maximal ankle power (r = 0.73, P < 0.01) and gait speed (r = 0.66, P < 0.05). In contrast, quasi-joint stiffness in controls negatively correlated with maximal ankle power (r = − 0.73, P < 0.05) and gait speed (r = − 0.76, P < 0.05).

Interpretation

Our findings suggested that ankle power during gait might be generated by increasing quasi-joint stiffness in patients with hemiparesis. In contrast, healthy individuals might decrease quasi-joint stiffness to avoid deceleration of forward tilt of the tibia. Our findings might be useful for selecting treatment for increased ankle stiffness due to contracture and spasticity in patients with hemiparesis.     

Electrocardiographic changes during therapeutic hypothermia

Aims

Induced mild therapeutic hypothermia (MTH) is an effective treatment to improve outcome after out-of-hospital resuscitation. Adverse events are rare, but arrhythmias and bleeding complications have been reported. So far, only few data about electrocardiographic changes and associated events have been reported.

Methods

Between 6/2005 and 3/2011, 109 comatose survivors of out-of-hospital cardiac arrest admitted to our institution underwent MTH. In an observational single-center study, we analyzed preclinical course, electrocardiographic changes, arrhythmias, laboratory parameters and complication rates before, during and after MTH.

Results

MTH led to a significant decrease of heart rate (85.0 ± 23.3 min⁻¹ at admission; 59.1 ± 20.5 min⁻¹ during, p < 0.01 and 63.1 ± 19.2 after hypothermia p < 0.05) a significant prolongation of PR (0.17 ± 0.04 s before, 0.18 ± 0.05 s during, p < 0.05; and 0.17 ± 0.04 s after hypothermia, p < 0.01) and QTc intervals (0.47 ± 0.05 s before, 0.49 ± 0.05 s during, p < 0.01; and 0.46 ± 0.05 s after hypothermia, p < 0.01). Two patients developed ventricular fibrillation during hypothermia, both had an acute myocardial infarction. No significant MTH related changes in electrolytes or coagulation parameters were observed. Major bleeding complications occurred in four cases (3.7%) with a trend towards more bleedings after use of preclinical thrombolysis (21.4% with to 6.4% without thrombolysis, p = 0.057). We did not find increased risk for bleeding complications in patients with double platelet inhibition after PCI (14.3% compared to 9.5% without PCI, p = 0.63) compared to those without PCI.

Conclusions

Under strict clinical and laboratory parameter control, induced mild therapeutic hypothermia can be applied to most patients after out-of-hospital cardiac arrest with no increased risk for arrhythmias despite significant electrocardiographic changes.     

Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking

Background

Information is limited about the relationships between clinical measures of static foot posture and peak plantar pressures under the medial column of the foot. The purpose was to examine these relationships during static standing and walking.

Methods

A single-group exploratory design using correlation and regression was used to determine relationships. Ninety-two healthy volunteers participated. Clinical measures of static foot posture including arch index, navicular drop and navicular drift were obtained during static standing. Peak plantar pressures under the hallux, medial forefoot, medial midfoot, and medial rearfoot were obtained during standing and walking.

Findings

Static foot posture was related to peak plantar pressures during standing and walking, but the strengths of relationships ranged from poor to fair. During standing, navicular drop was correlated (P ≤ 0.05) with hallux (r = 0.29) and medial forefoot (r = − 0.17) pressures, while arch index (r = − 0.17) and navicular drift (r = 0.25) were correlated (P ≤ 0.05) with hallux pressure. During walking, arch index, navicular drop and navicular drift were correlated (P ≤ 0.05) with hallux and medial forefoot pressures (r range − 0.30 to 0.41), while arch index (r = − 0.15) and navicular drop (r = 0.16) were correlated (P ≤ 0.05) with medial midfoot pressure. Regression models predicted (P ≤ 0.05) hallux (R² = 0.08) and medial midfoot (R² = 0.05) pressures during standing, and hallux (R² = 0.18), medial forefoot (R² = 0.07), and medial rearfoot (R² = 0.05) pressures during walking.

Interpretation

In healthy participants, lower arch foot postures are associated with greater pressures under the hallux and medial mid-foot and lower pressures under the medial forefoot, but the strength of these relationships may be only poor to fair.     

Novel adhesive glove device (AGD) for active compression-decompression (ACD) CPR results in improved carotid blood flow and coronary perfusion pressure in piglet model of cardiac arrest

Objective

ACD-CPR improves coronary and cerebral perfusion. We developed an adhesive glove device (AGD) and hypothesized that ACD-CPR using an AGD provides better chest decompression resulting in improved carotid blood flow as compared to standard (S)-CPR.

Design

Prospective, randomized and controlled animal study.

Methods

Sixteen anesthetized and ventilated piglets were randomized after 3 min of untreated VF to receive either S-CPR or AGD-ACD-CPR by a PALS certified single rescuer with compressions of 100 min⁻¹ and C:V ratio of 30:2. AGD consisted of a modified leather glove exposing the fingers and thumb. A wide Velcro patch was sewn to the palmer aspect of the glove and the counter Velcro patch was adhered to the pig's chest wall. Carotid blood flow was measured using ultrasound. Data (mean ± SD) was analyzed using one way ANOVA and unpaired t-test; p-value ≤ 0.05 was considered statistically significant.

Results

Right atrial pressure (mm Hg) during the decompression phase was lower during AGD-ACD-CPR (−3.32 ± 2.0) when compared to S-CPR (0.86 ± 1.8, p = 0.0007). Mean carotid blood flow was 53.2 ± 27.1 (% of baseline blood flow in ml/min) in AGD vs. 19.1 ± 12.5% in S-CPR, p = 0.006. Coronary perfusion pressure (CPP, mm Hg) was 29.9 ± 5.8 in AGD vs. 22.7 ± 6.9 in S-CPR, p = 0.04. There was no significant difference in time to ROSC and number of epinephrine doses.

Conclusion

Active chest decompression during CPR using this simple and inexpensive adhesive glove device resulted in significantly better carotid blood flow during the first 2 min of CPR.     

Investigation of the possibility of using ischemia-modified albumin as a novel and early prognostic marker in cardiac arrest patients after cardiopulmonary resuscitation

Background

Early and accurate prediction of survival to hospital discharge following resuscitation after cardiac arrest (CA) is a major challenge. Our aim was to investigate the levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) in CA patients and whether IMA levels are valuable early marker of post-cardiopulmonary resuscitation prognosis in CA patients.

Methods

We enrolled 52 in- or out-of-hospital CA patients, with 47 healthy volunteers as the control group (CG). Blood samples were taken for IMA and MDA measurement at the beginning or within 5 min of commencement of CPR. The patients were classified according to the Glasgow Outcome Score (GOS) into a poor outcome group (POG) and a good outcome group (GOG).

Results

Mean IMA levels were higher in POG (0.25 ± 0.07 ABSU) than in GOG (0.19 ± 0.07 ABSU, p = 0.002) and also than CG (0.16 ± 0.04 ABSU, p = 0.0001). The IMA levels were not significantly higher in GOG than in CG (p = 0.32). The mean MDA levels in POG (0.77 ± 0.27 nmol/ml) were comparable to the levels in GOG (0.75 ± 0.18 nmol/ml, p > 0.05), but were significantly higher than in CG (0.60 ± 0.15 nmol/ml, p = 0.001). MDA levels were not significantly higher in GOG than in CG (p = 0.06). The optimum cut-off point for IMA maximizing sensitivity and specificity was 0.235 ABSU, with sensitivity of 65.8% and specificity of 78.6%. The corresponding +PV and −PV were 85.3% and 45.8%, respectively.

Conclusion

In conclusion, though the result may not be applied clinically in every patient, the ischemia-modified albumin may be a valuable prognostic marker in cardiac arrest patients following CPR.     

Dynamics and association of different acute stress markers with performance during a simulated resuscitation

Aim

Whether mental stress negatively impacts team performance during cardio-pulmonary resuscitation (CPR) remains controversial; this may partly be explained by differences in stress measures used in previous studies. Our aim was to compare self-reported, biochemical and physiological stress measures in regard to CPR performance.

Methods

This prospective, observational study was conducted at the simulator center of the University Hospital Basel, Switzerland. Self-reported (feeling stressed and overwhelmed [stress/overload]), biochemical (plasma cortisol) and physiological (heart rate, heart rate variability) stress measures were assessed in 28 residents (teams of 2) before, during and after resuscitation. Team performance was defined as time to start CPR and hands-on time during the first 180 s.

Results

At baseline, significant negative correlations of heart rate variability with stress/overload and heart rate, as well as positive correlations of heart rate and cortisol were found. During resuscitation, self-reported, biochemical and physiological stress measures did not correlate significantly. There was no association of baseline stress measures with performance. During CPR, stress/overload was significantly associated with time to start CPR (regression coefficient 12.01 (95% CI 0.65, 23.36), p = 0.04), while heart rate was negatively associated with time to start CPR (regression coefficient −0.78 (95% CI −1.44, −0.11), p = 0.027) and positively with hands-on time (regression coefficient 2.22 (95% CI 0.53, 3.92), p = 0.015).

Conclusions

Self-reported stress (stress/overload) was the only predictor for low CPR performance. Biochemical measures showed no association, and physiological measures (heart rate) showed an inverse association, which may be due to physical activity, limiting its value as a mental stress marker in this acute setting.     

Apport de l’arthrodistension dans la prise en charge de la capsulite rétractile primitive de l’épaule : étude comparative versus rééducation

Objectives

To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone.

Materials and methods

This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments’ efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score.

Results

Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p = 0.005), anterior elevation (p = 0.001), lateral elevation (p = 0.005), external rotation (p = 0.006) and the Constant score (p < 0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p < 0.001 for PF, RP, BP, SF and RE; p = 0.01 for GH and VT and p = 0.002 for MH).

Conclusion

Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.     

Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain

Approximately thirty-four percent of people who experience acute low back pain (LBP) will have recurrent episodes. It remains unclear why some people experience recurrences and others do not, but one possible cause is a loss of normal control of the back muscles. We investigated whether the control of the short and long fibres of the deep back muscles was different in people with recurrent unilateral LBP from healthy participants. Recurrent unilateral LBP patients, who were symptom free during testing, and a group of healthy volunteers, participated. Intramuscular and surface electrodes recorded the electromyographic activity (EMG) of the short and long fibres of the lumbar multifidus and the shoulder muscle, deltoid, during a postural perturbation associated with a rapid arm movement. EMG onsets of the short and long fibres, relative to that of deltoid, were compared between groups, muscles, and sides. In association with a postural perturbation, short fibre EMG onset occurred later in participants with recurrent unilateral LBP than in healthy participants (p = 0.022). The short fibres were active earlier than long fibres on both sides in the healthy participants (p < 0.001) and on the non-painful side in the LBP group (p = 0.045), but not on the previously painful side in the LBP group. Activity of deep back muscles is different in people with a recurrent unilateral LBP, despite the resolution of symptoms. Because deep back muscle activity is critical for normal spinal control, the current results provide the first evidence of a candidate mechanism for recurrent episodes.     

Body temperature regulation and outcome after cardiac arrest and therapeutic hypothermia

Objective

Therapeutic temperature modulation is recommended after cardiac arrest (CA). However, body temperature (BT) regulation has not been extensively studied in this setting. We investigated BT variation in CA patients treated with therapeutic hypothermia (TH) and analyzed its impact on outcome.

Methods

A prospective cohort of comatose CA patients treated with TH (32–34 °C, 24 h) at the medical/surgical intensive care unit of the Lausanne University Hospital was studied. Spontaneous BT was recorded on hospital admission. The following variables were measured during and after TH: time to target temperature (TTT = time from hospital admission to induced BT target <34 °C), cooling rate (spontaneous BT − induced BT target/TTT) and time of passive rewarming to normothermia. Associations of spontaneous and induced BT with in-hospital mortality were examined.

Results

A total of 177 patients (median age 61 years; median time to ROSC 25 min) were studied. Non-survivors (N = 90, 51%) had lower spontaneous admission BT than survivors (median 34.5 [interquartile range 33.7–35.9] °C vs. 35.1 [34.4–35.8] °C, p = 0.04). Accordingly, time to target temperature was shorter among non-survivors (200 [25–363] min vs. 270 [158–375] min, p = 0.03); however, when adjusting for admission BT, cooling rates were comparable between the two outcome groups (0.4 [0.2–0.5] °C/h vs. 0.3 [0.2–0.4] °C/h, p = 0.65). Longer duration of passive rewarming (600 [464–744] min vs. 479 [360–600] min, p < 0.001) was associated with mortality.

Conclusions

Lower spontaneous admission BT and longer time of passive rewarming were associated with in-hospital mortality after CA and TH. Impaired thermoregulation may be an important physiologic determinant of post-resuscitation disease and CA prognosis. When assessing the benefit of early cooling on outcome, future trials should adjust for patient admission temperature and use the cooling rate rather than the time to target temperature.     

Influences of hamstring stiffness and strength on anterior knee joint stability

Background

Excessive anterior tibial translation is a prospective risk factor for anterior cruciate ligament injury, thus factors which limit this motion may reduce injury risk. Stiffness quantifies a muscle's resistance to lengthening, and stiffer hamstrings may resist changes in length induced by anterior tibial translation more effectively.

Methods

Anterior tibial translation, hamstring strength, and hamstring stiffness were assessed in 30 physically active volunteers. Simple correlations were used to evaluate relationships between stiffness, strength, and anterior tibial translation. Anterior tibial translation data were arranged into high and low groups based on the median value, and hamstring strength and stiffness were compared between these groups via t-tests.

Findings

Anterior tibial translation was correlated with hamstring stiffness (r = −0.538; P = 0.002), but not with hamstring strength (r = −0.088; P = 0.644). Hamstring stiffness and strength were not correlated (r = 0.054; P = 0.778). Hamstring stiffness was greater in the low anterior tibial translation group (t₂₈ = 2.186; P < 0.037; ES = 0.36), but hamstring strength did not differ between these groups (t₂₈ = 1.057; P < 0.300; ES = 0.17).

Interpretation

Greater hamstring stiffness, but not strength, results in a more stable knee joint evidenced by less anterior tibial translation. These findings suggest that the hamstrings’ ability to resist lengthening rather than their overall force production capacity may be an important contributor to anterior cruciate ligament injury risk. As muscle stiffness can be modified acutely and chronically, enhancing hamstring stiffness may be an important addition to anterior cruciate ligament injury prevention programs.     

Mechanical analysis of cuff tear arthropathy during multiplanar elevation with the AnyBody shoulder model

Background

This numerical study analysed the mechanics of cuff tear arthropathy with the AnyBody shoulder model.

Methods

The model simulated three frequent characteristics of cuff tear arthropathy: A supero-posterior massive rotator cuff tear, a proximal and static migration of the humeral head, and a contact between the humeral head and the scapula (glenoid &; acromion) with friction. The mechanics of the cuff tear arthropathy with and without friction were studied by analysing: the mechanics of the deltoid (i.e. length &; strength), the gleno-humeral and acromio-humeral contact forces, the friction moment, and the maximum elevation angle. Elevations in the frontal, scapular and sagittal planes were simulated.

Findings

Compared to an intact condition, the cuff tear arthropathy model without friction estimated a deltoid strength of − 18% (frontal = − 13%, scapular = − 17%, sagittal = − 25%), a gleno-humeral contact force of − 34% (frontal = − 60%, scapular = − 46%, sagittal = + 5%), estimated an acromio-humeral contact force of 240 N (frontal = 213 N, scapular = 184 N, sagittal = 324 N) and a maximum elevation angle of 77° (frontal = 80°, scapular = 87°, sagittal = 65°). Contact friction enhanced this behaviour, decreasing even more the gleno-humeral contact force and the maximum elevation angle, while increasing the acromio-humeral contact force.

Interpretation

This novel cuff tear arthropathy model suggests that friction and plane of elevation greatly influence the mechanics of the shoulder with cuff tear arthropathy. It also shows that the AnyBody simulation tool may be useful to study musculoskeletal pathologies and not only normal conditions.     

Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis

Background

Laterally wedged insoles have controversial effect in treating medial compartment knee osteoarthritis. This study examined the effects of unilateral and bilateral use of insoles having medial arch supports and of different inclinations on the frontal plane external hip, knee, subtalar moments and pelvic alignment.

Methods

Kinetic and kinematic gait parameters were collected from 21 patients with primary medial knee osteoarthritis. The insoles' inclinations were 0, 6 and 11°, where each of the 6° and 11° was used once unilaterally and another bilaterally while the 0° was used bilaterally as a control.

Findings

The Multivariate Analysis of Variance revealed significant increase in the external subtalar eversion moment using either of the 6° or 11° laterally wedged vs the 0° non-wedged insole conditions (P = 0.003). Moreover, there were significant increases in the external eversion moment using the 11° vs the 6° insole conditions (P < 0.05). However, there were no significant differences for the remaining tested variables (P > 0.05). The bivariate correlations revealed significant negative correlations between the subtalar eversion and knee adduction moments (r = − 0.409, P = 0.000) and the subtalar eversion and hip adduction moments (r = − 0.226, P = 0.049), and positive correlation between the hip and knee adduction moments (r = 0.268, P = 0.019).

Interpretation

The non-significant reduction in the external knee adduction moment may question the efficacy of using wedged insoles having medial arch supports in treating patients with medial knee osteoarthritis. Additionally, using such insoles did not produce appreciable mechanical effects on remote articulations as the hip and pelvis.     

The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training

In patients with phantom limb pain or complex regional pain syndrome (CRPS), sensory discrimination training increases tactile acuity, normalises cortical reorganisation and decreases pain. In healthy people, sensory cortical response, and tactile acuity, are greater if the participant looks towards the body part being stimulated. Does this effect enhance tactile training in CRPS patients? Ten patients underwent a 30-min tactile discrimination training session under four conditions (order randomised) in a 2 × 2 design: looking towards or away from the stimulated limb and seeing or not seeing skin. Tactile training imparted long-term improvement in tactile acuity when patients watched the reflected image of their unaffected limb in a mirror during training (that is, they looked towards the stimulated body part and could see the skin of the opposite body part in the mirror): two-point discrimination threshold (TPD) was 8 mm less 2 days after training than it was before training ([95% CI = 1.5–14.3 mm], p < 0.001). Although this condition also imparted a greater reduction in resting pain at post-treatment than the other conditions, and change in pain and change in TPD over the session were strongly related (r = 0.83, p < 0.001), there was no residual effect on pain at 2-day follow-up. In the other conditions, tactile acuity had returned to pre-training levels at 2-day follow-up. The results should directly improve management of CRPS, and have implications for rehabilitation of other conditions associated with nervous system injury or disease, for example stroke, in which tactile recovery is a major objective of rehabilitation.     

The angiotensin receptor blocker, telmisartan, reduces and stabilizes atherosclerosis in ApoE and AT1aR double deficient mice

The renin-angiotensin system (RAS) plays critical roles in the pathogenesis of atherosclerosis. Clinical studies demonstrate that pharmacological blockade of RAS with Angiotensin II type 1 receptor (AT1R) blockers (ARBs) is effective in the treatment of patients with cardiovascular diseases. Recent studies reported that telmisartan, an ARB, has a partial agonistic effect on peroxisome proliferator-activated receptor-gamma (PPAR-γ). The role of PPAR-γ-mediated signaling has been implicated in regulation of not only metabolic disorders but also atherosclerosis. Here, we investigated the effects of telmisartan, which is not related to AT1R blockade, using AT1aR and apolipoprotein E (ApoE) double-deficient (ApoE−/−AT1R−/−) mice in vivo. Both genetic ablation of AT1R in ApoE-deficient (ApoE−/−) mice and administration of telmisartan (10 mg/kg/day) to ApoE−/− mice for 20 weeks reduced the development of atherosclerosis (P < 0.05, respectively). Telmisartan decreased lipid deposition (P < 0.01) and increased collagen contents (P < 0.05) in plaques in ApoE−/− mice. Administration of telmisartan to ApoE−/−AT1aR−/− mice also inhibited the progression of atherosclerosis in aorta (P < 0.05) even in mice, which have no AT1aR genetically. Moreover, in these mice, telmisartan decreased macrophage accumulation and lipid deposition, and increased collagen contents in plaques in aortic root (P < 0.05, respectively), indicating stabilization of plaques. Telmisartan-treated ApoE−/−AT1aR−/− mice showed lower body weight and higher plasma high-density lipoprotein levels compared with vehicle-treated mice (P < 0.05, respectively). Telmisartan lowered systolic and diastolic blood pressure in ApoE−/−AT1aR−/− mice (P < 0.01). These results suggest that telmisartan has protective effects on the development of atherosclerosis and metabolic disorders beyond AT1R blockade in ApoE-deficient mice.     

Effects of continuous haemofiltration on serum enzyme concentrations, endotoxemia, homeostasis and survival in dogs with severe heat stroke

Aim

To examine the effectiveness of continuous haemofiltration as a treatment for severe heat stroke in dogs.

Methods

Dogs were randomly allocated to a control or continuous haemofiltration group (both n = 8). Heat stroke was induced by placing anaesthetised dogs in a high temperature cabin simulator. Upon confirmation of heat stroke (rectal temperature > 42 °C, mean arterial pressure (MAP) decrease > 25 mmHg), dogs were removed from the chamber and continuous haemofiltration was initiated and continued for 3 h for dogs in the continuous haemofiltration group. Dogs in the control group were observed at room temperature.

Results

Rectal temperature, haemodynamics, pH, blood gases and electrolyte concentrations rapidly returned to baseline in the continuous haemofiltration group, but not the control group. After 3 h, rectal temperature was 36.68 ± 0.51 °C in the continuous haemofiltration group and 39.83 ± 1.10 °C in the control group (P < 0.05). Continuous haemofiltration prevented endotoxin and all serum enzyme concentrations from increasing and caused malondialdehyde concentrations to decrease. After 3 h, endotoxin concentrations were 0.14 ± 0.02 EU ml⁻¹ in the continuous haemofiltration group and 0.23 ± 0.05 EU ml⁻¹ in the control group (P = 0.003), while malondialdehyde concentrations were 4.86 ± 0.61 mmol l⁻¹ in the continuous haemofiltration group and 8.63 ± 0.66 mmol l⁻¹ in the control group (P < 0.001). Five dogs died in the control group within 3 h, whereas no dogs died in the continuous haemofiltration group.

Conclusions

Continuous haemofiltration rapidly reduced body temperature, normalised haemodynamics and electrolytes, improved serum enzyme concentrations and increased survival in dogs with heat stroke. Continuous haemofiltration may be an effective treatment for heat stroke.     

Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: A randomized controlled trial

Background

Osteoarthritis is a common musculo-skeletal problem accompanied with muscle weakness. Muscle weakness may be readily improved by resistance training. Greater muscle strength has been associated with a lower knee joint loading rate.

Methods

We conducted a single-blind randomized controlled trial of 54 female patients with osteoarthritis in at least one knee, according to the American College of Rheumatology clinical criteria. Patients were randomized into a 6-month high intensity progressive resistance training or a sham-exercise program. The primary outcomes were first peak knee and hip adduction moment measured using three-dimensional gait analysis at self-selected habitual and maximal speeds. Secondary outcomes were sagittal plane knee and hip moments, peak muscle strength, gait speed, and self-reported knee osteoarthritis symptoms measured by the Western Ontario and McMaster Osteoarthritis Index (WOMAC).

Findings

Six months of high intensity resistance training did not change the first peak knee or hip adduction moment at either habitual or maximum walking speeds (P > 0.413) compared to the sham-exercise. However, the second peak hip adduction moment (P = 0.025) and WOMAC pain score (P < 0.001) were reduced significantly in both groups over time, but there was no group effect. The changes in the second peak hip adduction moment were inversely related to the changes in the WOMAC pain score (r = − 0.394, P = 0.009).

Interpretations

Muscle strength training in women with osteoarthritis, while effective for reducing osteoarthritis symptoms, appeared to operate through mechanisms other than improved knee or hip joint loading, as paradoxically, improved symptoms were related to decreases of hip adduction moment in late stance.