Control of dynamic stability during gait termination on a slippery surface in Parkinson's disease

This study investigated how Parkinson's disease (PD) affects the ability to switch from locomotion to gait termination (GT) during planned and cued GT and examined the effect of PD on the integration of a reactive, balance maintenance strategy into voluntary GT. After a series of stops on a stable surface, eight participants with and 10 without PD stopped on a surface, which slid quickly and unexpectedly forward mimicking a slippery surface. PD caused instability during the completely voluntary nonslippery stops (P = 0.012) but not during the slippery stops, which required a reactive movement. The PD group walked slower [0.9–1.0 m/s vs. 1.3 m/s, respectively (P < 0.001)] with shorter steps during the first step of nonslippery GT (P = 0.016) and with wider steps during all steps of nonslippery GT (P ≤ 0.05). Similar to controls, the PD group increased lateral stability during planned GT compared to cued GT (P = 0.007). The timing of gait termination was similar between groups in all conditions. During the unexpected perturbation, both groups used a generalized slip response to regain balance after the perturbation. PD did not affect the ability to stop walking or to integrate a balance‐correcting response into GT but did affect movement speed, size, and stability of the voluntary movement. © 2008 Movement Disorder Society     

Yersinia-related Arthritis in the United Kingdom. A Report of 12 Cases and review of the Literature

Reactive arthritis following infection with Yersinia is endemicin Scandanavian countries; the prevalence is low in the UK,however. We have reviewed the literature pertaining to Yersinia-relatedreactive arthritis in the UK and describe 12 patients who presentedover a 3-year period with an asymmetrical seronegative polyarthropathyand serological evidence of recent Yersinia infection. Fivepatients recalled having a diarrhoeal illness prior to the onsetof the arthropathy. None had a prior history of psoriasis, inflammatorybowel disease or ankylosing spondylitis. A history of urethraldischarge was elicited from one patient. Extra-articular manifestationswere seen in three patients (iritis in two, erythema nodosumin another). Four patients developed chronic joint disease afterperiods of 4, 6, 8, and 18 months, respectively. The prevalenceof Yersinia-related arthritis in the UK may be higher than previouslythought.     

The difference in anatomy of the lumbar anterior longitudinal ligament in young african-americans and scandinavians

Objective: To examine possible structural differences in the lumbar anterior longitudinal ligament between young African-American and Scandinavian people.Design: The lumbar anterior longitudinal ligament was examined in 48 African-American and Scandinavian young men and women (17 to 30 years old). Apart from the selection of gender, age, height, and weight, all subjects were recruited consecutively during routine forensic autopsies. Sections of the ligament were obtained from the L1 and the L5 vertebra for thickness and width measurements and histologic preparations. The measurements were performed with a digital vernier caliper with an accuracy of 0.1mm.Results: The width of the L1 part of the lumbar anterior longitudinal ligament in the African-American group (27.5 ± 1.8mm) was greater than that in the Scandinavian group (17.7 ± 1.5mm) (p < .001), and the thickness of the L1 part in the African-American group (3.8 ± 0.4mm) was greater than that in the Scandinavian group (3.3 ± 0.3mm) (p < .001). The width of the L5 part in the African-American group (34.1 ± 2.0mm) was greater than that in the Scandinavian group (25.0 ± 1.5mm) (p < .001), and the thickness of the L5 part in the African-American group (3.3 ± 0.3mm) was greater than that in the Scandinavian group (2.2 ± 0.3mm) (p < .001). The cross-sectional area was greater in the African-American group in both sections (L1, African-American 106.4 ± 13.7mm2 vs Scandinavian 52.8 ± 7.9mm²; L5, African-American 112.2 ± 14.6mm² vs Scandinavian 55.6 ± 6.7mm²) (p < .001). No histologic differences between the two groups were observed.Conclusions: The lumbar anterior longitudinal ligament was considerably wider and thicker, which yielded a markedly greater cross-sectional area, in African-American than in Scandinavian subjects. In contrast, the ligament appears to be histologically similar in the two groups. These are previously unrecognized differences in anatomy between young African-American and Scandinavian people.     

Diagnosis and Management of the Painful Shoulder. Part 2: Examination, Interpretation, and Management

Abstract: Diagnosis, interpretation and subsequent management of shoulder pathology can be challenging to clinicians. Because of its proximal location in the schlerotome and the extensive convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns can be broadly distributed to the deltoid, trapezius, and or the posterior scapular regions. This pain behavior can make diagnosis difficult in the shoulder region, as the location of symptoms may or may not correspond to the proximity of the pain generator. Therefore, a thorough history and reliable physical examination should rest at the center of the diagnostic process. Effective management of the painful shoulder is closely linked to a tissue‐specific clinical examination. Painful shoulder conditions can present with or without limitations in passive and or active motion. Limits in passive motion can be classified as either capsular or noncapsular patterns. Conversely, patients can present with shoulder pain that demonstrates no limitation of motion. Bursitis, tendopathy and rotator cuff tears can produce shoulder pain that is challenging to diagnose, especially when they are the consequence of impingement and or instability. Numerous nonsurgical measures can be implemented in treating the painful shoulder, reserving surgical interventions for those patients who are resistant to conservative care.     

The effect of solvent/detergent-treated plasma on red cells stored in vitro

BACKGROUND: The potential use of solvent/detergent-treated plasma (S/D plasma) in transfusion practice raises concerns about the cytolytic effects that any residual solvent and detergent in the virally inactivated blood component might have on units of red cells in vitro, if the two components are mixed during preparation. STUDY DESIGN AND METHODS: S/D plasma was mixed with variously processed units of stored red cells, in vitro, to evaluate the effect the residual solvent and detergent would have on cell membrane integrity. A paired protocol design was used in which half-units of red cells were exposed to S/D plasma (test), and the matched half-units were exposed to either the supernatant additive solution from the original red cell unit or standard fresh-frozen plasma (FFP) (control). After incubation for up to 5 days, the units were evaluated for evidence of hemolysis or changes in other red cell storage assays. RESULTS: This study showed that, for fresh additive solution red cells (AS-1), the 5-day storage plasma hemoglobin levels were comparable in the red cells exposed to S/D plasma (21 mg/dL) and in the paired half-units stored in the original AS-1 supernatant (31 mg/dL) (p > 0.05). Similar findings were recorded for stored AS-1 red cells (S/D plasma; 111 mg/dL vs. AS-1 supernatant, 147 mg/dL; p > 0.05); stored CPDA-1 red cells (S/D plasma, 133 mg/dL vs. FFP, 103 mg/dL; p > 0.05); frozen red cells (S/D plasma, 28 mg/dL vs. FFP, 18 mg/dL; p > 0.017); and stored irradiated AS-1 red cells (S/D plasma, 608 mg/dL vs. AS-1 supernatant, 726 mg/dL; p > 0.05). Comparable results were found for other assays, including levels of plasma potassium, osmotic fragility, and red cell antigen titer. CONCLUSION: These data show that S/D plasma does not induce red cell lysis even after 5 days of in vitro storage. These results are consistent with previous findings by this laboratory that platelets are not harmed by storage in S/D plasma. Red cells resuspended in S/D plasma and stored for up to 5 days maintain in vitro storage characteristics that are acceptable for the use of the cells in clinical transfusion practice.     

Innervation of dystrophic muscle after muscle stem cell therapy

Introduction: Duchenne muscular dystrophy (DMD) is caused by loss of the structural protein, dystrophin, resulting in muscle fragility. Muscle stem cell (MuSC) transplantation is a potential therapy for DMD. It is unknown whether donor‐derived muscle fibers are structurally innervated. Methods: Green fluorescent protein (GFP)–expressing MuSCs were transplanted into the tibials anterior of adult dystrophic mdx/mTR mice. Three weeks later the neuromuscular junction was labeled by immunohistochemistry. Results: The percent overlap between pre‐ and postsynaptic immunolabeling was greater in donor‐derived GFP⁺ myofibers, and fewer GFP⁺ myofibers were identified as denervated compared with control GFP^– fibers (P = 0.001 and 0.03). GFP⁺ fibers also demonstrated acetylcholine receptor fragmentation and expanded endplate area, indicators of muscle reinnervation (P = 0.008 and 0.033). Conclusion: It is unclear whether GFP⁺ fibers are a result of de novo synthesis or fusion with damaged endogenous fibers. Either way, donor‐derived fibers demonstrate clear histological innervation. Muscle Nerve 54 : 763–768, 2016     

Intramuscular nerve distribution pattern of ankle invertor muscles in human cadaver using sihler stain

Introduction: We sought to the ideal sites for botulinum toxin injection by examining the intramuscular nerve patterns of the ankle invertors. Methods: A modified Sihler method was performed on the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles (10 specimens each). The muscle origins, nerve entry points, and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the lateral malleolus (0%) to the fibular head (100%). Results: Intramuscular arborization patterns were observed at 20–50% for the flexor hallucis longus, 70–80% for the tibialis posterior, and 30–40% for the flexor digitorum longus. Conclusions: These findings suggest that treatment of muscle spasticity of the ankle invertors involves botulinum toxin injections in specific areas. These areas, corresponding to the areas of maximum arborization, are recommended as the most effective and safest points for injection. Muscle Nerve 53 : 742–747, 2016