Risk of Hand Syndromes in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan

The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications.The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders.Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48–1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15–3.24 and 2.99, 95% CI = 2.55–3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86–1.95) and DD (HR = 1.83, 95% CI = 1.39–2.39) than with CTS (HR = 1.31, 95% CI = 1.28–1.34) and LJM (HR = 1.24, 95% CI = 1.13–1.35).Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.     

Amyloid precursor protein, heat-shock proteins, and Bcl-2 form a complex in mitochondria and modulate mitochondria function and apoptosis in N2a cells

Neurons that degenerate in the brains of persons with Alzheimer's disease accumulate mitochondrial amyloid precursor protein (APP), which is thought to negatively affect mitochondrial function and cellular homeostasis. Because proteins that enter mitochondria require assistance from chaperone proteins, we hypothesized that heat-shock proteins (HSPs) help accumulate APP in mitochondria. We found that APP overexpression in N2a cells (APP cells) did not elicit mitochondrial dysfunction. Because cerebral hypoperfusion-associated energy deficiency is an important etiology for Alzheimer's disease, we also challenged the cells with serum starvation. APP/HSP/Bcl-2 complexes formed within the mitochondria of serum-starved APP cells, but not control cells. Mitochondria containing APP/HSP/Bcl-2 complexes induced apoptosis. We hypothesize that APP/HSP/Bcl-2 complexes diminish the functional capacities of HSPs and Bcl-2, which leads to mitochondrial injury and apoptosis.     

Predictors of Adherence to an Antidepressant Medication Regimen Among Patients Diagnosed with Depression in Taiwan

This study explored the predictors of medication adherence among Taiwanese people with major depression and dysthymic disorder. Previous research indicates that depressed patients vary in compliance with their medication regimen. Poor compliance reduces the therapeutic effect of medication. Self-report questionnaires were used for this cross-sectional study conducted with 181 outpatients diagnosed with major depression or dysthymic disorder. About 50% of depressed patients reported good medication adherence. The predictors of adherence were patient income, treatment efficacy, and understanding the importance of continuing medication. Professionals should use collaborative communication and cultural values clarification with depressed patients and their families to improve the awareness of illness and to increase the likelihood of medication compliance.     

Kinematics and muscle activity of the head,lumbar and knee joints during 180° turning and sitting down task in older adults

Background

The “180° turning and sitting down task” is a very conscious movement that requires focusing on turning at the exact moment, and very few studies address on this topic in older adults. The purpose of the study was to compare kinematics and electromyography of the head, lumbar and knee joints during 180°turning in older and young adults.

Methods

Twenty older adults and 20 younger adults were assessed. A 16-channel telemetry electromyography system with electrogoniometers and an inclinometer were used to record the head, lumbar and knee joint kinematic and electromyography data during the 180° turning. This movement had been further divided into 4 phases (braking, mid-stance, swing, and terminal loading) for analysis.

Findings

There were significant differences in the joint displacement and muscular activity among the different phases. Comparison between groups showed that the older adults group had less lateral lumbar flexion, less knee flexion and lower velocity of the head and knee flexion compared to young adults during turning. The electromyography data of the left biceps femoris, left gastrocnemius and left erector spinae muscles in the older adults group showed significantly higher levels than in the young adults.

Interpretation

Older adults need to adjust velocities of moving joints and increase the extensor synergy muscles of the back and the stance leg to provide posture stability. Kinematics and neuromuscular modulations of the head, lumbar and knee are required according to the various phases of the turn movements and change with aging.     

A Cadaveric and Preliminary Clinical Study of Ultrasonographically Assisted Percutaneous Carpal Tunnel Release

The aim of this study was to assess the effectiveness and safety profile of a new technique for ultrasonographically assisted percutaneous carpal tunnel release. Experiments were performed on 40 hands in 20 cadavers. We first performed a detailed ultrasonographic examination and correlation study that included surgical dissection of the transverse carpal ligament, the related neurovascular structures and the bony landmarks of the radiocarpal, midcarpal and carpometacarpal joints of the right hand. We then used the measurements we made for percutaneous carpal tunnel release of the transverse carpal ligament using intra-operative ultrasonography for guidance and a hook knife on the left-hand side. The completeness of the release and the potential risks of injury to the flexor tendon and neurovascular bundles were examined. Using real-time intra-operative ultrasonographic monitoring to clearly delineate these targets, we were able to percutaneously release the transverse carpal ligament completely in 18 (90%) of the 20 hands and partially release it in 2 without injuring any neurovascular bundles. We then performed the procedure on 91 consecutive cases of carpal tunnel syndrome and found that the sensory disturbances disappeared in 100% patients 12 mo post-operatively; only 2 hands were graded as unsatisfactory. There were no intra- or post-operative complications. Based on the results from the cadaveric studies and our successful preliminary clinical outcomes, we conclude that this method is tolerable and that its clinical application can be encouraged.     

Sonographic patterns of splenic abscess: an analysis of 34 proven cases

Background: The sonographic patterns of splenic abscess are seldom reported. We report the different sonographic patterns in 34 proven cases. Methods: From 1984 to June 2000, 42 patients were diagnosed with splenic abscess by abscess aspiration or pathologic findings of surgical specimens. Among them, 34 cases underwent sonographic studies. Results: Fifteen cases had typical abscess echo patterns that included gas in the abscess (two cases) and debris in the abscess cavity (13 cases). Five cases of abscess showed subcapsular lesions with or without echo in the lesion. Two cases of abscess showed a thickened wall mimicking a tumor with central necrosis. Two cases showed a pattern suggesting a cyst. Ten cases showed a pattern suggesting tumor: eight had multiple lesions and two had solitary lesions. Of those 10 cases, seven multifocal abscesses were hypoechoic, and two solitary and one multifocal abscess were mixed echoic. Mortality from multiple splenic abscesses was higher than that from solitary abscess (p = 0.032). Both patients with gas in the abscess expired. Conclusion: Sonography of a splenic abscess is variable. A typical pattern was seen in only 44.1% (15 of 34) of patients in our series. We suggest using needle aspiration in each suspected case. Multiple and gas-containing abscesses indicate a poor prognosis. Received: 19 October 2001/Accepted: 12 December 2001     

Input-selective potentiation and rebalancing of primary sensory cortex afferents by endogenous acetylcholine

Acetylcholine (ACh) plays important roles in the modulation of activity and plasticity of primary sensory cortices, thus influencing sensory detection and integration. We examined this in urethane-anesthetized rats, comparing cholinergic modulation of short latency, large amplitude field postsynaptic potentials (fPSPs) in the visual cortex (V1) evoked by stimulation of the ipsilateral lateral geniculate nucleus (LGN), reflecting direct thalamocortical inputs, with longer latency, smaller amplitude fPSPs elicited by contralateral LGN stimulation, reflecting indirect, polysynaptic inputs. Basal forebrain (BF) stimulation (100 Hz) produced a significant (45%), gradually developing potentiation of the smaller, contralateral fPSPs, while ipsilateral fPSPs showed less enhancement (15%), shifting the relative strength of dominant/ipsi- and weaker/contralateral inputs to V1. Systemic or local, cortical blockade of muscarinic receptors (scopolamine) reduced potentiation of contralateral fPSP without affecting ipsilateral enhancement, thus preventing the relative amplification of contralateral inputs following BF stimulation. Systemic nicotinic receptor blockade (mecamylamine) resulted in depression of ipsilateral, and reduced enhancement of contralateral fPSPs after BF stimulation. N-methyl-d-aspartate receptor blockade (systemic MK-801) abolished ipsilateral fPSP enhancement without affecting contralateral potentiation. Neither drug reduced the amplification of contralateral relative to ipsilateral signals in V1. In a second experiment in the barrel cortex, BF stimulation enhanced multiunit activity elicited by whisker deflection in a muscarinic-sensitive manner. Similar to the observations in V1, this effect was more pronounced for weaker multiunit activity driven by a surround whisker than activity following principal whisker deflection. These experiments demonstrate that ACh release following BF stimulation exerts surprisingly selective effects to amplify non-dominant inputs to sensory cortices. We suggest that, by diminishing the imbalance between different afferent signals, ACh release during states of behavioral activation acts to induce a long-lasting facilitation of the detection and/or integration of signals in primary sensory fields of the cortical mantle.