Lack of echocardiographic and Doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors

OBJECTIVE: To assess the prevalence of echocardiographic and Doppler abnormalities in psoriatic arthritis (PsA) patients without clinically evident cardiovascular manifestations or classic atherosclerosis risk factors. METHODS: Fifty PsA patients were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients seen during the period of recruitment that had classic cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. RESULTS: In PsA patients the frequency of aortic and tricuspid (10%) and mitral regurgitation (16%) was not different from that seen in matched controls (10, 4, and 12%). Also, the pulmonary artery systolic pressure was normal in the group of PsA patients (23.4+/-3.9 mm Hg). The prevalence of diastolic dysfunction, in all cases due to impaired relaxation, was similar in PsA patients (28%) and controls (24%) (P=0.65). In addition, no significant echocardiographic and Doppler differences were observed when PsA patients with polyarticular pattern were compared with the remaining PsA patients. CONCLUSIONS: The present study shows that actively treated PsA patients without cardiovascular risk factors or clinically evident cardiovascular disease do not exhibit silent subclinical echocardiographic abnormalities.     

Swimmers' painful shoulder arthroscopic findings and return rate to sports

Shoulder pain is the most common musculo-skeletal complaint in competitive swimmers. It remains one of the shoulder pain syndromes in overhead athletes where no golden standard of treatment exists. Eighteen competitive swimmers who all had undergone shoulder arthroscopy for therapy-resistant shoulder pain were retrospectively evaluated with respect to operative findings and ability to return to their sport after the operation. The most common finding at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in five shoulders (28%). Operative procedures included debridement in 11 swimmers, partial release of the coraco-acromial ligament in four, and bursectomy in four. Sixteen (89%) responded to the follow-up evaluation. Nine swimmers (56%) were able to compete at preinjury level after 4 (2-9) months. Findings at arthroscopy suggest that the term "Swimmer's shoulder" covers a variety of pathologies including labral wearing and subacromial impingement. Arthroscopic debridement of labral tears or bursectomy in swimmers with shoulder pain has a low success rate with regard to return to sport. Further understanding and investigation of this syndromes complex pathophysiology is needed.     

慢性中耳炎的CT诊断

目的：探讨CT对慢性中耳炎的诊断价值。方法：回顾性分析经手术病理确诊的慢性中耳炎45例的CT表现特点。结果：14例胆脂瘤型中耳炎CT表现为鼓室、鼓窦内软组织密度影,鼓室扩大,窦入口扩大,鼓室壁破坏、硬化。听小骨移位、骨质吸收、破坏。其它征象包括乙状窦、鼓室盖、水平半规管、面神经管水平段骨质破坏。29例肉芽肿型中耳炎CT表现为中耳腔内的软组织密度影,部分有液平,鼓室壁增生、硬化,骨质破坏少见,听小骨可出现吸收破坏,但程度较轻,一般无移位。2例单纯型中耳炎表现为中耳腔内的软组织密度影,1例有液平,鼓室壁骨质硬化,无骨质破坏。结论：依据鼓室内软组织密度影的形态分布,鼓室壁破坏情况及听小骨改变,通过CT检查可对大部分慢性中耳炎做出明确诊断。     

Rasagiline is neuroprotective in an experimental model of brain ischemia in the rat

Summary. The neuroprotective effects of intravenous rasagiline were investigated in a rat model of stroke. Middle cerebral artery (MCA) occlusion was performed in male rats and the short- (neurological severity score [NSS], infarct size), intermediate- (cognition) and long-term (necrotic area) effects were assessed. A bolus (3 mg/kg) of rasagiline followed by a 3-h infusion (3 mg/kg/h), initiated immediately after MCA occlusion, reduced infarct size by 48.6% and NSS by 32.7% relative to saline treatment. Cognitive function, tested in a water maze 2–3 weeks after occlusion, also significantly improved compared with saline-treated controls. Necrotic brain area was 35–50% smaller with rasagiline than with saline following a single bolus dose. The single bolus rasagiline dose was as effective as a rasagiline bolus followed by rasagiline infusion in short-term outcomes. The neuroprotective effect of rasagiline was fully reproducible when administered at 2 h following occlusion but not after 4 h.     

Positive and negative factors for the treatment outcomes following total ankle arthroplasty? A systematic review

BackgroundPatient selection, surgeon’s experience and implant design play an integral role and affect the treatment outcomes of total ankle arthroplasty (TAA). The aims of this study were to investigate the positive and negative attributes that correlate with different clinical and radiographic outcomes.MethodsEight-nine studies matched the inclusion criteria: (1) studies of primary TAA with uncemented prosthesis; (2) mean follow-up of no less than 2-year; (3) reports of clinical and radiographic outcomes, and exclusion criteria: (1) non-English study; (2) more than one type of prosthesis without separated data; (3) kin studies with shorter follow-up or smaller cohort. Age, etiology, preoperative deformity, surgeon’s experience, follow-up duration and prosthetic type were studied with respect to different outcomes by mixed-effects logistic regression analysis.ResultsPatients factor: older patients reported less pain or stiffness and demonstrated less radiographic loosening which did not require additional surgical intervention. More traumatic arthritis experienced adjacent joints degeneration after TAA. Surgeon factor: less experienced surgeons had more intraoperative complications. Lack of experience for complications management without implant retrieval during early period might result in more revisions or fusion was done. Prosthetic factor: updated instrumentation decreased malalignment. If the polyethylene (PE) insert was significantly narrower than the metal components more implant instability and subsequent severe particulate wear was seen. Designs with flat-on-flat articulation and ridge at the center of the talar component associated with more PE fracture. Minimal bone resection reduced postoperative fractures. A flat cut of the tibial component and a flat undersurface with press-fit by two screws or pegs of the talar component demonstrated less postoperative fractures, whereas a syndesmosis fusion and a small triangular shape with one central fin of the talar component experienced more loosening which did not require additional surgery. Anatomic conical shape of the talar component seemed to reduce adjacent joint degeneration. Finally, fewer failures were found in patients who received HINTEGRA and Salto Talaris.ConclusionsBased on our investigation, some positive and negative factors for different clinical and radiographic outcomes were found, which should be taken into consideration in clinical practice and ankle implant design.     

Proteus综合征的临床影像学表现（附2例报告和文献复习）

目的分析Proteus综合征的临床影像学表现特征,提高对本病的认识。方法报告二例符合Proteus综合征诊断标准的病例,分析其临床、影像表现特征并复习文献。结果 Proteus综合征的临床和影像表现错综复杂,以多发性、过度生长的错构瘤、脑回状结缔组织痣、皮肤痣和偏侧肥大,巨脂（趾）,颅骨畸形,颅内多发肿瘤,多发外生骨疣,骨肥厚,掌、指骨征阳性以及血管畸形等为特征。结论 Proteus综合征临床表现和影像表现缺乏特异性,诊断困难,提高对本病的认识是正确诊断的关键,影像表现结合临床资料,对诊断有一定的提示作用。     

Steatocystoma multiplex with hair shaft abnormalities

Steatocystoma multiplex (SM) is an unusual benign disorder of the pilosebaceous duct characterized by multiple cysts with little or no nail and hair involvement. We report a 30‐year‐old woman with multiple cystic nodules located on the neck, axillae and forearms as well as patchy scalp alopecia. Histopathological examination of the lesions was diagnostic of SM. Trichoscopy revealed pili torti and pili canaliculi. This patient represents an unusual clinical presentation of SM because of the presence of hair abnormalities.