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OBJECTIVES@#To compare the clinical effect on Bell's facial palsy in the acute stage between the staging comprehensive treatment with acupuncture-moxibustion and western medication.@*METHODS@#Sixty patients with Bell's facial palsy in the acute stage were randomly divided into an observation group and a control group, with 30 cases in each one. The patients in the control group were administered orally with prednisone acetate tablets and methylcobalamin tablets until the 28th day of illness. In the observation group, the staging comprehensive treatment with acupuncture-moxibustion was adopted. On the affected side, Qianzheng (EX-HN 16), Yifeng (TE 17), Sibai (ST 2), Yangbai (GB 14), Jiache (ST 6), Dicang (ST 4) and Touwei (ST 8), etc. were stimulated. In the acute stage (Day 1 to 7 of illness), the routine acupuncture and the point-toward-point needle insertion were delivered, no any manipulation was exerted at acupoints, and the needles were retained for 30 min. In the subacute stage (Day 8 to 14 of illness), on the base of the treatment as the acute stage, the depth of needle insertion was adjusted at a part of acupoints and the even needling technique was operated by twisting needle. Besides, electroacupuncture (EA) was attached to Qianzheng (EX-HN 16) and Dicang (ST 4), with continuous wave of low intensity and high frequency, 100 Hz, for 20 min. In the recovery stage (Day 15 to 28 of illness), on the base of the treatment as the subacute stage, the heavy stimulation of acupuncture was given, in which, the sticking and lifting needle techniques were delivered after the needles were inserted from Sibai (ST 2) toward Dicang (ST 4), and from Dicang (ST 4) toward Jiache (ST 6), separately; warm needling was operated at Yifeng (TE 17), and EA changed to stimulate the acupoints with the intermittent wave of high intensity and low frequency, 2 Hz, for 30 min. Acupuncture-moxibustion was given once every other day until the end of the 28th day of illness. The level of House-Brackmann facial nerve function rating scale (H-B grade),the score of Sunnybrook facial nerve grading system (Sunnybrook), the score of facial disability index (FDI), the temperature difference in the infrared thermal imaging facial area and electromyogram (EMG) situation of the affected muscle group were observed before and after treatment in the two groups. Using musculoskeletal ultrasound,the facial nerve diameter was detected and the clinical effect was compared between the two groups.@*RESULTS@#After treatment, the level of H-B grade, Sunnybrook score, the scores of physical function and social life function in FDI were improved when compared with those before treatment in the patients of either group (P<0.01, P<0.05), and the results of these evaluations in the observation group were better than those of the control group (P<0.05). After treatment, the temperature difference of the frontal area, the eye area, the zygomatic area and the mouth corner was declined in comparison with that before treatment in the two groups (P<0.05), and the temperature difference in each area in the observation group was lower than that of the control group (P<0.05).The root mean square (RMS) of the frontal muscle group, the zygomatic muscle group and the orbicularis muscle group on the affected side increased in comparison with that before treatment in the two groups (P<0.01), and RMS of the observation group was higher than that of the control group (P<0.05) after treatment. Before treatment, the diameter of the facial nerve on the affected side was larger than that on the healthy side (P<0.01), and after treatment, the diameter on the affected side was reduced when compared with that before treatment in the two groups (P<0.01); the diameter of the facial nerve on the affected side in the observation group was smaller than that of the control group (P<0.05), while, the diameter on the affected side was larger when compared with the healthy side in the control group (P<0.05). The total effective rate of the observation group was 93.3% (28/30), higher than that of the control group (83.3% [25/30], P<0.05).@*CONCLUSIONS@#The staging comprehensive treatment with acupuncture-moxibustion is clearly effective on Bell's facial palsy in the acute stage, which affirms the effectiveness of acupuncture-moxibustion for the acute stage of Bell's facial palsy in comparison with conventional western medication.
Subject(s)
Humans , Facial Paralysis/therapy , Moxibustion , Acupuncture Therapy , Bell Palsy/therapy , FaceABSTRACT
Objective @#To compare the ultrasound signs of symptomatic joint lesions in rheumatoid arthritis (RA) and gouty arthritis ( GA) , musculoskeletal ultrasound ( MSUS) was utilized. @*Methods @#A retrospective analysis was performed for 85 hospitalized patients with RA and 55 hospitalized patients with GA in the same period , and the differences in general data , diseased joints and ultrasound signs between the two groups were compared. @*Results@#The gender, age and diseased joints of the two groups were statistically significant (all P < 0. 05) . The detection rate of knee joint lesions was the highest; the RA group had high sensitivity , high specificity of meniscal injury , and high diagnostic efficiency of bone erosion , while the diagnostic performance of the three combined ultrasound signs of punctate strong echo , double track sign and tophi in the GA group was higher than that of any individual diagnosis , and the sensitivity and specificity were also higher. The course of disease in the RA group was positively correlated with bone erosion (P < 0. 05) , and the course in the GA group was positively correlated with tophi (P < 0. 05) .@*Conclusion @#The ultrasound signs of RA and GA are different , and MSUS has good value in the diagnosis and differential diagnosis of the two.
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ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.
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The fenrou zhijian is defined as potential gap between different layers in the three-dimensional network structure formed by the twelve meridian tendons. Various pathological changes of the meridian tendons lead to the adhesion and closure of fenrou zhijian, causing abnormal mechanical conduction of the meridian tendon system, which in turn leads to painful bi syndrome of meridian tendons. As such, restarting the fenrou zhijian is the key to acupuncture treatment for painful bi syndrome of meridian tendons. Under the guidance of musculoskeletal ultrasound, the level and the angle of needle insertion of acupuncture at fenrou zhijian could be accurately controlled, the efficacy of acupuncture is improved.
Subject(s)
Humans , Meridians , Acupuncture Therapy , Needles , Pain , Tendons/diagnostic imagingABSTRACT
At present,the evaluation method of clinical efficacy of acupuncture and moxibustion is highly subjective,and the applied objective imaging data also has shortcomings of long time,large radiation and low cost performance.Musculoskeletal ultrasound technology can solve these problems well,and has gradually become the first choice in the diagnosis or treatment evaluation of many diseases.it is also widely used in clinical and experimental research of acupuncture.Musculoskeletal ultrasound has the advantages of real-time,non radiation,fast imaging,objectivity and so on.This article summarizes and analyzes the advantages of musculoskeletal ultrasound in the evaluation of acupuncture clinical efficacy,and provides relevant reference for its further clinical application and development.
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ObjectiveTo evaluate the inter-rater and test-retest reliability of echo intensity of ultrasound image for quality of quadriceps femoris in patients with knee osteoarthritis (KOA). MethodsFrom March to December, 2021, 33 patients with unilateral KOA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine were included. Ultrasound was used to observe the cross sections of rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL), and the images were saved. Two independent raters analyzed the average gray value of the picture with the Image J. One of the raters repeated the measurement. The intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC) and coefficient of variation (CV) were calculated and the Bland-Altman charts were drawn. ResultsThe gray value was higher in the RF, VM and VL in the affected side than in the healthy side (t > 2.262, P < 0.05). The inter-rater reliability was excellent, with ICC 0.982 to 0.995, SEM 1.60 to 3.82, CV 1.49% to 5.90%, and MDC value 4.43 to 10.59. The test-retest reliability of the rater was excellent, with ICC 0.969 to 0.990, SEM 2.37 to 5.41, CV 2.22% to 4.84%, and MDC value 6.57 to 15.00. Bland-Altman charts analysis showed that the consistency was good. ConclusionThe quadriceps femoris muscle quality is different between the affected and the healthy sides in patients with unilateral KOA. It is reliable to evaluate muscle echo intensity by Image J.
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Objective:Based on the research results of the national continuing medical education project "musculoskeletal ultrasound and new technology quality class" held by the Department of Ultrasound Diagnosis of Peking University Third Hospital, to explore and analyze the effect of basic and applied teaching method based on musculoskeletal ultrasound.Methods:Totally 109 participants attending the classes held on April 14-18, 2019 and on September 9-13, 2019 were selected as study objects, and the training effects of quality private classes were evaluated by questionnaires, operational tests and theoretical tests. SPSS 21.0 was used for t test. Results:The results showed that more than 80% of students were satisfied with the teaching content, teaching plan and teaching materials. Through the class training, the greatest gains of the students were that the operation ability [67 cases (30.7%)] and the theoretical level [53 cases (24.3%)] had been significantly improved. All 109 students passed the operation test. There were no statistical differences in the average scores of theoretical tests among the students with different professional titles, academic qualifications and whether they were from primary hospitals (75-80 points, P>0.05) . Conclusion:The musculoskeletal ultrasound quality private class can improve the students' operating ability and theoretical level in the musculoskeletal system. The class model can guarantee the teaching quality and provide a new direction for continuing medical education.
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With the continuous development of ultrasound equipment and imaging technology, the application of ultrasound imaging technology is more and more wide, and gradually covers the whole process of disease diagnosis and treatment. Focusing on the highlights of ultrasound development, this article briefly introduces the new fields and new progress of clinical application of ultrasound from interventional ultrasound, point-of-care ultrasound, and musculoskeletal ultrasound.
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OBJECTIVE@#To observe the effect of acupotomy on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis and to reveal the possible therapeutic mechanism involved in the effect of acupotomology on the treatment of knee osteoarthritis(KOA).@*METHODS@#Twenty-four male New Zealand rabbits aged 6 months and weighed (2.0±0.5) kg were randomly divided into blank group, model group and acupotomy group, 8 rabbits in each group. KOA model was established by modified Videman method with left hind limb extended plaster immobility for 6 weeks. In acupotomy group, the transfascial focal points of quadriceps femoris muscle were released by acupotomy under the guidance of Jingjin theory for 4 times and once a week, and the treatment points include Hedingci, Binwaixia, Binneixia. Blank group and model group were fed normally without intervention. One week after the end of the intervention, the pennation angle(PA), muscle thickness(MT), cross-sectional area(CSA) and strain ratio(SR) of rectus femoris were measured by ultrasound. HE staining was used to observe the changes of the tissue morphology, the number of muscle fibers and the average area of muscle fibers. The myofibril of rectus femoris, sarcomere and myofilament were observed by transmission electron microscope.@*RESULTS@#The PA of rectus femoris muscle in the blank group was (9.05±0.21)°. The MT was(1.09±0.09) cm and the CSA was(1.30±0.01) cm2. The PA of rectus femoris muscle in the model group was (3.06±0.15)°. The MT was (0.71±0.02) cm and the CSA was(0.77±0.02) cm2. The PA of rectus femoris muscle in the acupotomy group was (6.94±0.28)°. The MT was (0.80±0.05) cm and the CSA was(0.94±0.03) cm2. The muscle PA, MT and CSA of rectus femoris in the model group were significantly smaller than those in the blank group (P<0.05). Those in acupotomy group were significantly increased compared with those in model group (P<0.05). The SR of rectus femoris muscle was 1.19±0.02 in the blank group, 3.50±0.05 in the model group and 1.99±0.07 in the acupotomy group. The elastic SR of the model group was significantly higher than that of the blank group (P<0.05). These in acupotomy group was significantly lower than that in model group(P<0.05). The results of HE staining showed:in blank group, the fascicles of rectus femoris were arranged neatly, the number of beam of muscle fibers within the fixed visual field was 94.38±3.50 and the average CSA was(0.75±0.22) mm2. In model group, the fascicles of rectus femoris with different sizes were disorganized with a small amount of inflammatory cell infiltration, the number of beam of muscle fibers within the fixed visual field was 196.63±2.62 and the average CSA was(0.26±0.03) mm2. Compared to the blank group, a significant increase in the number of muscle fibers in the fixed field in the model group (P<0.05) and the average CSA decreased significantly(P<0.05). In acupotomy group, the rectus femoris fascicles in the acupotomy group tended to be arranged in a more orderly manner, with the inflammatory cells decreased, the number of beam of muscle fibers within the fixed visual field was 132.88±4.61 and the average CSA was(0.70±0.07) mm2. Compared to the model group, a significant decrease in the number of muscle fibers in the fixed field in the model group(P<0.05) and the average CSA increased significantly(P<0.05). The results of transmission electron microscope showed:compared with the blank group, the overall arrangement of the myofibrils of the rectus femoris in the model group was less structured. There was fracture between the muscle fibers and the sarcomere, the myofilaments were disordered, and the fracture of the Z line was discontinuous. Compared with the model group, the myofibrillar texture of rectus femoris in acupotomy group was clearer, and the Z line was more continuous.@*CONCLUSION@#Based on the jingjin theory, the release of quadriceps femoris by acupotomy can effectively improve the morphology and structure of rectus femoris, and promote the repair and reconstruction of chronic skeletal muscle injury in rabbits with KOA, which may be one of the mechanisms of acupotomy in the treatment of KOA.
Subject(s)
Animals , Humans , Male , Rabbits , Acupuncture Therapy , Muscle, Skeletal , Osteoarthritis, Knee/therapy , Quadriceps Muscle , UltrasonographyABSTRACT
Abstract Objective: To evaluate musculoskeletal ultrasound (MSUS) as a screening tool for rheumatoid arthritis (RA) and osteoarthritis (OA) patients in a rheumatology-screening program. Patients and methods: To raise awareness for rheumatic diseases, a mobile rheumatology office was deployed in different cities of Germany ("Rheuma-Truck"). Standardized questionnaire assessment, testing for rheumatoid factor and citrullinated peptide antibodies and medical student driven MSUS of the clinically dominant hand/foot including wrist, MCP-II, -III, -V, PIP-II, -III, MTP-II and -V were offered free of charge to the population. In case of suspicious results, a rheumatologist was consulted. Results: In MSUS, 192 of 560 selected volunteers (aged 18-89, mean 52.7 years; 72.9% female) had suspicious findings including synovitis or erosions primarily affecting the MTP-II (11.8%), dorsal wrist (8.9%), and MCP-II (7%). 354 of the 560 volunteers further visited a rheumatologist of whom 76 were diagnosed with RA. According to the 'US7 Score', a sum scores ≥ 5 was significantly predictive for RA (odds ratio (OR) 5.06; confidence interval (CI) 0.83-35.32). 313 volunteers displayed signs of OA including osteophytes, while MCP-II (36.2%), MCP-III (14.8%), and the wrist (10.5%) were mostly affected. Diagnosis of RA was favoured over OA if the wrist (OR 4.2; CI 1.28-13.95), MTP-II (OR 1.62; CI 1.0-2.6), and MCP-V (OR 2.0; CI 1.0-3.8) were involved. Conclusion: Medical student driven MSUS by the 'US7 Score' can facilitate diagnosis of RA in rheumatology-screening programs due to the level of the score and the affected joints. A high rate of unknown OA signs was detected by MSUS. A mobile rheumatology office displays an opportunity to screen patients for RA and OA.
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Objective:To explore the application effect of flipped classroom teaching method in musculoskeletal ultrasound teaching for standardized residency training of ultrasound department.Methods:In the study, 30 residents in ultrasound department of The Second Affiliated Hospital of Chongqing Medical University were collected and divided into control group ( n=15) and experimental group ( n=15). The control group was taught by traditional teaching method and the flipped teaching method was adopted in the experimental group. All residents were trained for 3 months. At the end of the training, theoretical test and operating skill test as well as the questionnaire survey were performed to evaluate the effects of these 2 teaching methods. SPSS 17.0 was used for t test and chi-square test. Results:The experimental group were superior to the control group in the aspects of the theoretical test scores, operating skill test scores, improving learning efficiency, building clinical thinking patterns, improving self-study ability, and there were significant differences. The satisfaction degree of teaching methods in the experiment group was higher than that in the control group, with significant differences ( P<0.001). Conclusion:Flipped classroom teaching method can improve the teaching outcomes and quality to ensure smooth completion of the teaching objectives.
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OBJECTIVE@#To observe the imaging features of focus of knee joint tendon in patients with knee osteoarthritis (KOA) by musculoskeletal ultrasound (MSUS) technique.@*METHODS@#One hundred KOA patients and 100 healthy subjects were included. All the KOA patients were palpated by the sequence of foot @*RESULTS@#The top-5 focus of knee tendon of KOA patients were located in medial inferior patella, medial tibial condyle, inferior patella, Zusanlici and Hedingci. The thickness of ligaments and tendons in extension and flexion positions in KOA patients were thicker than that in healthy subjects (@*CONCLUSION@#The focus of knee joint tendon in KOA patients shows significantly thickened musculoskeletal imaging features.
Subject(s)
Humans , Healthy Volunteers , Knee Joint/diagnostic imaging , Osteoarthritis, Knee/diagnostic imaging , Tendons/diagnostic imaging , UltrasonographyABSTRACT
OBJECTIVE@#To explore the difference in phenotype recognition of PsA patients in two clinical scenarios, physical examination with and without ultrasound assessment.@*METHODS@#PsA patients who visited the rheumatology and clinical immunology department of Peking University First Hospital between January 2010 and October 2020, with complete data of clinical and ultrasound assessment were enrolled. The phenotypes were first identified based on physical examination only, and then combined with enthesitis and dactylitis shown on power doppler and gray-scale ultrasound. The phenotype groupings without and with ultrasound assessment were presented with Wayne diagram. The distributions of different clinical phenotypes were compared by using χ2 test or Fisher's exact test. The differences of clinical phenotypes with and without ultrasound assessment were compared by using Wilcoxon signed rank test.@*RESULTS@#A total of 227 patients with PsA were enrolled with one or more clinical domains. Physical examination revealed that psoriasis was in 209 (92.1%, 209/227) patients, nail involvement in 98 (43.2%, 98/227) patients, peripheral arthritis in 219 (96.5%, 219/227) patients, axial involvement in 25 (11.0%, 25/227) patients, dactylitis in 80 (35.2%, 80/227) patients, and enthesitis in 18 (7.9%, 18/227) patients. Besides 18 patients with clinical enthesitis, ultrasound scan revealed acute enthesitis in 80 patients, with hypoechogenicity (55 cases), tendon thickening (62 cases), and presence of Doppler signals (48 cases). Similarly, dactylitis on ultrasound was found in 18 patients besides those patients with clinical dactylitis. Compared with the phenotypes recognized based on physical examination only, the additional ultrasound assessment revealed that the most common phenotypes, peripheral arthritis was significantly less frequently recognized (49.8% vs. 27.8%, P < 0.001), however on the other hand, the proportion of the patients with peripheral arthritis and enthesitis was significantly increased (4.4% vs. 18.1%, P < 0.001). The phenotype of peripheral arthritis combined with enthesitis, and dactylitis was also dramatically increased (1.8% vs. 17.6%, P < 0.001).@*CONCLUSION@#Ultrasound is a useful tool to identify enthesitis and dactylitis. With the aid of ultrasound assessment, rheumatologists can better identify the lesions of PsA, accurately identify the phenotypes, and further guide the subsequent treatment.
Subject(s)
Humans , Arthritis, Psoriatic/diagnostic imaging , PhenotypeABSTRACT
【Objective】 To evaluate musculoskeletal ultrasound (MSUS) detected subclinical synovitis of rheumatoid arthritis (RA) with different clinical remission criteria so as to explore the clinical characteristics of subclinical synovitis. 【Methods】 Forty-six consecutive patients with RA in clinical remission [disease activity score-28 (DAS28)≤2.6] underwent clinical and MSUS examinations at baseline and 1 year follow-up. Clinical remission was defined according to the DAS28 using the erythrocyte sedimentation rate (DAS28-ESR) and C-reactive protein level (DAS28-CRP), clinical disease activity index (CDAI), simplified clinical disease activity index (SDAI), and American College of Rheumatology/European League Against Rheumatism criteria Boolean (ACR/EULAR criteria). Subclinical synovitis was assessed by MSUS. Differences between the subclinical synovitis and non-subclinical synovitis groups were analyzed. 【Results】 The percentages of patients who achieved DAS28-ESR, DAS28-CRP, CDAI, SDAI, and ACR/EULAR remission at baseline and 1 year were 97.8%, 95.6%, 67.4%, 54.3%, 52.2% and 91.3%, 93.5%, 54.3%, 50.0%, and 45.6%, respectively. Subclinical synovitis was detected in 55.5%, 54.5%, 45.2%, 40.0%, 41.6% and 45.2%, 46.5%, 40.0%, 39.1%, and 38.1% of these patients, respectively. There were 45.6% and 41.3% patients who fulfilled all the criteria, yet 38.1% and 36.8% still had evidence of subclinical synovitis at baseline and 1 year. Compared with the patients without subclinical synovitis, those with subclinical synovitis had a significantly positive rate of anti-CCP antibody and a higher disease activity score at baseline (P<0.05). 【Conclusion】 MSUS detected subclinical synovitis is common. The positive anti-CCP antibody and higher disease activity score at baseline may be related to subclinical synovitis in patients with RA in clinical remission.
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OBJECTIVE@#To observe the clinical effect of electronic moxibustion on dysphagia in patients with achalasia of cricopharyngeus muscle after stroke.@*METHODS@#Sixty patients with dysphagia of achalasia of cricopharyngeus muscle were randomly divided into an observation group and a control group, 30 cases in each group. One patient in the observation group and 2 cases in the control group dropped off. The patients in the control group were treated with routine medical treatment, acupuncture treatment and swallowing rehabilitation training; the patients in the observation group were additionally treated with electronic moxibustion at Lianquan (CV 23), Tiantu (CV 22), Tianding (LI 17) and Futu (LI 18), 30 min each treatment. Both groups were treated 5 times a week for 4 weeks. The musculoskeletal ultrasound (MSUS) was applied to test the activity of parapharyngeal wall and the dysphagia score of Ichiro Fujishima was compared before and after 4-week treatment.@*RESULTS@#After treatment, the activity of the parapharyngeal wall and the dysphagia score of Ichiro Fujishima were increased in both groups (<0.01, <0.05). The changes of activity of parapharyngeal wall and dysphagia score of Ichiro Fujishima in the observation group were greater than the control group (<0.05, <0.01).@*CONCLUSION@#Electronic moxibustion can improve the impaired swallowing function and reconstruct the normal swallowing process.
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Resumen Introducción: Anormalidades ultrasonográficas se describen con cierta frecuencia en articulaciones de sujetos asintomáticos, las cuales generan incertidumbre en el contexto de evaluación y tratamiento de la enfermedad articular inflamatoria; a pesar de ello, en Colombia no existen estudios al respecto y la evidencia disponible es escasa, hecha en un bajo número de participantes y con transductores menores a 18 MHz en su gran mayoría. Objetivos: Describir los hallazgos ultrasonográficos articulares en manos y pies de un grupo de voluntarios asintomáticos, su asociación con las características sociodemográficas y la concordancia intra e interobservador de sus mediciones. Materiales y métodos: Estudio descriptivo y analítico en el que se incluyeron 182 voluntarios asintomáticos. Dos médicos con experiencia en ecografía musculoesquelética evaluaron el aspecto dorsal de 5.460 recesos articulares mediante la escala semicuantitativa de Szkudlarek y la utilización de un transductor lineal de 18 MHz. Resultados: La mediana de edad de los participantes fue de 42 arios, 60,4% de ellos mujeres. En 87% de los voluntarios se identificaron en total 232 hallazgos, el 68,1% correspondió a derrame articular, 29,3% a hipertrofia sinovial, 2,1% a erosiones y 0,4% a Doppler de poder. Los pies mostraron mayores hallazgos que las manos (70,7% vs. 29,3%). Las articulaciones en las que más se identificaron anormalidades fue la primera articulación metatarsofalángica (52%), la tercera metatarsofalángica (15%) y la radiocarpiana (9,5%). Se halló relación positiva entre el derrame articular y la hipertrofia sinovial con la edad, ocupación manual exclusiva y tiempo laboral mayor de 10 años. La concordancia intraobservador fue moderada (Kappa = 0,4591) y la interobservador fue leve (Kappa = 0,2155). Conclusiones: La ausencia de señal Doppler de poder, el no compromiso radioulnar distal, la ausencia de sinovitis acompañada de erosión y una mayor predominancia de alteraciones leves al nivel de las manos, sumado a la ausencia de hallazgos al nivel de la quinta articulación metatarsiana, constituyen hallazgos potencialmente específicos de sujetos asintomáticos que merecen ser confirmados como tal en futuros estudios.
Abstract Introduction: Ultrasound (US) abnormalities have often been described in the joints of asymptomatic subjects, which may lead to uncertainty in the evaluation and treatment of inflammatory joint disease. Despite this, the available evidence is scarce, with few participants, and in the vast majority with transducers less than 18Mhz. In Colombia there are currently no published studies about this topic. Objectives: To describe the ultrasound findings in hand and foot joints in asymptomatic volunteers, their association with sociodemographic characteristics, and intra- and inter-observer concordance of the measurements. Materials and methods: Descriptive and analytical study within 182 asymptomatic volunteers. Two physicians with musculoskeletal ultrasound experience evaluated the dorsal aspect of 5460 articular recesses using the semi-quantitative scale of Szkudlarek using a 18 MHz linear transducer. Results: The median age of the participants was 42 years, including 60.4% women. A total of 232 abnormal findings were identified in 87% of the volunteers, with 68.1% corresponding to joint effusion, 29.3% synovial hypertrophy, 2.1% erosions, and 0.4% positive power Doppler. The feet evaluation showed more findings than the hands (70.7 vs. 29.3%). The joints in which most abnormalities were identified were the first metatarsophalangeal joint (52%), third metatarsophalangeal joint (15%), and radiocarpal joint (9.5%). A positive association was found between joint effusion and synovial hypertrophy with age, exclusive manual activity, and occupation for more than ten years. The intra-observer concordance was moderate (Kappa = .4591) and the inter-observer was low (Kappa = .2155). Conclusions: The absence of power Doppler signal, the absence of abnormalities in distal radioulnar, the absence of synovitis accompanied by erosion, and a greater predominance of mild alterations in the hand joints, added to the absence of findings in the fifth metatarsal joint, can be potential specific findings of asymptomatic subjects and might be confirmed in future studies.
Subject(s)
Humans , Joints , Synovitis , Radiography , Ultrasonography , Asymptomatic DiseasesABSTRACT
Objective:To investigate the reliability of the morphological measure of medial gastrocnemius by musculoskeletal ultrasound imaging on the standing and prone positions, and compare the differences in the structural parameters of the medial gastrocnemius in different positions. Methods:From December, 2017 to May, 2018, 30 healthy young subjects were measured the muscle thickness, fascicle length and pennation angle of medial gastrocnemius on the prone and standing position respectively by two testers with musculoskeletal ultrasound. One of the testers re-tested three days later. The intra-class correlation coefficient (ICC), measurement standard error (SEM) and minimum detectable change (MDC) of all muscle morphological parameters in different positions were calculated respectively, and the differences of the morphological measurement of the medial gastrocnemius between these two positions were compared. Results:In the prone position, the ICC of inter-rater was 0.932 to 0.943 and the ICC of intra-rater was 0.880 to 0.915. In the standing position, the ICC of inter-rater was 0.922 to 0.938, and the ICC of intra-rater was 0.839 to 0.925. There were significant differences in muscle thickness, fascicle length and pennation angle of medial gastrocnemius in standing position and prone position (P < 0.01). Inter-rater SEM of muscle thickness and fascicle length was less in standing position than in prone position, while intra-rater MDC of pennation angle was less in prone position. Conclusion:It is reliable to measure medial gastrocnemius in standing and prone positions with ultrasonography. Morphological measurement of gastrocnemius is more accurate in standing position, while the measurement in prone position is more sensitive.
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OBJECTIVE: To explore related factors of changes in gouty patients by ultrasonography after initiation of uric acid lowering therapy. METHODS: There were 72 gout patients enrolled who admitted to First hospital of Peking University from December 2012 to June 2017. All the patients had clinical and ultrasound examination at both knees, ankles and feet joints at the baseline. Regular uric acid lowering therapy started for one year. The endpoint was the last time who repeat the ultrasound examination during the follow up.According with uric acid level and its measuring time, the area under the curve was calculated to reflect the uric acid burden. RESULTS: In the 216 jonts of 72 patients, double contour sign were detectable in 112/216(51.85%), tophi were detectable in71/216(32.87%).Among MTP Joints, DCS was detected in 32/144(22.22%), and tophi in 47/144(32.64%). Among Knees joints, DCS was detected in 33/144(22.92%), tophi in 4/144(2.78%). Among ankle joints, DCS was detected in 47/144(32.64%), tophi in 20/144(13.89%).DCS disappearance occurred in 38/55(69.09%) joints positive for DCS at baselineTime-to-disappearance was 148 days(985~133 days). Tophi disappeared completely in 18/45 joints(40%). Time-to-disappearance was 382.5 days(686~397.25 days). There was no significant difference in age, BMI, duration of disease and complications between DCS persisted group and DCS disappearance group.SUA in the DCS disappeared group at baseline, second, third, fourth and ninth months of follow-up. was significantly lower than that of the non-disappeared group. SUA load in the DCS group was significantly lower than the non-disappeared group. Post hoc tests showed that SUA levels fell significantly from baseline through fourth month of follow-up in DCS disappearance group, and SUA of the sixth months was the lowest. CONCLUSION: To screen for specific features of gout such as DCS or tophi by US at initiation of ULT and during follow-up is a useful, and effective way to detect the lowering and often disappearance of burden of urate load in gouty joints.
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@#Objective To explore the clinical effect of sling exercise on postpartum low back pain (PLBP). Methods From February, 2017 to February, 2018, 66 PLBP patients were randomly divided into control group (n = 33) and observation group (n = 33). The control group received routine rehabilitation physiotherapy and American chiropractic, and the observation group was supplemented with sling exercise therapy additionally. They were evaluated with Numerical Rating Scale (NRS), Oswestry Disability Index (ODI) and the thickness of transversus abdominis before and six weeks after treatment. Results Before treatment, there was no significant difference in the scores of NRS, ODI and the thickness of transversus abdominis between two groups (P > 0.05). Six weeks after treatment, the scores of NRS and ODI significantly decreased (t > 14.579, P < 0.001), and the transversus abdominis thickness significantly improved (t > 15.855, P < 0.001) in both groups. All the above indexes were significantly better in the observation group than in the control group (t > 4.818, P < 0.001). Conclusions ling exercise therapy, combined with American chiropractic treatment and routine rehabilitation physiotherapy, can further relieve pain in patients with PLBP, and improve the function and the quality of life.
ABSTRACT
Rheumatic diseases often involve the musculoskeletal system, including rheumatoid arthritis (RA), spondyloarthritis (SpA), gouty arthritis, systemic sclerosis (SSc) and polymyalgia rheumatica (PMR), which are difficult to cure and have a high disability rate, thus seriously affect patients′work and life. A simple, convenient and effective means is needed for disease′s diagnosis and activity monitoring in clinic. Musculoskeletal ultrasound (MSUS) scans the superficial joints and muscles, and can detect the inflammation in disease′s early stage. It has the advantages of safety, high sensitivity and repeatability, and is widely applied in rheumatic diseases.