Value of High-Frequency Ultrasound in the Diagnosis of Pronator Teres Syndrome / 中国医学科学院学报

Objective To investigate the clinical value of high-frequency ultrasound in the diagnosis of pronator teres syndrome (PTS). Methods The high-frequency ultrasound was employed to examine and measure the median nerve of the pronator teres muscle in 30 patients with PTS and 30 healthy volunteers (control group).The long-axis diameter (LA),short-axis diameter (SA) and cross-sectional area (CSA) of the median nerve were measured.The receiver operating characteristic curve of the median nerve ultrasonic measurement results was established,and the area under the curve (AUC) was calculated.The diagnostic efficiency of each index for PTS was compared with the surgical results as a reference. Results The PTS group showed larger LA[(5.02±0.50) mm vs.(3.89±0.41) mm;t=4.38,P=0.013],SA[(2.55±0.46) mm vs.(1.70±0.41) mm;t=5.19,P=0.009],and CSA[(11.13±3.72) mm2 vs.(6.88±2.68) mm2;t=8.42,P=0.008] of the median nerve than the control group.The AUC of CSA,SA,and LA was 94.3% (95%CI=0.912-0.972,Z=3.586,P=0.001),77.7% (95%CI=0.734-0.815,Z=2.855, P=0.006),and 78.8% (95%CI=0.752-0.821,Z=3.091,P=0.004),respectively.With 8.63 mm2 as the cutoff value,the sensitivity and specificity of CSA in diagnosing PTS were 93.3% and 90.0%,respectively. Conclusion High-frequency ultrasound is a practical method for diagnosing PTS,and the CSA of median nerve has a high diagnostic value.

Rehabilitation of Mobility for Critically Ill Patients Based on World Health Organization Family International Classifications: A Scoping Review / 中国康复理论与实践

Objective:To analyze rehabilitation of functioning of mobility for critically ill patients based on the framework of the World Health Organization Family International Classifications (WHO-FICs). Methods:A scoping review of rehabilitation of functioning of mobility for critically ill patients had been conducted. Literatures on early mobilization or rehabilitation in the field of critical illness from databases of Web of Science, PubMed, CNKI, and Wanfang up to February 28, 2021 were retrieved. The diseases, functioning, rehabilitation intervention, functioning evaluation and environment of patients in critical ward had been reviewed. Results:Based on WHO-FICs framework, this paper reviewed literatures in five dimensions: the type of diseases, functioning, rehabilitation intervention, functioning evaluation and environment factors. The diseases included respiratory system diseases (MD10-MD6Y), neurological system diseases (MB40-MB9Y), cardiovascular system diseases (MC80-MC9Y), post-surgical (MD80-ME4Y, ME60-ME6Y, ME80-MF1Y), and others (NA00-NF2Z, MA00-MA3Y, 1G40-1G41). The functioning included movement-related structures (s720-s760), neuromusculoskeletal and movement-related functions (b710-b740), mobility (d4), self-care (d5), and remunerative employment (d850). The rehabilitation interventions were divided into three categories based on the International Classification of Health Interventions (ICHI) β-3: therapeutic, preventive, and health promotion interventions. The evaluation of functioning mainly involved joint mobility, muscle strength, muscle tone, de Morton Mobility Index, Functional Status Score for Intensive Care Unit (FSS-ICU), 6-Minute Walking Test (6WMT), intensive care unit (ICU) length of stay and so on. The intensive care environment was also discussed using ICF environment factors. Conclusion:This paper proposed a framework of rehabilitation of mobility for critically ill patients based on the WHO-FICs. It focused on respiratory system disease, neurological system diseases, cardiovascular system diseases, post-surgical with mobility dysfunction. To implement interventions in therapeutic, preventive, and health promotion to optimize patients' function, and to prevent complications and secondary dysfunction, and improve their well-being.

Progress on treatment for patellofemoral arthritis / 中国骨伤

As a common disease of knee joint disease, the diagnosis and treatment of patellofemoral arthritis has not clear clinical consensus at present, conservative treatment only has a certain value for the disease with early stage and single disease. With the continuous improvement of understanding of pathogenesis and advancement of surgical techniques, minimally invasive and joint replacement technology has been rapid development, more and more alternative treatment options could be chosen. Technique of osteotomy of tibial tuberosity and removal of patella at the early stage were seldom used. According to development stage of disease, and combined with age, economic capacity, patients considering knee joint functional requirements and other factors, the balance of soft tissue under arthroscopy and denervation for cartilage injury in elderly patients with grade I to III surgery is more appropriate, and joint replacement is effective for cartilage injury in elderly patients with grade IV. Early debate is focus on total knee arthroplasty whether exist excessive medical treatment, patellofemoral joint replacement meet to demand for replacement of single patellofemoral degeneration with improvement of prosthesis design. Due to technical difficulties of cartilage transplantation and anatomical characteristics of patellofemoral joint, report of application of cartilage transplantation for patellofemoral arthritis is less, but with continuous improvement of technology, cartilage transplantation will be a good method for improving clinical symptoms, reducing medical costs, putting off joint replacement time.

Insertion of gluteus maximus tendo-chilles lengthening with Z-shaped for the treatment of severe gluteal muscle contracture / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical curative effects of gluteal muscle contracture release combined with insertion of gluteus maximus tendo-chilles lengthening with Z-shaped in treating severe gluteal muscles contracture.</p><p><b>METHODS</b>From 2006 May to 2011 May, 20 patients (35 sides) with severe gluteal muscle contracture were collected, including 12 males and 8 females, aged from 8 to 34 years old with an average of 13 years old; the courses of disease ranged from 3 to 21 years. All patients manifested abnormal gait at different degree, knees close together cannot squat,positive syndrome of Ober, positive test of alice leg. Gluteus contracture fascia release were performed firstly in operation, then insertion of tendo-chilles lengthening with Z-shaped were carried out. Preoperative and postoperative gait, and knee flexion hip extensor squat test, cross leg test, adduction and internal rotary activity of hip joint, stretch strength and motor ability after hip abduction were observed and compared.</p><p><b>RESULTS</b>Twenty patients were followed up for 1 to 5 years. Gluteus maximus were released thoroughly, and snapping hip was disappeared, Ober syndrome were negative. There was significant differences in knee flexion hip extensor squat test, adduction and internal rotary activity of hip joint,stretch before and after operation (P<0.01). Gluteus muscle strength was protected,stretch strength and motor ability of hip joint were recovered well. Among them,31 cases got excellent results and 4 good.</p><p><b>CONCLUSION</b>For severe gluteal muscles contracture,insertion of gluteus maximus tendo-chilles lengthening with Z-shaped performed after gluteus contracture fascia release could release gluteal muscle contracture to the greatest extent and obtain postoperative curative effect without resection of normal hip muscle fibers and destroy joint capsule.</p>

DUOX2 mutations in children with congenital hypothyroidism / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the features of DUOX2 mutations and genotype-phenotype relationship in children with congenital hypothyroidism (CH), in order to provide evidence for gene diagnosis and gene treatment of CH.</p><p><b>METHODS</b>Blood samples were collected from 10 CH children with thyromegaly. Genomic DNA was extracted from peripheral blood leukocytes. All exons of DUOX2 gene were analyzed using PCR and direct sequencing.</p><p><b>RESULTS</b>G3632A mutation in the exon 28 of DUOX2 that may result in arginine to histidine substitution at codon 1211 was found in one patient. T2033C mutation in the exon 17 of DUOX2 that may result in histidine to arginine substitution at codon 678 was found in three patients. They were all heterozygous mutations.</p><p><b>CONCLUSIONS</b>Heterozygous mutations in DUOX2 may affect protein function and cause CH. The relationship between DUOX2 genotypes and clinical phenotypes is unclear and needs further studies.</p>