Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study.

BACKGROUND: Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis. AIM: To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness. DESIGN: Observational, case-control study. SETTING: Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION: Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study. METHODS: The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS). RESULTS: The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008). CONCLUSIONS: Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up. CLINICAL REHABILITATION IMPACT: The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.

A rare case of an NLRP12-associated autoinflammatory disease.

Pathogenic variants in nucleotide-binding oligomerization-like receptor protein 12 (NLRP12) have been recently suggested as possible causes of autoinflammatory syndromes and should be considered for the differential diagnosis in the patients presenting with symptoms of autoinflammatory diseases. Here we report a very rare case of NLRP12-associated autoinflammatory disease patient who initially presented with polyarthritis and was diagnosed as FMF. Later, the genetic analysis excluded many autoinflammatory conditions including FMF and revealed a c.1206C>G; p.(Phe402Leu) variant in the NLRP12 gene. Awareness of rare autoinflammatory conditions is important to have the best approach to the patients presenting with common symptoms of autoinflammatory diseases.

Full can test: Mechanisms of a positive test in patients with shoulder pain.

BACKGROUND: The full can test is theorized to produce compressive loads on the supraspinatus tendon within the subacromial space. Characterizing the width of the subacromial outlet, scapular orientation, and shoulder pain during the full can test will improve the mechanistic understanding of the positive full can test. METHODS: Cross-sectional repeated measures design. Participants with subacromial pain syndrome (n=30) were compared to a matched control group (n=30) during 2 conditions: passive support, and the full can test. The full can test was performed with the arm elevated to 90° in the scapular plane. In both conditions, measurements were taken of acromiohumeral distance with ultrasonography, scapular position using electromagnetic tracking, shoulder strength using a dynamometer, and shoulder pain with the 11-point rating scale. FINDINGS: During the full can test, both groups had a decreased acromial humeral distance, scapular upward rotation, posterior tilt, external rotation and clavicular protraction as compared to passive support (p<0.05). The subacromial pain group as compared to the control group reported greater shoulder pain (p<0.001), reduced strength (p=0.002) and greater scapular anterior tilt (p<0.05) during the full can test. INTERPRETATION: This study indicates the mechanisms of a full can test are a reduction in the acromial humeral distance, accompanied by scapular kinematic changes. A positive test of increased pain and reduced strength in those with subacromial pain syndrome can be explained additionally by an increase in scapular anterior tilt. These mechanistic changes may lead to tendon compression, but this cannot be verified as direct tendon compression was not measured.

Empty can exercise provokes more pain and has undesirable biomechanics compared with the full can exercise.

BACKGROUND: The purpose of this investigation was to characterize the scapular position and scapular muscle activation during the empty can (EC) and full can (FC) exercises. The EC exercise has been shown to produce scapular kinematics associated with the mechanism leading to subacromial impingement syndrome (SAIS) but has not been investigated in patients with (SAIS). This investigation will help improve the treatment of patients with SAIS. METHODS: Participants with SAIS (n = 28) performed 5 consecutive repetitions of FC and EC exercises. Scapular and clavicular 3-dimensional positions and scapular muscle activity were measured during each exercise. Pain was measured with the numeric pain rating 11-point scale. RESULTS: Participants reported greater pain during the EC exercise vs the FC exercise (difference, 1; P = .003). During the EC exercise, participants were in greater scapular upward rotation (difference, 3°; P < .001), internal rotation (mean difference, 2°; P = .017), and clavicular elevation (difference, 3°, P < .001) and in less scapular posterior tilt (difference, 2°; P < .001). There was greater activity of upper trapezius (difference, 4%, P = .002), middle trapezius (difference, 3%; P < .001), and serratus anterior (difference, 0.5%; P = .035) during ascent, and during the descent of greater upper trapezius (difference, 2%, P = .005), and middle trapezius (difference, 1%; P = .003), but less activity of the lower trapezius (difference, 1%; P = .039). CONCLUSIONS: The EC exercise was associated with more pain and scapular positions that have been reported to decrease the subacromial space. Scapular muscle activity was generally higher with the EC, which may be an attempt to control the impingement-related scapular motion. The FC exercise of elevation is preferred over the EC exercise.

Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome.

PURPOSE: To characterize the supraspinatus tendon thickness, subacromial space, and the relationship between tendon thickness and subacromial space to further elucidate the mechanisms of subacromial impingement syndrome. METHODS: In a single-blind cross-sectional study, subjects were recruited with subacromial impingement syndrome (n = 20) and asymptomatic controls (n = 20) matched for age, gender, and hand dominance. Ultrasound images were collected using a 4-12-MHz linear transducer in B-mode of the supraspinatus tendon in the transverse (short axis) and the anterior aspect of the subacromial space outlet. Using image callipers, measurements of tendon thickness were taken at 3 points along the tendon and averaged for a single thickness measure. The subacromial space outlet was measured via the acromiohumeral distance (AHD) defined by the inferior acromion and superior humeral head. The occupation ratio was calculated as the tendon thickness as a percentage of AHD. RESULTS: The subacromial impingement syndrome group had a significantly thicker tendon (mean difference = 0.6 mm, p = 0.048) and a greater tendon occupation ratio (mean difference = 7.5 %, p = 0.014) compared to matched controls. There were no AHD group differences. CONCLUSIONS: The supraspinatus tendon was thicker and occupied a greater percentage of AHD, supporting an intrinsic mechanism. An extrinsic mechanism of tendon compression is theoretically supported, but future imaging studies need to confirm direct compression with elevation. Treatment to reduce tendon thickness may reduce symptoms, and surgical intervention to increase subacromial space may be considered if tendon compression can be verified.

Effects of different warm-up periods on knee proprioception and balance in healthy young individuals.

CONTEXT: There is limited information on the effects of different warm-up periods on proprioception and balance in the context of injury prevention. OBJECTIVE: To determine the effects of warm-up exercises on knee proprioception and balance and to compare the effectiveness of warming up periods. DESIGN: Pretest/posttest. SETTING: Research laboratory. PARTICIPANTS: 30 healthy subjects (19 women, 11 men; mean age 20.70 +/- 0.99 years). INTERVENTIONS: Exercise groups performed warm-up exercises (group 1, 5 minutes; group 2, 10 minutes). Joint Position Sense (JPS) was tested at 15 degrees , 30 degrees , and 60 degrees knee flexion (KF) on a JPS device. Balance was measured using the Neurocom Balance Master System. MAIN OUTCOME MEASURES: JPS absolute error (AE) was measured at 15 degrees , 30 degrees , and 60 degrees KF and postural control was measured. RESULTS: After exercise, we found significant improvements for AE of JPSs of 30 degrees right (R) KF, 15 degrees left (L) KF, and 60 degrees L KF in group 1. In group 2, AE of JPS values increased for all angles of both knees except 60 degrees R KF. AE of JPS values of 15 degrees R KF, 30 degrees R KF, 15 degrees L KF, 60 degrees L KF were significantly different in group 2 compared with group 1. In balance measurements, there were significant improvements for standing on foam with eyes closed (EC) position, velocity and R-L unilateral stance EC in group 1. There were significant improvements for velocity, end point, maximum excursion, and L unilateral stance EC in group 2. CONCLUSIONS: Both warm-up periods have positive effects on knee proprioception and balance. The 10-minute warm-up exercise improved proprioception by a greater amount than the 5 minutes warm-up exercise.

L-NAME prevents anxiety-like and depression-like behavior in rats exposed to restraint stress.

Stressful life events contribute to the development of many neuropsychiatric disorders including depression and anxiety. Animal studies based on the relationship of stress and depression or anxiety are scarce and controversial. Moreover, neither the neurobiological basis of anxiety and depression nor the mechanisms responsible for neurochemical regulation by stressful stimuli are well understood. This study was designed to investigate the possible contribution of both acute (2 h) and chronic (2 h X 15 d) restraint stress in the generation of anxiety and depression, and also to find out whether nitric oxide (NO) has a modulatory role in these behavioral reactions. Elevated plus-maze and forced swimming test (FST) were chosen for assessment of anxiety and depression, respectively, and N(G)-nitro L-arginine methyl ester (L-NAME, 10 mg/kg), a NO synthase (NOS) inhibitor, and L-arginine (50 mg/kg), a NO precursor, were used to evaluate the role of nitrergic system in restraint exposed rats. The results showed that acute and chronic stress caused depression-like and anxiety-like behaviors in rats and the acute inhibition of NOS by L-NAME prevented these acute and chronic stress-induced anxiogenesis and depression. These data lead to the conclusion that stress and NO seem to be involved in the generation of anxiety and depression.

Protective effects of dextromethorphan and tizanidine on ouabain-induced arrhythmias.

The effects of the opioid agonist dextromethorphan and the alpha 2-adrenoceptor agonist tizanidine on ouabain-induced cardiac arrhythmias were investigated in rats. Ouabain (10 mg/kg i.v.) elicited ventricular arrhythmias in all of the control rats. Administration of dextromethorphan (25 mg/kg i.v.) and tizanidine (0.1 mg/kg i.v.) 30 min before ouabain treatment significantly reduced the incidence of arrhythmias. We suggest that dextromethorphan and tizanidine showed these effects by decreasing excitatory amino acid (EAA) activity. It can be speculated that opioids and other EAA antagonists may have antiarrhythmic actions through both their central and peripheral effects as well.

Therapeutic drug monitoring in Turkey: experiences from Istanbul.

Therapeutic drug monitoring (TDM) has assumed an important place in patient management in the last few decades. In this study, serum drug levels determined in 7759 specimens sent to the Department of Pharmacology and Clinical Pharmacology in 1994 and 1998 for TDM were retrospectively evaluated. Monitored drugs were carbamazepine, valproate, phenytoin, phenobarbital, digoxin, theophylline, and salicylate. The comparison of the results obtained for the relevant 2 years showed that there was a remarkable increase in the number of requests for TDM per year and in the rate of serum drug levels that were within therapeutic range. Serum antiepileptic drug level monitoring accounted for a major part of the data. Overall data suggest that the use of TDM in antiepileptic drugs is improving; conversely, digoxin and theophylline are still not being properly monitored. In this study, the results are discussed in the light of rational TDM criteria.