Development of a Digital Healthcare Management System for Lower-Extremity Amputees: A Pilot Study.

The research, which was designed as a "pre- and post-single group" study, included patients with lower-limb amputation and aimed to evaluate the effectiveness of self-directed physical-strength training and cardiovascular exercise using a novel digital healthcare management service three times a week for 12 weeks. Muscle strength, thigh circumference, lipid profile and glycated hemoglobin levels, pulmonary function, quality of life, and physical activity level were evaluated before and after the intervention, while satisfaction was measured after the study. Among the 14 included patients, the proportion of adherence to the physical-strength training and physical-strengthening activity were 85.2% and 75.8%, respectively. The level of satisfaction with the digital healthcare management system was high. Significant changes were observed in the muscle-strength tests (dominant grip power and muscle strength of knee flexion and extension of the intact side), thigh circumference, and glycated hemoglobin levels. Further, the quality-of-life score showed improvement, although without significant differences. Individualized exercise management using the novel digital healthcare management system for lower-limb amputees could induce interest in self-care and promote physical activity and healthy behavior. Through this effect, we can expect a reduction in the incidence of cardiovascular diseases, diabetes mellitus, dyslipidemia, and severe injuries from falling.

Superficial radial sensory neuropathy: Medial and lateral branch injury.

INTRODUCTION: Superficial radial sensory nerve (SRN) injury may involve the main nerve or its distal medial or lateral branch. We investigated the utility of SRN conduction studies on the medial and lateral branches in patients with suspected SRN injury. METHODS: Fifteen patients with symptoms of SRN neuropathy were studied. Their clinical and electrophysiological findings were assessed according to sensory symptom areas. Three active recording electrode positions were used: snuff box (position A); medial branch (position B); and lateral branch (position C). RESULTS: In 7 patients with medial area symptoms, abnormal findings were seen in position B (100%) and position A (71%). In 3 patients with medial and lateral area symptoms, abnormal findings were seen in all positions. In 5 patients with lateral symptoms, abnormal findings were seen in position C only. CONCLUSIONS: Nerve conduction studies for each branch of the SRN are useful in patients with suspected SRN neuropathy.

Electrophysiological and ultrasonographic findings in ulnar neuropathy with Martin-Gruber anastomosis.

INTRODUCTION: It is important to understand the presence of Martin-Gruber anastomosis in patients with complete ulnar neuropathy at the elbow. CASE REPORT: We describe a patient with complete ulnar neuropathy at the elbow and Martin-Gruber anastomosis in the forearm, mimicking incomplete ulnar neuropathy with complete conduction block in the forearm segment. Ultrasonography of the ulnar nerve around the elbow demonstrated severe swelling of the ulnar nerve, which was compatible with severe ulnar neuropathy at the elbow. CONCLUSIONS: This case report demonstrates that combination of ultrasonography with electrophysiological studies can provide more detailed information about the changes of nerve structures and lesion sites.

Muscular polyarteritis nodosa.

We present an unusual case of a 26-year-old man with muscular polyarteritis nodosa (PAN) with severe calf pain and gait disturbance. Magnetic resonance imaging of the lower limbs demonstrated highly increased signal intensity in both soleus muscles and the lateral head of the left gastrocnemius muscle. Biopsies of the soleus muscle showed acute necrotizing arteritis. The calf pain and limited range of motion of ankle dorsiflexion subsided from day 1 on administration of oral corticosteroid at high dosage and were completely resolved by 4 months. After tapering corticosteroid to 10 mg, symptoms recurred. A combined regimen of immunosuppressants was found to maintain symptomatic relief.Muscular PAN should be included in the differential diagnosis of a patient presenting with symptoms of acute or subacute calf pain. Although this muscular PAN was so far been benign, complete remission of the underlying process may be difficult to achieve.

Tendinosis-like histologic and molecular changes of the Achilles tendon to repetitive stress: a pilot study in rats.

BACKGROUND: Tendinopathy (pain and tendon degeneration) is associated with repetitive use and mechanical overload. However, the etiology of tendinopathy remains unclear. Clarification of histologic and molecular changes of tendon to repetitive stress could provide better understanding of Achilles tendon disorders related to repetitive stress. QUESTIONS/PURPOSES: We asked whether repetitive stress simulating overuse of the Achilles tendon induced (1) histologic changes in rats similar to tendinosis (increased cellularity of fibrocytes, increased disorganization of collagen fiber, and increased roundness of the nucleus of the fibrocyte), (2) increased collagen Type III occurrence, and (3) increased inducible nitric oxide synthase (iNOS) expression. METHODS: We used an exercise protocol simulating repetitive, jerky, eccentric contraction of the triceps surae in 15 rats. We conducted the exercise for 2 hours per day, three times per week using the right rear legs only and the left legs as internal controls. We harvested Achilles tendons after either 2, 4, or 6 weeks of exercise, and evaluated changes in tendon thickness, fibrocyte count, collagen fiber arrangement, collagen fiber type, and occurrence of iNOS. RESULTS: Exercised Achilles tendons showed increased cellularity of fibrocytes at 4 and 6 weeks of exercise, and disorganized collagen fiber arrangement at 6 weeks of exercise. There was a trend for Type III collagen occurrence being greater in experimental groups. Expression of iNOS increased after 2 and 4 weeks of exercise when compared with that of the controls, but decreased after 6 weeks. CONCLUSIONS: These observations suggest repetitive, synchronized, passive, and jerky exercise induced by electrical stimulation can lead to the tendinosis-like changes in the Achilles tendons in rats with imbalance between synthesis and degeneration after 4 weeks of exercise. CLINICAL RELEVANCE: This newly designed exercise protocol may be used to design an animal model of Achilles tendon overuse. With this model, therapeutic interventions of tendinopathy could be analyzed by investigation of tendon biology and response in terms of histologic and molecular changes.

Randomized controlled trial for clinical effects of varying types of insoles combined with specialized shoes in patients with rheumatoid arthritis of the foot.

OBJECTIVE: To determine the effects of specialized shoes with insoles in patients with rheumatoid arthritis and the differences in terms of type of insole and anatomical location of foot pathology. DESIGN: Single-blinded randomized controlled trial. SETTING: Outpatients of physical medicine and rehabilitation clinic at university hospital. SUBJECTS: Forty-two patients with rheumatoid foot lesions were randomly assigned to two different orthotic intervention groups. The anatomical locations of the foot lesions were recorded (hindfoot or forefoot). INTERVENTION: Participants were provided with an extra deep forefoot-rockered shoe and either a custom-made semi-rigid insole or a ready-made simple soft insole. They wore the provided footwear for at least 3 hours a day over six months. MAIN OUTCOME MEASURES: Primary outcome measures were foot pain visual analogue scale (VAS) scores and Foot Function Index (FFI). Secondary outcome measures were erythrocyte sedimentation rate and C-reactive protein levels in blood, amounts of medications and active joint counts. These were checked at baseline and post intervention. RESULTS: Eight patients dropped out at follow-up after six months of treatment. At six-month follow-ups, VAS scores and total Foot Function Index scores had decreased significantly in both groups versus baseline but intergroup comparison showed no significant differences in view of type of insoles and anatomical locations of foot pathology. CONCLUSIONS: We were unable to identify differences between the types of insoles in terms of their clinical effects or between anatomical locations of foot lesions in the two groups, but both groups improved. Therapeutic shoes plus soft insoles might be effective enough in terms of foot pain and foot function for specific patients with rheumatoid foot problems regardless of the location of foot pathology.

Elimination Reactions of (E)- and (Z)-Benzaldehyde O-Pivaloyloximes. Transition-State Differences for the Syn and Anti Eliminations Forming Nitriles.

Elimination reactions of (E)- and (Z)-benzaldehyde O-pivaloyloximes 1 and 2 with DBU in MeCN have been investigated kinetically. The reactions are second order and exhibit substantial values of Hammett rho and k(H)/k(D) values, and an E2 mechanism is evident. The rate of elimination from 2 is approximately 20 000-fold faster than that from 1. For reactions of 1 with DBU in MeCN, a Hammett rho value of 2.4 +/- 0.1, k(H)/k(D) = 2.7 +/- 0.3, DeltaH() = 12.5 +/- 0.2 kcal/mol, and DeltaS() = -31.0 +/- 0.6 eu have been determined. The corresponding values for 2 are rho = 1.4 +/- 0.1, k(H)/k(D) = 7.8 +/- 0.3, DeltaH() = 8.8 +/- 0.1 kcal/mol, and DeltaS() = -23.6 +/- 0.4 eu, respectively. The results indicate that the nitrile-forming anti eliminations from 2 proceed via a more symmetrical transition state with a smaller degree of proton transfer, less negative charge development at the beta-carbon, and greater extent of triple-bond formation than that for the syn elimination.