Usefulness of ultrasound assessment of median nerve mobility in carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy of the upper extremity. Recently, dynamic ultrasound (US) imaging has shown differences in median nerve mobility between the affected and unaffected sides in CTS. PURPOSE: The present study was performed to compare the median nerve mobility between patients with CTS and healthy individuals, and to correlate median nerve mobility with the severity of CTS. MATERIAL AND METHODS: A total of 101 patients (128 wrists) with CTS and 43 healthy individuals (70 wrists) were evaluated. Electrodiagnostic studies were initially conducted to determine the neurophysiological grading scale (NGS). The cross-sectional area (CSA) of the median nerve and the grade of median nerve mobility were measured using US. RESULTS: The mean grade of median nerve mobility in the CTS group (1.9) was significantly lower than that in the control group (2.6; P < 0.001). There were significant negative correlations between the grade of median nerve mobility and distal motor latency of the median nerve (r = -0.218, P = 0.015), NGS (r = -0.207, P = 0.020) and CSA of the median nerve (r = -0.196, P = 0.028). CONCLUSION: The grade of median nerve mobility was negatively correlated with the severity of CTS. US assessment of median nerve mobility may be useful in diagnosing and determining the severity of CTS.

Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder?

OBJECTIVE: To investigate the correlation between arthrography, magnetic resonance imaging (MRI), and ultrasonography (US) findings in patients with idiopathic adhesive capsulitis (IAC) of the shoulder and their clinical presentation as well as functional impairment. DESIGN: Cross-sectional observational study. SETTING: Institutional practice. PARTICIPANTS: Patients (N=75) with a clinical diagnosis of unilateral IAC. INTERVENTIONS: Contrast-enhanced MRI, single-contrast arthrography, and US were performed in all patients. MAIN OUTCOME MEASURES: The thickness of the axillary recess, coracohumeral ligament (CHL), and enhanced portion in the rotator cuff interval was measured using MRI. Arthrography was used to calculate the total score of shoulder arthrographic criteria. US was used to measure the thickness of the inferior glenohumeral ligament (IGHL) and CHL, and the IGHL ratio and CHL ratio were calculated by comparing those of the unaffected side. RESULTS: None of the MRI parameters was correlated with clinical assessment scores. The total score of shoulder arthrographic criteria was negatively correlated with passive range of motion of the total shoulder motion (P<.05), shoulder forward flexion (P<.05), and abduction (P<.05). The total Constant-Murley score was well correlated with the total score of shoulder arthrographic criteria (P<.05). The total shoulder joint space capacity was positively correlated with passive range of motion of the total shoulder motion (P<.05) and shoulder forward flexion (P<.05). The IGHL thickness, IGHL ratio, CHL thickness, and CHL ratio were negatively correlated with shoulder external rotation (P<.05). CONCLUSIONS: The findings of arthrography and US in patients with IAC of the shoulder were correlated with clinical assessment scores, whereas all measuring parameters on MRI were not. US is recommended as the preferred option for diagnosing IAC of the shoulder because it is noninvasive, reflects the clinical features of IAC, and provides anatomical accuracy.

Effect of Sipjeondaebo-Tang on the Pharmacokinetics of S-1, an Anticancer Agent, in Rats Evaluated by Population Pharmacokinetic Modeling.

S-1 (TS-1®) is an oral fluoropyrimidine anticancer agent containing tegafur, oteracil, and gimeracil. Sipjeondaebo-tang (SDT) is a traditional oriental herbal medicine that has potential to alleviate chemotherapy-related adverse effects. The aim of the present study was to evaluate the effect of SDT on the pharmacokinetics of S-1. Sprague-Dawley rats were pretreated with a single dose or repeated doses of SDT for seven consecutive days (1200 mg/kg/day). After the completion of pretreatment with SDT, S-1 was orally administered and plasma concentrations of tegafur, its active metabolite 5-FU, and gimeracil were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS). A population pharmacokinetic model was developed to evaluate the effect of SDT on pharmacokinetics of tegafur and 5-FU. Although a single dose of SDT did not have any significant effect, the absorption rate of tegafur decreased, and the plasma levels of 5-FU reduced significantly in rats pretreated with SDT for seven days in parallel to the decreased gimeracil concentrations. Population pharmacokinetic modeling also showed the enhanced elimination of 5-FU in the SDT-pretreated group. Repeated doses of SDT may inhibit the absorption of gimeracil, an inhibitor of 5-FU metabolism, resulting in enhanced elimination of 5-FU and decrease its plasma level.

Alterations in Pharmacokinetics of Gemcitabine and Erlotinib by Concurrent Administration of Hyangsayukgunja-Tang, a Gastroprotective Herbal Medicine.

Gemcitabine and erlotinib are the chemotherapeutic agents used in the treatment of various cancers and their combination is being accepted as a first-line treatment of advanced pancreatic cancer. Hyangsayukgunja-tang (HYT) is a traditional oriental medicine used in various digestive disorders and potentially helpful to treat gastrointestinal adverse effects related to chemotherapy. The present study was aimed to evaluate the effect of HYT on the pharmacokinetics of gemcitabine and erlotinib given simultaneously in rats. Rats were pretreated with HYT at an oral dose of 1200 mg/kg/day once daily for a single day or 14 consecutive days. Immediately after pretreatment with HYT, gemcitabine and erlotinib were administered by intravenous injection (10 mg/kg) and oral administration (20 mg/kg), respectively. The effects of HYT on pharmacokinetics of the two drugs were estimated by non-compartmental analysis and pharmacokinetic modeling. The pharmacokinetics of gemcitabine and erlotinib were not altered by single dose HYT pretreatment. However, the plasma levels of OSI-420 and OSI-413, active metabolites of erlotinib, were significantly decreased in the multiple dose HYT pretreatment group. The pharmacokinetic model estimated increased systemic clearances of OSI-420 and OSI-413 by multiple doses of HYT. These data suggest that HYT may affect the elimination of OSI-420 and OSI-413.

Distribution of Platelet-rich Plasma after Ultrasound-Guided Injection for Chronic Elbow Tendinopathies.

Characteristics of the spreads of platelet-rich plasma (PRP) are not widely known despite commonly use. This study aims to evaluate whether PRP stays within the injected area by using ultrasonography, to improve understanding of the spreads of intratendinous injected PRP. Thirty-nine patients (15 males, 24 females; mean age, 49.3 years), who had symptoms on their elbows (> 6 months) and diagnosed as lateral (25 elbows) or medial (14 elbows) tendinopathies of elbow, were included. The severity of tendon pathology was assessed by ultrasonography as tear or no tear. Immediately after ultrasound-guided PRP injection, ultrasound images were evaluated to assess the area of PRP distribution, which was defined as the presence of fluid or microbubbles. Ultrasound revealed that 13 elbows had tendon tear and 26 had no tear, respectively. Post-injection ultrasound confirmed the injected PRP was within the tendon in all cases. The mean distance of distribution from the injection site was 12.6 mm (5.0-26.0 mm). There was no difference in the distance of PRP distribution between tendon tear and no tear. Injected PRP spread to soft tissue outside the tendon in 20 of 39 cases. Intra-articular extension of PRP was observed in 5 cases. Although PRP remained intratendinous after the injection in all cases, some portion tended to spread outside from the injection site in a short space of time. Postinjection ultrasonographic imaging has a value for observing the spreading patterns of intratendinous PRP injection.

Anatomic Differences in the Sacral Hiatus During Caudal Epidural Injection Using Ultrasound Guidance.

OBJECTIVES: The aim of this study was to clarify differences in the anatomic structure of the sacral hiatus and angle of needle insertion during caudal epidural steroid injection using ultrasound guidance in patients according to sex and age. METHODS: A total of 237 patients with low back pain with or without sciatica were included. Sonograms of the sacral hiatus were obtained, and caudal epidural steroid injection using ultrasound guidance was performed in all patients. The intercornual distance, diameter of the sacral canal, thickness of the sacrococcygeal ligament, optimal angle for needle insertion, and actual angle of needle insertion were measured. RESULTS: Between men and women, significant differences were observed for the intercornual distance (17.7 versus 16.5 mm; P< .01) and thickness of the sacrococcygeal ligament (4.3 versus 3.9 mm; P = .02). In all patients, the thickness of the sacrococcygeal ligament (r= 0.28) and diameter of the sacral canal (r= 0.40) were positively correlated with the optimal angle for needle insertion (P < .01). In women, the thickness of the sacrococcygeal ligament (r = -0.24), diameter of the sacral canal (r = -0.27), optimal angle for needle insertion (r = -0.29), and actual angle of needle insertion (r = -0.18) were negatively correlated with age. In men, only the diameter of the sacral canal was negatively correlated with age (r = -0.30). CONCLUSIONS: We found that the sacral hiatus has anatomic differences between patients of different sexes and ages. Understanding these differences, especially in women, may improve the safety and reliability of caudal epidural steroid injection.

Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve.

INTRODUCTION: We evaluated the effect of platelet-rich plasma (PRP) injection in a rabbit model of dextrose-induced median nerve injury. METHODS: New Zealand white rabbits (n = 15) were divided randomly into 3 groups. Three different regimens (group 1: 0.1 ml saline; group 2: 10% dextrose with PRP; group 3: 10% dextrose with saline) were injected within the carpal tunnel. Electrophysiological and histological findings were evaluated 12 weeks after the injection. RESULTS: The mean median motor latency in group 3 was significantly longer than that in groups 1 and 2. The cross-sectional area of the median nerve and subsynovial connective tissue thickness in group 3 were significantly larger than those in groups 1 and 2. CONCLUSIONS: PRP injection may be effective in controlling median nerve injury, as demonstrated by improvement in electrophysiological and histological findings 12 weeks after dextrose injection.

Efficacy of microcurrent therapy in infants with congenital muscular torticollis involving the entire sternocleidomastoid muscle: a randomized placebo-controlled trial.

OBJECTIVE: To compare the effects of a combination of therapeutic exercise and ultrasound with or without additional microcurrent therapy in infants with congenital muscular torticollis involving the entire sternocleidomastoid muscle. DESIGN: Prospective, randomized, placebo-controlled trial. SETTING: An outpatient rehabilitation clinic in a tertiary university hospital. SUBJECTS: Infants (n = 20) with congenital muscular torticollis involving the entire sternocleidomastoid muscle. INTERVENTIONS: Group 1 comprised 10 infants who received therapeutic exercise with ultrasound alone and Group 2 comprised 10 infants who received the same treatment with microcurrent therapy. MAIN MEASURES: Passive cervical rotational range of motion was measured at before treatment and one, two, three, and six months after initial treatment. Thickness, cross-sectional area, and red pixel intensity on colour histograms, which were all assessed before treatment and at three months after initial treatment. Additionally, the duration of treatment was measured. RESULTS: The mean passive cervical rotational range of motion measured at three months posttreatment was significantly greater in Group 2 (101.1°) than that in Group 1 (86.4°), and the thickness, cross-sectional area, and red pixel intensity of the affected sternocleidomastoid muscle were all less in Group 2 (7.8 mm, 100.3 mm(2), and 126.1, respectively) than those in Group 1 (9.6 mm, 121.5 mm2, and 140.5, respectively). The mean duration of treatment was significantly shorter in Group 2 (2.6 months) than in Group 1 (6.3 months). CONCLUSIONS: Microcurrent therapy may increase the efficacy of therapeutic exercise with ultrasound for the treatment of congenital muscular torticollis involving the entire sternocleidomastoid muscle.

Clinical Impairments and Rotator Cuff Tendon Pathology in Primary and Intrinsic Secondary Adhesive Capsulitis.

OBJECTIVE: This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. DESIGN: This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. RESULTS: Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. CONCLUSIONS: There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology.

Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial.

OBJECTIVE: To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease. DESIGN: A single-centre, prospective, randomized, double-blinded, controlled study. SETTING: University rehabilitation hospital. PARTICIPANTS: Thirty-nine patients with a supraspinatus tendon lesion (tendinosis or a partial tear less than 1.0 cm, but not a complete tear) who met the inclusion criteria recruited between June 2010 and February 2011. INTERVENTION: Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance. MEASUREMENTS: The Shoulder Pain and Disability Index, passive range of motion of the shoulder, a physician global rating scale at the six-month follow-up, adverse effects monitoring and an ultrasound measurement were used as outcome measures. RESULTS: The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection (P < 0.05). At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group (P < 0.05). No severe adverse effects were observed in either group. CONCLUSIONS: Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease.

Differences in lateral ankle ligaments between affected and unaffected legs in children with spastic hemiplegic cerebral palsy.

OBJECTIVES: To investigate the architectural alterations of the lateral ankle ligaments in spastic hemiplegic cerebral palsy. METHODS: Eight children (5 male and 3 female; mean age ± SD, 5.2 ± 2.7 years) with spastic hemiplegic cerebral palsy were recruited. A modified Ashworth scale and passive ankle dorsiflexion angle were evaluated. Sonograms of the anterior talofibular ligament and calcaneofibular ligament were obtained to measure ligament thickness, and the anterior talofibular/calcaneofibular ligament thickness ratio was calculated. Two sonographic measurements were taken to check for intra-rater reliability. RESULTS: The interclass correlation coefficients of the repeated anterior talofibular ligament and calcaneofibular ligament thickness measurements in the unaffected/affected legs were 0.960/0.945 and 0.922/0.933, respectively. The anterior talofibular ligament thickness in the affected legs was significantly greater than that in the unaffected legs (2.50 ± 0.35 versus 1.40 ± 0.28 mm; P = .011), but the calcaneofibular ligament thickness in the affected legs was significantly less than that in the unaffected legs (0.80 ± 0.18 versus 1.28 ± 0.31 mm; P = .021). The anterior talofibular/calcaneofibular ligament thickness ratio in the affected legs was significantly greater than that in unaffected legs (2.10 ± 0.81 versus 1.03 ± 0.13; P = .012). The ratio was positively correlated with the modified Ashworth scale and age but negatively correlated with the passive ankle dorsiflexion angle in the affected legs. CONCLUSIONS: This study revealed an increased anterior talofibular ligament thickness and a decreased calcaneofibular ligament thickness in the affected legs compared with the unaffected legs. These architectural features of the lateral ankle ligaments may contribute to the equinovarus deformity of the ankle together with spastic leg muscles in children with spastic hemiplegic cerebral palsy.

Efficacy of Intra-articular Triamcinolone and Hyaluronic Acid in a Frozen Shoulder Rat Model.

BACKGROUND: Intra-articular corticosteroid or hyaluronic acid (HA) is commonly prescribed for frozen shoulder. However, few studies have investigated histological and molecular changes after injection. PURPOSE: To compare the effectiveness of intra-articular injections of triamcinolone and HA in a frozen shoulder rat model and verify a greater effect of triamcinolone in passive shoulder abduction compared with HA. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty male Sprague-Dawley rats were randomly allocated into 4 groups (n = 5 in each): control group, which did not receive cast immobilization or injection, and 3 experimental groups, which received 3 weeks of unilateral shoulder immobilization followed by intra-articular injections (normal saline, triamcinolone, or HA) at the immobilized shoulder. Passive shoulder abduction angle, histological and immunohistochemical staining, and Western blotting results were assessed 2 weeks after injection. The intensity and extent of staining were converted to semiquantitative scores for further analysis. RESULTS: Shoulder abduction angles before sacrifice were 153.0°± 2.7° (control group), 107.0°± 5.7° (saline group), 139.0°± 9.6° (triamcinoline group), and 110.0°± 10.6° (HA group), showing significant differences between control and saline groups, control and HA groups, saline and triamcinoline groups, and triamcinoline and HA groups (P < .001) but not between control and triamcinoline groups (P = .053). Histologic evaluation revealed an increase in synovial folds and thickening of the capsular membrane in the saline and HA groups; this change was not evident in the triamcinolone group. A comparison of semiquantitative scores revealed greater expression levels of proteins involved in fibrosis and angiogenesis in the saline and HA groups compared with the control and triamcinolone groups. In Western blotting, the expression of inflammatory cytokines and the receptor for advanced glycation end products was significantly lower in the triamcinolone and HA groups than in the saline group. CONCLUSION: Triamcinolone injection was more effective than normal saline or HA injection in improving range of motion and reversing fibrotic and angiogenic features of frozen shoulder. Both triamcinolone and HA injections elicited anti-inflammatory effects. CLINICAL RELEVANCE: The antifibrotic and antiangiogenic properties of triamcinolone and the anti-inflammatory properties of both triamcinolone and HA should be considered when performing injections in clinical settings.

Spastic cerebral palsy in children: dynamic sonoelastographic findings of medial gastrocnemius.

PURPOSE: To study the elastic properties of the medial gastrocnemius (GCM) in children with spastic cerebral palsy. MATERIALS AND METHODS: The study protocol was approved by the Research Ethics Committee of the hospital, and informed consent was obtained from each child's parent. Fifteen children with spastic cerebral palsy (group 1) and 13 children without neurologic and musculoskeletal disabilities (group 2) were included. Because group 1 included three children with hemiplegia, the total number of legs examined was 27. Children in group 2 had both legs examined, for a total of 26 legs studied. The modified Ashworth scale score of the ankle in group 1 was assessed by a physical therapist. A physiatrist performed ultrasonography and dynamic sonoelastography (DS) together, measured the thickness of the GCM, and calculated the GCM ratio in both groups. On color-scaled DS images, the DS score of the GCM was graded from DS 1 (purple to green: soft) to DS 4 (red: stiff), and the color histogram of the GCM was subsequently analyzed. Strain ratio and local shear wave velocity were calculated in the GCM and the soleus muscle by using acoustic radiation force impulse imaging. RESULTS: The GCM ratio in group 1 was significantly smaller than that in group 2. The DS score of GCM in group 1 was significantly higher than that in group 2. The median red pixel values were significantly higher, and the blue pixel values were significantly lower on color histogram in group 1 than those in group 2. The strain ratio in group 1 was significantly lower than that in group 2, and the local shear wave velocity of GCM in group 1 was higher than that in group 2. There were significant correlations between the modified Ashworth scale scores and DS parameters. CONCLUSION: DS demonstrated a difference in muscle stiffness in the GCM between children with spastic cerebral palsy and those without neurologic and musculoskeletal disabilities.

Sonoelastographic evaluation of medial gastrocnemius muscles intrinsic stiffness after rehabilitation therapy with botulinum toxin a injection in spastic cerebral palsy.

OBJECTIVE: To investigate intrinsic stiffness changes using real-time sonoelastography (RTS) in the medial gastrocnemius muscle (GCM) after rehabilitation therapy with botulinum toxin type A (BTA) injection in spastic cerebral palsy (CP). DESIGN: Prospective study using ultrasonography and RTS. SETTING: An inpatient rehabilitation clinic. PARTICIPANTS: Children (N=17) with spastic CP (mean age, 57±22y, age range, 26-110mo). INTERVENTION: Rehabilitation therapy and intramuscular injection of BTA in both medial and lateral GCMs. MAIN OUTCOME MEASURES: RTS was obtained on the medial GCM, and the elastic pattern of the medial GCM was graded from RTS 1 (purple to green: soft) to RTS 4 (red: stiff) on the basis of color-scaled RTS. RTS score, color histogram, Modified Ashworth Scale (MAS) score of the ankle plantar flexor muscles, and Gross Motor Function Measure (GMFM) score were obtained before intervention and 4 weeks after intervention. The correlations among RTS score, GMFM, and MAS score were determined. Intrarater reliability was also evaluated. RESULTS: Before and at 4 weeks after intervention, the mean RTS score decreased from 3.4 to 1.5 (P<.05), median red pixel intensity decreased from 112.5 to 101.3 (P<.05), median blue pixel intensity increased from 82.6 to 90.4 (P<.05), mean MAS score of the ankle decreased from 2.7 to 1.3 (P<.05), and mean GMFM score increased from 54.55% to 62.32%. Significant correlations were observed between the RTS score and the MAS score. Intrarater reliability was high. CONCLUSIONS: Our results suggest that more information about the change of spastic muscle in CP after rehabilitation treatment with BTA may be gained by estimating muscle stiffness using RTS combined with clinical scale measurements.

Diagnostic value of real-time sonoelastography in congenital muscular torticollis.

OBJECTIVES: The purpose of this study was to evaluate the possible use of real-time sonoelastography in infants with congenital muscular torticollis for predicting treatment outcomes. METHODS: The study included 20 infants with a sternocleidomastoid muscle thickness of greater than 10 mm, a sonoelastographic score of 4, and involvement of the entire length of the muscle (group 1) and 30 infants with a sternocleidomastoid muscle thickness of less than 10 mm, a sonoelastographic score of 3, and involvement of only part of the muscle (group 2). A physiatrist performed B-mode sonography and sonoelastography together, measured the thickness of the sternocleidomastoid muscle, and calculated the cross-sectional area of the involved muscle in both groups. On color scale sonoelastography, the sonoelastographic score of the sternocleidomastoid muscle was graded from 1 (purple to green: soft) to 4 (red: stiff), and the color histogram of the muscle was subsequently analyzed. RESULTS: The thickness and cross-sectional area of the sternocleidomastoid muscles in group 1 were significantly greater than those in group 2 (P = .001). On the color histograms, the median red pixel values in group 1 were significantly greater than those in group 2 (P = .001). In group 1, the mass in the affected muscle completely disappeared in 16 infants (80%), and a residual mass was detected in 4 (20%) on B-mode sonography at the final outcome. However, in group 2, the mass in the affected sternocleidomastoid muscle completely disappeared in all of the infants. CONCLUSIONS: These findings suggest that real-time sonoelastography, although an ancillary technique to conventional sonography, may predict treatment outcomes of congenital muscular torticollis.

The effects of treatment using polydeoxyribonucleotide through extracorporeal shock wave therapy: synergic regeneration effects on atrophied calf muscles in immobilized rabbits.

Background: This study aimed to examine the synergic effects of polydeoxyribonucleotide (PDRN) through extracorporeal shock wave therapy (ESWT) on atrophied calf muscles in cast-immobilized rabbit models. Methods: Twenty male New Zealand rabbits (aged 12 weeks) were allocated into four groups. Four types of procedures [0.7 mL normal saline to Group 1 (G1-NS); 0.7 mL PDRN to Group 2 (G2-PDRN); ESWT to Group 3 (G3-ESWT); and 0.7 mL PDRN with ESWT to Group 4 (G4-PDRN + ESWT)] were injected to the atrophied calf muscles of the rabbits after two weeks of cast immobilization. Radial ESWT (0.1 mJ/mm2, 3 Hz, 1,500 shocks) was performed twice weekly. The circumference of the calves, compound muscle action potential (CMAP) of the tibial nerves, and thickness of the gastrocnemius (GCM) muscle were evaluated after two weeks of treatment. Type I and II GCM muscle fibers were immunohistochemically stained using monoclonal anti-myosin, anti-VEGF (vascular endothelial growth factor), and anti-PECAM-1 (platelet endothelial cell adhesion molecule-1) antibodies, and the cross-sectional area (CSA), VEGF ratio, and PECAM ratio were measured after 2 weeks of treatment. Statistical differences among the four groups were determined using analysis of variance (ANOVA). Results: The G4-PDRN + ESWT group had a significantly greater circumference of calf muscles, thickness of the GCM muscle, CMAP of the tibial nerve, and CSA of the GCM muscle fibers (type I, II, and total) (hereinafter termed "the four categories") than those in the remaining three groups (P<0.05). Rabbits in the G3-ESWT group had significantly higher results in the four categories than in G1-NS and G2-PDRN groups (P<0.05). G2-PDRN rabbits had significantly higher results in the four categories than those in G1-NS (P<0.05). The VEGF and PECAM-1 ratio of the medial GCM muscle fibers in G4-PDRN + ESWT were significantly higher than those in the remaining three groups (P<0.05). Conclusions: ESWT combined with PDRN injection was more effective in muscle regeneration than ESWT, PDRN injection alone, or normal saline injection on atrophied calf muscles in rabbit models.

Clinical, Radiographic, and Ultrasound Findings Between Simple and Complicated Baker's Cysts.

PURPOSE: The aim of the study was to compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker's cysts. METHODS: Forty-seven knees with Baker's cysts in 45 patients with knee pain were identified from a chart review. Baker's cysts were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analog scale score, Kellgren-Lawrence grade, ultrasound findings, including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared. RESULTS: There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated Baker's cysts (5.7 ± 3.0 mm) was significantly greater than that in simple Baker's cysts (3.8 ± 3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated Baker's cysts (22 knees, 88.0%) than in the simple Baker's cysts (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC. CONCLUSIONS: Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC.

Effects of intra-articular pulsed radiofrequency current administration on a rabbit model of rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial proliferation and inflammation. Intra-articular corticosteroid injections are commonly used for the treatment of arthritis affecting one or two joints. Although corticosteroid injections are fast-acting, repeated usage can result in severe adverse events. Recently, intra-articular pulsed radiofrequency (PRF) stimulation has been proposed to treat arthritis. The aim of the present study was to compare the effectiveness of intra-articular PRF with corticosteroid injection based on histopathological and motion analysis of an ovalbumin (OVA)-induced RA rabbit model. RA was induced in the right knee joint of 18 rabbits via OVA injection. The rabbits were randomly allocated into a PRF, an intra-articular corticosteroid injection or a sham PRF stimulation group. Movement was assessed in the rabbits before treatment, then at 2, 4 and 8 weeks after treatment using walking distance, fast walking time and mean walking speed. Histopathological evaluation of the distal femur and synovium was conducted 2, 4 and 8 weeks after treatment. Motion analysis demonstrated that changes in all movement variables showed significant group and time interaction as well as group effect among the three groups. The semiquantitative score based on the histopathological findings for the distal femoral condyle decreased 2 and 4 weeks after both the PRF and steroid groups, compared with the sham PRF group. Moreover, in the synovium, the semiquantitative histological score in the PRF and steroid groups tended to be lower compared with the sham PRF group, although this result was not statistically significant. Thus, intra-articular PRF stimulation may delay cartilage destruction and improve functional motion in RA.

Airway invasion in non-neurologically ill patients with dysphagia: Contributing factors and associated problems during swallowing process. A retrospective observational study.

Dysphagia can occur among patients receiving medical care despite having no history of neurologic disease. The current study aimed to investigate factors contributing to airway invasion among non-neurologically ill patients with dysphagia.This retrospective study included 52 non-neurologically ill patients who complained of swallowing difficulty and consulted the Department of Rehabilitation Medicine for videofluoroscopic swallowing studies between January 2018 and June 2019. Patients were then divided into 2 groups according to the presence of airway invasion (penetration or aspiration) based on videofluoroscopic swallowing study findings, with group 1 (n = 26) consisting of patients with airway invasion and group 2 (n = 26) consisting of those without airway invasion. Demographic information, functional ambulation ability within the past 3 months, presence of community acquired pneumonia (CAP), nutritional status, degree of dehydration, history of intensive care unit stay, history of endotracheal intubation, and videofluoroscopic dysphagia scale were reviewed.Patients with airway invasion exhibited decreased functional ambulation ability, greater incidence of CAP, and lower serum albumin concentration than patients without airway invasion (P < .05). Airway invasion among non-neurologically ill patients was significantly associated with functional ambulation ability [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.14-11.19; P = .03], serum albumin concentration under 3.5 g/dL (OR, 4.90; 95% CI, 1.39-17.32; P = .01), and presence of CAP (OR, 5.06; 95% CI, 1.56-16.44; P = .01). Groups 1 and 2 had a videofluoroscopic dysphagia scale score of 37.18 and 16.17, respectively (P < .05). Moreover, bolus formation, tongue-to-palate contact, premature bolus loss, vallecular residue, coating of pharyngeal wall, and aspiration score differed significantly between both groups (P < .05).Airway invasion among non-neurologically ill patients was related to decreased functional ambulation ability, lower serum albumin concentration, and presence of CAP. The results presented herein can help guide clinical management aimed at preventing airway invasion among non-neurologically ill patients.