Can Repeated Ponseti Management for Relapsed Clubfeet Produce the Outcome Comparable With the Case Without Relapse? A Clinical Study in Term of Gait Analysis.

BACKGROUND: The prevention and treatment of relapsed clubfoot remained challenging tasks. There were controversies as to treatment options and management, such as complete subtalar release, application of an Ilizarov external frame, or repeated Ponseti method; and different options were available in different treatment centers. This study was designed to evaluate the clinical outcome of relapsed clubfeet treated by repeated Ponseti method in comparison with the cases without relapse in term of gait analysis and to clarify the clinical efficacy of repeated Ponseti method in treating the relapsed clubfeet. METHODS: Thirty-seven patients (53 feet) were retrospectively identified from our database according to the inclusion and exclusion criteria. Among the 37 patients, 17 cases (25 relapsed clubfeet) were assigned to group I, whereas 20 cases (28 clubfeet without relapse) were assigned to group II. Clinical examination, gait analysis, and kinematic gait deviation criteria from Texas Scottish Rite Hospital for Children were used for evaluation. RESULTS: There was statistically significant difference in the parameters of foot length, stride length, and single limb support time (%gait cycle) between the 2 groups (P<0.05). No statistically significant difference was found in the kinematic parameters of total hip, knee, and ankle excursion, peak knee and ankle flexion and extension, and internal foot progression (P>0.05). There was no statistically significant difference in peak hip, knee, and ankle flexion moment, peak knee valgus moment, and peak ankle power (P>0.05). No statistically significant difference was found in equinus and calcaneus gait, increased ankle dorsiflexion, foot drop, and internal foot progression angle (P>0.05). CONCLUSIONS: Repeated Ponseti method for relapsed clubfeet can yield good or excellent clinical results. We recommend repeated Ponseti method as the treatment choice for relapsed clubfeet in the early stage. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

[Features of different contemporary acupuncture and moxibustion schools in the treatment of post-stroke spastic paralysis].

Acupuncture and moxibustion has certain advantages in the treatment of post-stroke spastic paralysis，but the treatment methods and diagnosis and treatment ideas are complicated. This paper sortes out the representative contemporary acupuncture and moxibustion schools in the treatment of post-stroke spastic paralysis, analyzes their academic origins，summarizes and compares the theory，acupoint selection and technique characteristics of different schools in the diagnosis and treatment of this disease，so as to provide some references for guiding optimal treatment schemes selection in clinic.

[Effects of tuina on the mechanical properties of skeletal muscles of four limbs in patients with chronic fatigue syndrome].

OBJECTIVE: To study the effects of tuina on the mechanical properties of skeletal muscles of four limbs in patients with chronic fatigue syndrome (CFS). METHODS: Thirty CFS patients were recruited as the test group, while another 30 healthy volunteers were recruited as the healthy control group. Patients in the test group received tuina therapy, 30 min each time, once every other day, for totally 10 times. Isokinetic testing technology was used to compare peak torque (PT), total watt (TW), average power (AP), and flexor/extensor (F/E) ratio in the elbow and knee muscles of CFS patients before and after treatment. The Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale was used to evaluate the fatigue degree before and after treatment, and compared with the healthy control group. RESULTS: After treatment the FACIT fatigue scale score decreased significantly in the test group when compared with before treatment (27.5 +/- 9.1 vs 42.5 +/- 11.2), showing statistical difference (P < 0.05). The pre-treatment PT, TW, AP, and F/E ratio in the skeletal muscle were all lower in the test group than in the healthy control group. Compared with before treatment in the test group, patients' elbow 60 degrees/s angular velocity values during exercise extensor PT and TW, knee 60 degrees/s and 180 degrees/s angular velocity values during exercise flexor PT and TW increased significantly; elbow extensor and knee extensor, flexor AP was significantly elevated; knee in 180 degrees/s angular velocity of movement F/E ratio significantly increased, and all the differences were statistically significant (P < 0.05). The improvement of the fatigue degree in CFS patients and elbow in 60 degrees/s angular velocity values under the flexor and extensor TW, and flexor AP value of the degree of improvement were negatively correlated (r = -0.282, -0.482, -0.285, P < 0.05, P < 0.01). Meanwhile, the muscles with the knee in 180 degrees/s angular velocity was negatively correlated with the F/E ratio of the degree of improvement (r = -0. 330, P < 0.05). CONCLUSIONS: CFS patients have lowered mechanical properties of four limbs. Tuina therapy can improve the biomechanical properties of limb skeletal muscle and reduce the overall degree of fatigue in patients. The changes of limb skeletal muscle and mechanical properties can provide objective reference for the clinical diagnosis and assessment of CFS.

Copper-Catalyzed Selective Oxidative Cross-Coupling of Tryptophols and Tryptamines To Access Heterocyclic 3a,3a'-Bisindolines.

The first example of cyclization cross-coupling of tryptophols and tryptamines has been realized by copper catalysis with air or oxone as the terminal oxidant, resulting in the direct construction of a new class of heterocyclic 3a,3a'-bisindolines in moderate to good yields with high chemoselectivities. A series of mechanistic control experiments were also conducted, indicating that the copper catalyst selectively coordinates with the nitrogen moiety of the tryptamine to initiate the oxidation, and a nucleophilic-alkylation process is proposed for the carbon-carbon bond-forming in the reaction. The novel synthetic strategies and molecular skeletons outlined in this work provide new ideas and concepts for the design of other useful reaction and potential drugs.

[A study of median frequencies of skeletal muscle undergoing Tuina intervention in patients with chronic fatigue syndrome].

OBJECTIVE: To study the changes in median frequency (MF) from a surface electromyogram of skeletal muscles and functional assessment of chronic illness therapy (FACIT) figure scale scores for patients with chronic fatigue syndrome (CFS) before and after Tuina treatment. METHODS: A controlled clinical trial was adopted. Thirty-two patients suffering from CFS were enrolled according to the inclusion criteria from outpatient department of Shanghai Yueyang Hospital of Integrated Chinese and Western Medicine in China; thirty normal people whose gender, age, height and body mass were concordant with the CFS patients were selected as the normal group. Surface electromyography was used to detect the median frequency (MF) of biceps, quadriceps, and waist and back muscle before and after a 20-day course of treatment. CFS patients also were asked to fill out the figure scale of FACIT to evaluate the degree of fatigue. RESULTS: There was no significant difference in surface electromyography MF of myoelectric signal of biceps and quadriceps between CFS and normal person; however, the waist and back muscle MF of the normal person was significantly lower than that of the CFS patients. Before and after treatment, there were no obvious changes in the MF of myoelectric signals of all muscles. Tuina significantly decreased the scale score of FACIT. CONCLUSION: Tuina can improve the symptom of patients with CFS.

[Therapeutic effect on post-stroke spastic paralysis of upper extremity treated with combination of kinematic-acupuncture therapy and rehabilitation training].

OBJECTIVE: To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training. METHODS: A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group (30 cases) and a control group (30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui (GV 20), Dazhui (GV 14), Jiaji (EX-B 2) from T1 to T8, Tianzong (SI 11), Jianzhen (SI 9), Jianyu (LI 15) and Quyuan (SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity (FMA-UE), the grade of the modified Ashworth scale (MAS) and the score of the modified Barthel index scale (MBI) were compared between the two groups. RESULTS: Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group (P<0.01). In 14 days of treatment, FMA-UE score in the observation group was higher than that in the control group (P<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups (P<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups (P<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment (P<0.05). Compared with the score before treatment, MBI score was increased in 7 and 14 days of treatment respectively in the observation group (P<0.05, P<0.01). In 14 days of treatment, MBI score was increased in the control group (P<0.01). CONCLUSION: For the patients with post-stroke spastic paralysis of the upper extremity at the non-acute stage, the combined treatment with kinematic-acupuncture therapy and rehabilitation training obviously improves the motor function of the upper extremity and the muscle tone of elbow joint and metacarpophalangeal joint. The therapeutic effect of this combination is better than that of the combined treatment of the conventional acupuncture with rehabilitation training. Additionally, this combined therapy improves the ability of daily life activity.

Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis.

BACKGROUND: Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients. METHODS: From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores. RESULTS: Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation. CONCLUSIONS: LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.

Functional Assessment of the Foot Undergoing Percutaneous Achilles Tenotomy in Term of Gait Analysis.

Background. This study was designed to evaluate the function of the foot undergoing the procedure of percutaneous Achilles tenotomy (PAT) in case of clubfoot management in terms of gait analysis. Methods. Nineteen patients with unilateral clubfeet were retrospectively reviewed from our database from July 2012 to June 2016. The result in all the cases was rated as excellent according to the scale of International Clubfoot Study Group (ICSG). The affected sides were taken as Group CF and the contralateral sides as Group CL. Three-dimensional gait analysis was applied for the functional evaluation of the involved foot. Results. Statistical difference was found in physical parameters of passive ankle dorsiflexion and plantar-flexion. No statistical difference was found in temporal-spatial parameters. There was statistical difference in kinematic parameters of total ankle rotation, ankle range of motion, and internal foot progression angle and in kinetic parameters of peak ankle power. No statistical difference was found in other kinematic and kinetic parameters. Conclusions. It is demonstrated that the procedure of PAT is safe and efficient for correcting the equinus deformity in case of clubfoot management and preserving the main function of Achilles tendon at the minimum of four-year follow-up.

[Effects of manipulation on mechanical properties of cervical and degree of fatigue in patients with cervical spondylosis].

OBJECTIVE: To explore the mechanism of manipulation in treating cervical spondylosis. METHODS: From August 2008 to December 2009, 65 patients with cervical spondylosis were randomly divided into manipulation group and traction group. There were 32 patients in manipulation group, of which 30 cases obtained followed-up, including 10 males and 20 females, ranging in age from 30 to 65 years,with an average of (42.31 +/- 13.23) years; the mean course of diseases was (12.40 +/- 6.23) months, and the average weight was (61.21 +/- 10.23) kg. In traction group, there were 33 patients, 30 cases obtained follow-up, including 11 males and 19 males, ranging in age from 30 to 65 years, with an average of (45.54 +/- 14.35) years; the mean course of diseases was (13.25 +/- 6.06) months and average weight was (62.31 +/- 10.45) kg. Biodex III Isokinetic Testing System and TeleMyo 2400 T Surface EMG was applied to test the mechanical properties and fatigue of neck muscles before and after treatment. RESULTS: The mechanical properties of neck muscles: measuring in the 60 degrees/s and 120 degrees/s angular velocity, there were no significant difference (P > 0.05) in peak torque (PT), average power (AP), peak torque of flexor/extensor peak torque ratio (F/E) before treatment, while manipulation group was improved more than traction group in PT, AP, F/E after treatment (P < 0.05), and there was significant difference (P < 0.05). For the degree of fatigue: there was no significant difference (P > 0.05) in IEMG, MPF compared by two groups before treatment, but the manipulation group was improved more than the traction group in IEMG, MPF after treatment (P < 0.05), and there was significant difference (P < 0.05) on the right side. CONCLUSION: Manipulation can improve contraction forces and work efficiency of neck muscle, coordination ability of flexors and extensors muscles, efficiency of neck muscle, and recover mechanical properties and can alleviate fatigue of neck muscles in patients with cervical spondylosis.