Elbow Myositis Ossificans: Radiographic Evolution with Histologic Correlation

No abstract available

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Ultrasound-guided 5-in-1 injection: trigger point injections and nerve hydrodissections for non-specific upper back pain

No abstract available

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Microdialysis to quantify inflammatory cytokines in the glenohumeral joint: A brief methods report.

Microdialysis quantifies in vivo soft-tissue biochemical concentrations via passive diffusion of interstitial molecules through a porous membrane into a dialysate. The purpose of this pilot study was to evaluate a technique to measure inflammatory cytokines associated with rotator cuff tendinopathy by inserting a microdialysis catheter into the posterior glenohumeral joint (GHJ). The technique was tested in a convenience sample of six pain-free, able-bodied Veterans. Complete dialysate samples were collected in two participants. Two participants' sample volumes were smaller than what was required for analysis (30μL) and thus were diluted. Catheter failures in two participants prevented collection altogether. Three cytokine concentrations were quantified: interleukin-1 receptor antagonist (IL-1RA), IL-8, and Regulated on Activation, Normal T-cell Expressed and Secreted (RANTES). Microdialysis is not recommended for use in the GHJ, yet quantification of GHJ cytokines could yield valuable information to better understand pathophysiology of the joint and its surrounding tissues. Another technique, such as joint lavage, may be a more attractive alternative to overcome the limitations of microdialysis in the GHJ. Address all correspondences to: Nathan S Hogaboom, PhD, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Phone: 973-243-6876. E-mail: nhogaboom@kesslerfoundation.org This material is the result of work supported with resources and the use of facilities at the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System. This project used the UPCI Cancer Biomarkers Facility: Luminex Core Laboratory that is supported in part by award P30CA047904. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship (Grant #1247842) and IGERT Fellowship (DGE 1144584). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of the National Science Foundation. The contents of this paper do not represent the views of the Department of Veterans Affairs or the United States Government. Aside from the aforementioned grants, the authors report no conflicts of interest. Part of these data was presented at the 2018 Meeting of the American Congress of Rehabilitation Medicine. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intractable Central Pain in a Patient with Diffuse Glioma: Case Report

Central neuropathic pain can be difficult to treat and, subsequently, cause a great amount of disability and distress to patients, which limits quality of life. Common etiologies include: stroke, spinal cord injury, multiple sclerosis, infection, vasculitis, and malignancy. This case is a description of an 18-year-old male patient diagnosed with a grade IV diffuse glioma who experienced severe neuropathic pain refractory to first-line treatment options including: gabapentinoids, tricyclic antidepressants, and selective serotonin and norepinephrine reuptake inhibitors. The patient remained on high-dose oral gabapentin as well as methadone and high-dose oxycodone for pain control at the time of submission. The purpose of this case report is to review the nociceptive pathways as well as explore the role of opioids in central neuropathic pain secondary to neoplasm as a better understanding of these topics can aid in physiatrists better taking care of these patients and improving function and quality of life. Corresponding Author Details: 1Nicholas Aaron Horan, 1100 Blythe Blvd, Charlotte, NC 28203, Ph: 704-355-6050, Fax: 704-355-0709. nicholas.horan@atriumhealth.org Author Disclosures: No competing interests or sources of funding were provided for this case report. No financial benefits were present for the authors. This case has not been presented or published in any form. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Complement component 4 variations may influence psychopathology risk in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Abstract

CYP21A2 defects result in congenital adrenal hyperplasia (CAH), an autosomal recessive disorder characterized by impaired adrenal steroidogenesis. CYP21A2 lies within the major histocompatibility complex in an area of the genome highly susceptible to genetic variation. Alterations in the neighboring complement component 4 isotypes C4A and C4B have been associated with psychiatric and autoimmune disease. The purpose of this study was to evaluate C4A and C4B in patients with CAH in relation to CYP21A2 genotype and psychiatric and autoimmune comorbidity. We determined the copy numbers of C4A and C4B in 145 patients with CAH (median age: 15.5 years, IQR: 16.8) and 108 carrier relatives (median age: 41.5 years, IQR: 12.0) and evaluated serum C4 concentrations. Comorbidity was determined by medical record review. Only 30% of subjects had the expected two copies each of the two C4 genes. C4B copy number determined total C4 copy number and serum C4 concentration, negatively correlated with carriership of a 30-kb deletion (P < 10^− 5), and positively correlated with carriership of p.V281L (P < 10^− 5). High C4A copy number (≥ 3) was associated with increased risk of having an externalizing psychiatric condition (relative risk: 2.67, 95% CI: 1.03–6.89, P = 0.04). No association was found between C4 copy number and autoimmune disease. Mutation-specific C4 structural variations commonly occur in patients with CAH and may have important clinical consequences, including increased risk of psychiatric morbidity.

Trial registration NCT00250159 (November 7, 2005).

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Honey bee workers generate low-frequency vibrations that are reliable indicators of their activity level

Abstract

In social insects, the tuning of activity levels among different worker task groups, which constitutes a fundamental basis of colony organization, relies on the exchange of reliable information on the activity level of individuals. The underlying stimuli, however, have remained largely unexplored so far. In the present study, we describe low-frequency thoracic vibrations generated by honey bee workers (Apis mellifera) within the colony, whose velocity amplitudes and main frequency components significantly increased with the level of an individual's activity. The characteristics of these vibrations segregated three main activity level-groups: foragers, active hive bees, and inactive hive bees. Nectar foragers, moreover, modulated their low-frequency vibrations during trophallactic food unloading to nestmates according to the quality of the collected food. Owing to their clear association with the activity level of an individual and their potential perceptibility during direct contacts, these low-frequency thoracic vibrations are candidate stimuli for providing unambiguous local information on the motivational status of honey bee workers.

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Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time mean (SD) were 73.0 (14.8) and 86.6 (5.7) min (P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P 

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