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OBJECTIVE: Aortic regurgitation, conduction disturbances, increased myocardial fibrosis and pericarditis could be seen in ankylosing spondylitis (AS). However, less attention has been paid to supraventricular arrhythmias (SVA) and atrial conduction system changes. We aimed to assess SVA and conduction system changes in patients with AS. PATIENTS AND METHODS: Twenty-eight patients (24 men; mean age, 28.7 ± 5.7 years) with AS and 30 healthy volunteers (26 men; mean age, 29.3 ± 5.8 years) were enrolled. All subjects were evaluated by 24-hour ambulatory electrocardiogram, 12 lead standard electrocardiogram (ECG) for P wave dispersion (Pd), and signal-averaged ECG (SAECG) for P wave duration (SAPWD). RESULTS: SVAs were detected in 9 patients with AS (32%) and 3 controls (10%; p = 0.02). Mean SAPWD (115.7 ± 28.6 ms vs. 100.2 ± 18.7 ms, p = 0.017) and mean Pd (11.9 ± 4.8 ms vs. 9.3±3.6 ms, 0.023) was longer in patients with AS than the control group. When patient with AS were divided into 2 subgroups as patients with or without SVA, the Pd (16.2 ± 5.0 vs. 9.9 ± 3.2, p = 0.001), SAPWD (151.4 ± 7.8 vs. 98.7 ± 16.1, p = 0.001) and Bath ankylosing spondylitis disease activity index (BASDAI) (5.1 ± 1.6 vs. 3.7 ± 1.0, p = 0.014) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. There was a strong positive correlation between BASDAI and SAPWD (r = 0.622, p = 0.001). There was also a moderate positive correlation between BASDAI and Pd (r = 0.479, p = 0.01). CONCLUSIONS: SVA were detected more frequently in AS than control group. SAPWD and Pd were prolonged in patients with AS. Clinical severity assessed with BASDAI had a positive correlation with prolongation of SAPWD and Pd. [ABSTRACT FROM AUTHOR]

This study is based on thermal performance analysis and evaluation of the National Observatory guesthouse with the software SUNCODE-PC. The study is unique owing to its high-altitude site (2465 m) in a remote area, harsh climate (with almost no data available), and functional restrictions of astronomical facilities. The design is thermally evaluated through different modes of application of insulation, materials, types of glazing, window/wall ratios, Trombe walls, winter night insulation, summer ventilation and shading. [Copyright &y& Elsevier]

Objective: Efficacy of tender point [TeP] injections in fibromyalgia syndrome [FMS] has not been well described in the literature. The goal of our study was to determine the extent of benefit from such injections in this syndrome in the usual clinical practice setting.Methods: Tender points at most symptomatic sites of forty-one patients with FMS, 40 females and one male, were injected with a mixture of 1/2 ml 1% lidocaine and 1/4 ml intralesional triamcinolone diacetate suspension, and prospectively followed for a mean period of 66 [range 14-240] weeks. All patients were asked to maintain a diary to record the duration of pain relief from injections. They continued their usual therapies.Results: On an average, 3.97 injections per visit were performed. Mean duration of pain relief per injection site was 13.1 +/- 9.4 weeks, excluding a single outlier patient. Only one patient failed to obtain any relief at any injected site. There were no side-effects with the exception of a brief postinjection flare in one patient. No demographic or clinical variables at initial consultation were associated with duration of pain relief, with the exception of anxiety and depression scores, which were negatively correlated [P < 0.001].Conclusion: Our prospective but open study demonstrates that TeP injections are a useful and safe adjunct to other forms of therapy in FMS. However, further studies in the future are indicated. [ABSTRACT FROM AUTHOR]

Increased neopterin concentrations and altered tryptophan degradation are observed in diseases concomitant with cellular immune activation. This may be involved in the pathogenesis of several age-related disorders such as neurodegenerative disorders, autoimmune diseases, cardiovascular system disorders and malignancies. Therefore, in the present study, the evaluation of immune system activation by determination of tryptophan degradation and serum neopterin levels was carried out in volunteers aged ≥65 and 0.05). Effects of gender, smoking habit, pathology and drug use on measured parameters were also evaluated. In conclusion, our findings show that aging is associated with immune activation, and immune activation may be induced by the number of existing pathologies as well as the number of drugs used.

The profiles of unconjugated pteridines such as neopterin and biopterin and of tryptophan metabolism change in many pathologic conditions such as rheumatoid arthritis, malignancies and autoimmune diseases and are related to the release of pro-inflammatory cytokines. However, studies on potential effects of drugs are very limited. This study investigates whether meloxicam, a non-steroidal anti-inflammatory drug, may cause any alteration of the pteridine pathway and tryptophan metabolism in 22 patients who admitted to the Physical and Rehabilitation Medicine outpatient clinic in the Hacettepe University Hospital and suffering from various musculoskeletal pain conditions without systemic inflammation. Urine concentrations of neopterin, biopterin and xanthopterin, and serum concentrations of neopterin, tryptophan, and kynurenine, and the activity of dihydropteridine reductase were measured at the beginning of the therapy and after a 15 days treatment with meloxicam. Average urine concentrations (± S.E.M.) of pterins before therapy (neopterin: 263 ± 15.6 μmol/mol creatinine, biopterin: 72.4 ± 13.4 μmol/mol creatinine, and xanthopterin: 675 ± 93.0 μmol/mol creatinine) were not changed during meloxicam therapy (neopterin: 230 ± 30.7 μmol/mol creatinine = 88% of baseline, biopterin 115 ± 26.5 μmol /mol creatinine = 159% of baseline, and xanthopterin 684 ± 88.0 μmol/mol creatinine = 101% of baseline; all differences not significant). The activity of dihydropteridine reductase was 6.02 ± 0.21 nmol/cytochrome C reduced/min/5 mm disc before and 6.28 ± 0.18 nmol/cytochrome C reduced/min/5 mm after treatment (= 104% of baseline; p = 0.088). Serum concentrations of neopterin 6.04 ± 0.33 nmol/L before treatment increased to 6.89 ± 0.48 nmol/L after treatment (= 114% of baseline; p

Objectives: This study analyzes the stimulation parameters implemented during two successful trials that used non-invasive transcutaneous spinal cord stimulation (tSCS) to effectively improve upper extremity function after chronic spinal cord injury (SCI). It proposes a framework to guide stimulation programming decisions for the successful translation of these techniques into the clinic., Materials and Methods: Programming data from 60 participants who completed the Up-LIFT trial and from 17 participants who subsequently completed the LIFT Home trial were analyzed. All observations of stimulation amplitudes, frequencies, waveforms, and electrode configurations were examined. The incidence of adverse events and relatedness to stimulation parameters is reported. A comparison of parameter usage across the American Spinal Injury Association Impairment Scale (AIS) subgroups was conducted to evaluate stimulation strategies across participants with varying degrees of sensorimotor preservation., Results: Active (cathodal) electrodes were typically placed between the C3/C4 and C6/C7 spinous processes. Most sessions featured return (anodal) electrodes positioned bilaterally over the anterior superior iliac spine, although clavicular placement was frequently used by 12 participants. Stimulation was delivered with a 10-kHz carrier frequency and typically a 30-Hz burst frequency. Biphasic waveforms were used in 83% of sessions. Average stimulation amplitudes were higher for biphasic waveforms. The AIS B subgroup required significantly higher amplitudes than did the AIS C and D subgroups. Device-related adverse events were infrequent, and not correlated with specific waveforms or amplitudes. Within the home setting, participants maintained their current amplitudes within 1% of the preset values. The suggested stimulation programming framework dictates the following hierarchical order of parameter adjustments: current amplitude, waveform type, active/return electrode positioning, and burst frequency, guided by clinical observations as required., Conclusions: This analysis summarizes effective stimulation parameters from the trials and provides a decision-making framework for clinical implementation of tSCS for upper extremity functional restoration after SCI. The parameters are aligned with existing literature and proved safe and well tolerated by participants., Competing Interests: Conflict of Interest Kristen Gelenitis, Jared Pradarelli, Jenny Suggitt, Amanda Turner, and Markus Rieger are employees of ONWARD Medical. Andrea Santamaria, Jessica M D’Amico, Edelle Field-Fote, and Chet Moritz are paid consultants of ONWARD Medical. The remaining authors reported no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study investigated the effect of cervical and lumbar transcutaneous spinal cord stimulation (tSCS) combined with intensive training to improve walking and autonomic function after chronic spinal cord injury (SCI)., Methods: Two 64-year-old men with chronic motor incomplete cervical SCI participated in this single-subject design study. They each underwent 2 months of intensive locomotor training and 2 months of multisite cervical and lumbosacral tSCS paired with intensive locomotor training., Results: The improvement in 6-Minute Walk Test distance after 2 months of tSCS with intensive training was threefold greater than after locomotor training alone. Both participants improved balance ability measured by the Berg Balance Scale and increased their ability to engage in daily home exercises. Gait analysis demonstrated increased step length for each individual. Both participants experienced improved sensation and bowel function, and 1 participant eliminated the need for intermittent catheterization after the stimulation phase of the study., Conclusion: These results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI., Impact: Multisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Paralysis of the upper extremity severely restricts independence and quality of life after spinal cord injury. Regaining control of hand and arm movements is the highest treatment priority for people with paralysis, 6-fold higher than restoring walking ability. Nevertheless, current approaches to improve upper extremity function typically do not restore independence. Spinal cord stimulation is an emerging neuromodulation strategy to restore motor function. Recent studies using surgically implanted electrodes demonstrate impressive improvements in voluntary control of standing and stepping. Here we show that transcutaneous electrical stimulation of the spinal cord leads to rapid and sustained recovery of hand and arm function, even after complete paralysis. Notably, the magnitude of these improvements matched or exceeded previously reported results from surgically implanted stimulation. Additionally, muscle spasticity was reduced and autonomic functions including heart rate, thermoregulation, and bladder function improved. Perhaps most striking is that all six participants maintained their gains for at least three to six months beyond stimulation, indicating functional recovery mediated by long-term neuroplasticity. Several participants resumed their hobbies that require fine motor control, such as playing the guitar and oil painting, for the first time in up to 12 years since their injuries. Our findings demonstrate that non-invasive transcutaneous electrical stimulation of the spinal networks restores movement and function of the hands and arm for people with both complete paralysis and long-term spinal cord injury.

Upper extremity function is the highest priority of tetraplegics for improving quality of life. We aim to determine the therapeutic potential of transcutaneous electrical spinal cord stimulation for restoration of upper extremity function. We tested the hypothesis that cervical stimulation can facilitate neuroplasticity that results in long-lasting improvement in motor control. A 62-year-old male with C3, incomplete, chronic spinal cord injury (SCI) participated in the study. The intervention comprised three alternating periods: 1) transcutaneous spinal stimulation combined with physical therapy (PT); 2) identical PT only; and 3) a brief combination of stimulation and PT once again. Following four weeks of combined stimulation and physical therapy training, all of the following outcome measurements improved: the Graded Redefined Assessment of Strength, Sensation, and Prehension test score increased 52 points and upper extremity motor score improved 10 points. Pinch strength increased 2- to 7-fold in left and right hands, respectively. Sensation recovered on trunk dermatomes, and overall neurologic level of injury improved from C3 to C4. Most notably, functional gains persisted for over 3 month follow-up without further treatment. These data suggest that noninvasive electrical stimulation of spinal networks can promote neuroplasticity and long-term recovery following SCI.

Background and Objective: Gait impairment, falls due to balance problems and fatigue are among the most important complaints in patients with multiple sclerosis (MS) and cause significant functional limitation. Use of complementary and alternative medicine (CAM) to help symptom management and to improve quality of life is growing among MS patients. Yoga is widely used as one of these CAM interventions, however, the number of studies that show the efficacy of yoga training in MS is inadequate. In this study, we aimed to evaluate the effects of a short term yoga program on fatigue, balance and gait in patients with MS., Method: Eight volunteer ambulatory MS patients with clinically definite relapsing remitting MS whose Expanded Disability Status Score (EDSS) is less than or equal to 6.0, and eight healthy subjects were included in the study. Patients participated in 12 weeks of a bi-weekly yoga program under supervision. At their baseline and after yoga therapy, the Fatigue Severity Scale (FSS) and Berg Balance Scale (BBS) are used to assess fatigue and balance. Three dimensional gait analysis is done using the Vicon 612 system with six cameras and two Bertec force plates, before and after therapy., Results: After short term yoga therapy, statistically significant achievements were obtained in fatigue, balance, step length and walking speed. Although sagittal plane pelvis and hip angles, ankle plantar flexor moment, powers generated at the hip and ankle joints at the pre-swing were improved, the improvements were not statistically significant., Conclusion: Yoga therapy is a safe and beneficial intervention for improving fatigue, balance and spatiotemporal gait parameters in patients with MS. Further studies with a larger sample size and longer follow-up will be needed to evaluate the long term effects of yoga therapy., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: It is well-known that pulmonary function is altered in patients with ankylosing spondilitis (AS) owing mainly to the restriction of chest expansion. In addition to musculoskeletal factors, development of pulmonary function abnormalities may also deteriorate exercise tolerance of the patients., Aim: The aim of this study was to examine the pulmonary function and exercise tolerance of AS patients., Design: A case controlled study., Setting: Outpatient clinic of an university hospital., Population and Methods: Twenty-two men with the diagnosis of definite AS and 20 healthy controls matched according to age, sex, smoking habits and physical activity level were enrolled in this study. After a detailed physical examination, pulmonary function and exercise tolerance were assessed by "Sensormedics-Vmax 229" ergospirometry system. Maximal exercise testing was performed on a cycle ergometer using "10 watt ramp" protocol., Results: Patients with AS had lower chest expansion, vital capacity and exercise tolerance than healthy subjects. Exercise tolerance strongly correlated with the patients' age, disease duration, chest expansion, modified Schober test, and vital capacity. In stepwise regression analysis, the best regression model for explaining the total variation of exercise tolerance selected only vital capacity as an independent variable (R²=54.9%)., Conclusion: Rather than musculoskeletal manifestations, exercise intolerance was mainly explained by pulmonary function impairment in AS patients., Clinical Rehabilitation Impact: These results suggest that efforts should be directed not only towards improving spinal mobility but also towards increasing cardiopulmonary fitness in AS patients.

Objective: The aim of this study was to evaluate heart rate variability (HRV) and heart rate recovery (HRR) in otherwise healthy ankylosing spondylitis (AS) patients and control subjects., Methods: A total of 28 patients with AS and 30 volunteers matched for age and sex were enrolled. All subjects underwent HRV analysis, exercise testing (ET), and transthoracic echocardiography. HRR indices were calculated by subtracting first, second, and third minute heart rates (HR) from the maximal HR., Results: The AS and control groups were similar with respect to age (28.7 ± 5.7 vs. 29.3 ± 5.8 years), gender distribution [(male/female) 24/4 vs. 26/4], and left ventricular ejection fraction (LVEF) (63.8 ± 2.8% vs. 65.7 ± 3.6%). Mean HRR1 (24.8 ± 4.2 vs. 28.8 ± 5.5, P = 0.001) and HRR2 (42.0 ± 4.4 vs. 48.0 ± 6.3, P = 0.001) values were significantly higher in control group. SDNN, SDANN, RMSDD, and PNN50 significantly decreased; LF and LF/HF increased in AS patients compared with control subjects., Conclusions: Patients with AS has lower HRR and HRV indices with respect to normal subjects. Cardiac autonomic functions might be involved in AS patients even in patients without cardiac symptoms.

Denervation of sensory and sympathetic nerve fibers and reduced blood flow result in decreased bone mineral density (BMD). In this study, we aim to detect the effect of compression of brachial plexus and subclavian vessels on the forearm BMD in patients with thoraric outlet syndrome (TOS). Twenty-three patients with TOS (17 females and 6 males) were enrolled in the study. Thirty-three extremities of the patients with TOS were classified as true neurogenic (1), vascular (15) and disputed neurogenic TOS (17). Thirty upper extremities of 15 age- and sex-matched healthy subjects were evaluated as controls. Electrophysiological testings and Doppler ultrasonography were performed. Comparisons of the dominant and the non-dominant forearm BMD between patients and controls, and between the involved and the non-involved sides in TOS patients revealed no significant differences (P < 0.05). In conclusion, intermittent compression of brachial plexus and subclavian vessels in patients with disputed and vascular TOS does not seem to affect forearm BMD. Further studies are needed to detect the effect of persistent neurovascular compression in TOS.

The purpose of this study was to determine whether a measurable decrease in isokinetic (dynamic) and isometric (static) hand strengths occurs in carpal tunnel syndrome (CTS) patients. Eighteen CTS patients and 20 healthy controls were included in the study. Isokinetic (eccentric and concentric) and isometric grip and pinch strengths were measured with a Biodex System 3 dynamometer (Biodex Medical System, Inc. New York). All strength measurements, except isometric and isokinetic (concentric/eccentric) three-point pinch and isokinetic (concentric) tip pinch, revealed statistically significant differences between CTS patients and controls. Measurable decrease in hand strengths may exist in CTS despite normal manual assessments. Although both isokinetic (dynamic) and isometric (static) dynamometers are capable of detecting this decrease, neither technique seems better than the other.

Background: Psoriasis is a common dermatological disease with erythematous plaques where articular and extra articular findings (tenosynovitis and enthesitis) may well accompany. The aim of this current study was to evaluate the Achilles' tendon of psoriasis patients with ultrasonography., Methods: The study comprised 30 psoriasis patients and 20 healthy controls. Ankle ultrasonography was performed with posterior approach, the joint in neutral or in a little dorsiflexed position. The statistical analysis was carried out with a Student's t-test and Spearman correlation tests., Results: The mean values of Achilles' tendon thickness of two groups were compared: the psoriatic group was found to have thicker tendon measurements (P = 0.00). The tendons of the patients with radiologically proven enthesopathy were found to be even thicker (P = 0.001)., Conclusions: We encourage the use of diagnostic ultrasonography for evaluation of enthesopathy manifestations in psoriasis patients as an adjunct to conventional methods owing to its convenience and promising results.

Reported here is a 28-year-old female who presented with severe right knee pain and swelling nearby the joint. Ultrasonography, magnetic resonance imaging and eventually surgery were performed. She was diagnosed to have a cystic hygroma in the vastus lateralis muscle. This is the first patient of a cystic hygroma in the quadriceps muscle.

Objective: To describe possible differences between male and female patients with fibromyalgia syndrome (FM) in their clinical manifestations., Methods: Five hundred thirty-six consecutive patients with FM (469 women, 67 men) seen in a university rheumatology clinic and 36 healthy men without significant pain seen in the same clinic were included in the study. Data on demographic and clinical features were gathered by a standard protocol. Tender point examination was performed by the same physician. Level of significance was set at p < or = 0.01., Results: Several features were significantly (p < or = 0.01) milder or less common among men than women, including number of tender points (TP), TP score, "hurt all over," fatigue, morning fatigue, and irritable bowel syndrome (IBS). The total number of symptoms was also fewer among men and approached significance (p = 0.02) by parametric test, but reached significance (p = 0.001) by nonparametric analysis. All clinical and psychological symptoms as well as TP were significantly (p < 0.01) more common or greater in male patients with FM than healthy male controls, with the exception of IBS (p = 0.03). Patient assessed global severity of illness, Health Assessment Questionnaire disability score, and pain severity were similar in both sexes., Conclusion: Male patients with FM had fever symptoms and fewer TP, and less common "hurt all over," fatigue, morning fatigue, and IBS, compared with female patients. Stepwise logistic regression showed significant differences between men and women in number of TP (p < 0.001).

In this study, we evaluated the effects of commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on oxidative stress and anti-oxidant system. Sixteen healthy volunteers and 35 patients diagnosed as one of musculoskeletal disorders were included in the study. Patients were treated with one of the three NSAIDs (i.e. naproxen, tiaprofenic acid, acemetacin) or paracetamol for 15 days. Erythrocyte glutathione S-transferase, erythrocyte and plasma glutathione peroxidase, and erythrocyte catalase (CAT) activities and plasma malondialdehyde level as lipid peroxidation index were detected in the blood samples of the patients, at the beginning of the study (0 week), after treatment for 15 days (2nd week), and at the end of 1 week-washout period (3rd week). The most affected enzyme by NSAIDs was erythrocyte catalase, which tended to increase at the end of 2 weeks treatment, and decrease at the end of 1 week-washout period. In the groups treated with acemetacin, naproxen and tiaprofenic acid, plasma malondialdehyde levels were decreased at some extent, but at the end of washout period a rebound increase was observed in acemetacin group. Our results suggest that NSAIDs have different influences on oxidative stress and anti-oxidant system related parameters. These effects seem to be related with the mechanisms of some of the adverse effects, which are not well understood yet. Further studies with larger groups are needed to illuminate the relationship between adverse effects of NSAIDs and the effects of these drugs on anti-oxidant system, and to clarify their mechanisms of therapeutic action, as well.

Neopterin and biopterin are two products of the pteridine pathway. Even though their roles and interrelationships have not been exactly clarified, neopterin is known as a biomarker of cell-mediated immunity. In this case, the highly elevated neopterin levels are parallel to the slightly elevated biopterin levels. On the other hand, the reduced form of biopterin-tetrahydrobiopterin is an essential cofactor of aromatic monoxygenases that leads to synthesis of tyrosine, tryptophan and dopamine neurotransmitters and its concentration in body fluids and tissues is maintained by the enzyme dihydropteridine reductase (DHPR). Increased numbers of activated lymphocytes can be found in peripheral blood, in the synovial fluid and synovial membranes or patients with rheumatoid arthritis (RA). Since the present study was undertaken to evaluate the role of the pteridine pathway in RA, we measured urine neopterin levels and dried blood DHPR activities in 36 patients with RA and in 20 healthy volunteers, in parallel with other clinical parameters. We found that neopterin excretion was significantly increased in RA patients compared with controls. The means were 433 +/- 216, 153 +/- 43 and 111 +/- 34 mumol/mol creatinine for patients in active stage, in remission and controls, respectively. Our results suggest that urine neopterin levels were strongly dependent on the stage and activity of RA. Either as an effect of the disease itself or of drug administration, slightly reduced DHPR activities were detected (3.484 +/- 0.304 for control, 2.974 +/- 0.255 in active stage RA, and 3.048 +/- 0.302 red cytochrome C/min/5 mm disc in remission).