MRC Scale Research Articles

Two-stage distalization of the mental foramen to manage posterior mandibular vertical bone deficiency—a prospective observational study

Inferior alveolar nerve (IAN) transpositioning is a modality utilized to manage posterior mandibular vertical deficiency. Several complications have been reported including improper implant positioning, mandibular body fracture, and neurosensory disturbance. The aim of this prospective observational study was to introduce a two-stage mental foramen distalization technique to minimize the complications associated with IAN transpositioning. Ten patients with severely atrophied mandibular ridges were included. Cone beam computed tomography was ordered to accurately locate the position of the IAN and its incisive terminal branch before designing the outline of two cortical osteotomies anterior and posterior to the mental foramen. The osteotomies were created using a piezoelectric device, followed by separation and identification of the nerve. The incisive branch was severed to freely transpose the IAN. A new foramen was created far distally and the cortical windows were repositioned and fixed with two screws. Healing was uneventful for all patients. Neurosensory recovery was assessed by MRC scale. All cases showed full recovery within 6 weeks, except for two patients who showed complete recovery after 16 weeks. Four months postoperative, all patients showed complete consolidation of the cortical windows without any signs of failure implants were placed at the pre-planned surgical sites. Histomorphometric analysis of core biopsies from seven surgical sites showed bone area percentages ranging from 46% to 63%. The two-stage mental foramen distalization technique is a predictable and safer technique for IAN transpositioning specifically in cases of vertical bone deficiency associated with limited inter-arch space.

Does walking the day of total hip arthroplasty speed up functional independence? A non-randomized controlled study

BackgroundFew data address modalities for speeding up functional independence in subjects included in a fast-track approach after total hip arthroplasty (THA). The study aim was to assess short-term effects of mobilization and walking the day of THA (WDS) on independence, pain, function and quality of life.MethodsSeventy-one patients were allocated in a study (SG: n = 36) or control (CG: n = 35) groups according to time of surgery and recovery from anesthesia. Patients who recovered lower limbs sensitivity (disappearance of sensation deficits) and motility (MRC scale ≥3 at knee, ankle and great toe extension) by 7.00 p.m. made up the SG, whereas patients who underwent surgery later and recovered from anesthesia after 7.00 p.m. made up the CG. SG underwent WDS, whereas CG performed mobilization and walking the day after surgery starting the same physiotherapy program 1 day later. Patients were evaluated for independence (Functional Independence Measure - FIM), pain (Numeric Rating Scale - NRS), hip function (Harris Hip Score - HHS) and quality of life (EuroQoL-5Dimension - EQ. 5D and EQ. 5D-VAS)the day before surgery, at 3 and 7 days in a hospital setting. Analysis of Covariance with age (SG: mean 60.9, SD 9.0; CG: mean 65.5, SD 8.9) and BMI (SG: mean 27.4, SD 2.8; CG: mean 26.7, SD 2.4) as covariates was used to assess between-group differences over time.ResultsBetween-groups differences were observed for FIM total and motor scores (p = 0.002, mean difference: 2.1, CI95: 0.64, 3.7) and FIM self-care (p = 0.01, mean difference: 1.7, CI95: 0.41, 3) in favor of SG at 3 days. Between-group differences were found for FIM self-care (p = 0.021, mean difference: 1.2, CI95: 0.18, 2.1) in favor of SG at 7 days. FIM total and motor scores (p < 0.001), FIM self-care (p = 0.027) and transfer-locomotion (p < 0.001) and HHS (p = 0.032) decreased after surgery followed by improvements in postoperative days (p ≤ 0.001). No differences were found for NRS, EQ. 5D and EQ. 5D-VAS.ConclusionsWDS produces additional benefits in patients’ independence in the first week after THA. Absence of pain aggravation or adverse effects on hip function and quality of life may allow clinicians to recommend WDS to promote discharge with functional independence.

Predictors of cough-specific and generic quality of life in sarcoidosis patients.

Background:Cough is frequent symptom in sarcoidosis and its impact on patient’s quality of life (QoL) has not been adequately addressed so far.Objectives:The goal of this study was to determine the significant predictors of cough-specific and generic QoL in sarcoidosis patients.Methods:In the prospective study 275 sarcoidosis patients administered Patient Reported Outcomes instruments for measurement of dyspnea (Borg and MRC scales) and fatigue (Fatigue Assessment Scale (FAS) and Daily Activity List (DAL)), as well as patients’ QoL (cough-specific Leicester Cough Questionnaire (LCQ) and generic tool – 15D). The LCQ contains 3 domains covering physical, psychological and social aspects of chronic cough. Pulmonary function tests (spirometry and diffusing capacity for carbon monoxide) and serum angiotensin converting enzyme (sACE) were also measured.Results:Dyspnea measured by Borg scale and impairment of daily activities determined by DAL instrument as well as sACE were the strongest predictors of all cough-specific QoL domains. Mental aspect of patients’ fatigue was significantly correlated with all domains except with psychological LCQ domain. Regarding the generic QoL, the following significant predictors were: dyspnea measured by MRC scale, overall fatigue determined by FAS and physical domain of the LCQ.Conclusion:It is important to measure both cough-specific and generic QoL in sarcoidosis patients since they measure different health aspects and their predictors can be different. We demonstrated that physical domain of cough-specific QoL is significant predictor of generic QoL. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 158-168)

Results of health-improving treatment of patients with a new COVID-19 coronavirus infection in a phthisiopulmonological sanatorium

The results of sanatorium treatment of 102 patients (aged 18 to 79 years, 30 men and 72 women) who have had a new coronavirus infection (COVID-19) are presented in the article. Materials and methods. A 21-day health im-proving program was developed to restore the functions of external respiration, increase mobility, achieve psych-oemotional stability, and restore patients’ daily activities. Exercise tolerance (6-minute walking test, Borg scale, mMRC scale), hypoxia tolerance (Genchi and Stange func-tional tests), peripheral muscles’ strength (MRC scale), ox-ygen saturation, anxiety and depression intensity (HADS Hospital Anxiety and Depression Scale), quality of life (EQ-5D), and nutritional status were evaluated, as well as in-dicators of external respiratory function of patients upon admission and discharge from the sanatorium. Results.In the result of such therapy clinical and laboratory indi-cators improved (patients rarer complained of weakness (down from 73% to 3.9%), shortness of breath during exercise (from 58 to 14.7%), manifestations of angiodis-tonic syndrome (from 39 to 3%), and ESR level (from 40 to 13.7%). During the 6-minute walk test, there was a sig-nificant increase in the distance traveled compared to the test at admission in all observation groups. 83 out of 90 test subjects (92.2%) co vered a longer distance covered. On average, the distance increased 14% in patients with mild COVID, the average increase was 81 meters, 12% (47 meters) in patients with moderate severity, and 21% (112 meters) in those who had severe infection. Psych-oemotional state evaluated by the Hospital Anxiety and Depression Scale showed a decrease in the average level of anxiety from 4.9 to 3.6, and depression — from 4.3 to 3 points. The average quality of life score (EQ-5D ques-tionnaire) at discharge was 7.3 points compared to 8.9 at admission. Conclusion. The authors demonstrated the effectiveness of the sanatorium-resort care in achieving psychoemotional stability and restoring daily activities in COVID-19 recovalescents

TIMP-1 and MMP-9 expressions in COPD patients complicated with spontaneous pneumothorax and their correlations with treatment outcomes.

Objective:To study the expressions of TIMP-1 and MMP-9 in patients with chronic obstructive pulmonary disease (COPD) complicated with spontaneous pneumothorax, and their correlations with treatment outcomes.Methods:A total of 80 COPD patients complicated with spontaneous pneumothorax treated in our hospital from December 2015 to December 2017. The serum expressions of TIMP-1 and MMP-9 in 80 COPD patients complicated with spontaneous pneumothorax (COPD group) and 52 healthy volunteers (control group) were detected by ELISA. The correlations of TIMP-1 and MMP-9 expressions with arterial blood gas parameters as well as scores of MRC breathlessness scale and St. George’s Respiratory Questionnaire (SGRQ) were analyzed.Results:The serum expressions of TIMP-1 and MMP-9 of COPD group were significantly higher than those of control group (P<0.05), but the two groups had similar MMP-9/TIMP-1 ratios (P>0.05). For COPD group, TIMP-1 expression, MMP-9 expression, MMP-9/TIMP-1, Sa(O2) and p(O2) were not correlated (P>0.05). TIMP-1 expression was significantly positively correlated with MRC scale and SGRQ scores (P<0.05). Sa(O2), p(O2) and MRC scale score of low MMP-9 expression, low TIMP-1 expression and low MMP-9/TIMP-1 group were significantly improved compared with those of high MMP-9 expression, high TIMP-1 expression and high MMP-9/TIMP-1 group (P<0.05). MMP-9 expression, TIMP-1 expression or MMP-9/TIMP-1 was not correlated with improvement of SGRQ score. Pulmonary function improvement (Sa(O2) improvement rate ≥5% and/or p(O2) improvement rate ≥10%) was correlated with serum MMP-9 expression, baseline Sa(O2) and p(O2).Conclusion:Increase of serum TIMP-1 and MMP-9 expressions in COPD patients was correlated with symptoms and scores of quality of life, and the expressions were also correlated with short-term treatment reactivity.

Importance of intensive and prolonged rehabilitative treatment on the Guillain-Barrè syndrome long-term outcome: a retrospective study

Guillain-Barrè syndrome (GBS) is often associated with a residual disability. Nonetheless, poor and incomplete studies have been published addressed towards the assessment of importance of physiotherapy (FKT) in the recovery. The aim of the study was to explore the effects of prolonged FKT associated with medical therapy and to evaluate the long-term outcome. A retrospective analysis was carried out on patients with GBS who needed to continue rehabilitation after hospitalization and admitted to the Neurological Department of La Spezia from 2003 to 2017. MRC and GBS-Disability scale (GBS-DS) were performed at the time of greatest clinical disability, after medical therapy, and at the end of the overall FKT. The final outcome evaluation was based on the ability to walk with or without support. ANOVA with Bonferroni post-test were used to compare MRC and GBS-DS. Ninety-six patients were admitted, but only 51 satisfied inclusion criteria. Forty patients performed intensive treatment for an average of 60.95days, and 31 of them, once discharged, are required to continue FKT as outpatients for a mean period of 96.45days. The mean value of MRC and GBS-DS post-FKT improved significantly compared with the post-medical therapy. Concerning walking, among the 40 patients who did not walk before therapy, 8 need support after the medical therapy and 4 (11.76%) cannot walk independently at the last follow-up. In conclusion, FKT associated to medical therapy can improve the outcome of the disease, if performed for periods exceeding 6months.

CLINICAL OUTCOME OF ARTHROSCOPIC ROTATOR CUFF REPAIR IN PATIENTS 2 AGED 70 YEARS AND OLDER

Aim: The purpose of this study was to evaluate the outcome of arthroscopic rotator cuff 13 repair in patients aged 70 years or older and report our results in terms of pain, range of 14 motion, muscle strength, and functional outcome. 15 Materials and Methods: We performed retrospective data review and identified 97 16 shoulders (94 patients) of our interest with minimum 24 months of follow-up. All patients 17 were evaluated with Visual Analogue Scale (VAS), Range of motion (ROM), Manual 18 Muscle Strength, and Oxford Shoulder Score (OSS) preoperatively and at final follow-up. 19 Patient satisfaction was determined by asking patients whether they were satisfied (yes 20 or no). Statistical analysis was performed using paired t test to compare pre and 21 postoperative measures and Mann-Whitney U test to see the effect of age and gender on 22 the final outcome. 23 Results: Of 97 shoulders, 70 (67.9%) shoulders were available for final evaluation with 24 a mean age of 73.56 years (70 to 81) and mean follow-up of 57.52 months (24 to 122). 25 Mean VAS for pain was improved from 8.4 (6 to 10) to 1.04 (0 to 5) (P < 0.001) at final 26 follow-up. Mean forward flexion, abduction, external rotation increased from 112.50o to 27 165.43o (P < 0.001), 114.36o to 166.86o (P < 0.001), 45.14o to 73.64o (P <0.001) 28 respectively, as well as, Internal rotation also improved in 55 patients (78.5%, n = 70) at 29 final follow-up. Mean muscle strength of Supraspinatus (SSP) and Infraspinatus (ISP) 30 according to MRC scale was significantly improved (P < 0.05) from 2.84 (2 to 4) to 4.67 31 (4 to 5) and from 2.77 (2 to 4) to 4.64 (3 to 5) at the final follow-up respectively. Mean 32 OSS was improved from 11.49 to 44.40 (P < 0.001) and only three patients (4.28%, n = 33 70) were subjectively less than satisfied at final follow-up. 34 Conclusions: There was a significant improvement in shoulder function with a low 35 complication rate. Hence, we have no hesitation to recommend repair in this age group. 36 Provided the rotator cuff is not grossly wasted, and patient is fit to undergo surgery, age 37 should not be the criteria for determining repairability.

Shoulder pain after recent stroke (SPARS): hemiplegic shoulder pain incidence within 72 hours post-stroke and 8–10 week follow-up (NCT 02574000)

ObjectivesThis study aimed to identify very early incidence of hemiplegic shoulder pain within 72hours (HSP), how clinical assessment was related to pain at 8–10 week follow-up and explore current standard therapy/management. DesignObservational, prospective. SettingTeaching hospital hyper-acute and follow-up stroke services. Participants121 consecutive patients with confirmed cerebral infarct/haemorrhage recruited within 72hours of stroke onset. InterventionsN/A. Main outcome measuresSubjective report of pain severity and aggravating factors: using numerical rating scales and pain questionnaire (ShoulderQ), shoulder abductor and flexor muscle strength (Oxford MRC Scale), Neer’s Test of sub-acromial pain, shoulder subluxation and soft tissue shoulder palpation. ResultsAt initial assessment (<72hours), 35% (42/121) reported HSP. At follow-up (8–10 weeks), 44% (53/121) had pain: pain persisted in 32 of the original 42, resolved in 10 and had developed since initial assessment in 21. Pain at follow-up was associated with a statistically significant higher frequency of severe shoulder muscle weakness (MRC grade ≤2) and gleno-humeral subluxation at initial assessment. Soft tissue palpation and Neer’s Test detected pain but did not predict development of HSP. 50/121 patients had 140 therapy interventions, particularly targeted to those with a higher HSP risk. ConclusionThis study reports HSP at an earlier time point after stroke than previous publications. Patients with severe arm weakness and/or shoulder subluxation within 72hours are at significantly higher risk of HSP at 8–10 weeks. These data highlight the high incidence of HSP, the non-standardized therapy approach, and can inform sample size calculations for future intervention studies.Clinical Trial Registration: NCT02574000 (clinicaltrials.gov).

C-Reactive Protein - A Predictable Biomarker in Ischemic Stroke

C-reactive protein (CRP) is a non-specific inflammatory marker, correlated with the severity and prognosis of ischemic stroke. We performed a retrospective study in which were included 81 patients diagnosed with acute ischemic stroke admitted between January and July 2017 in the Department of Neurology, Sibiu Emergency Clinical Hospital. CRP values were classified on three levels (0 - 5 mg / L, 5 - 50 mg / l and] 50 mg / l). We examined the correlation between CRP levels according to the type of ischemic (lacunar / territorial) stroke, the degree of motor deficit (quantified by the mRC scale), the associated risk factors and the mortality rate. PCR values above 50 mg / L were found in patients with territorial stroke (15%). Moderate motor deficits predominate, with PCR values ranging from 5-50 mg / L. The most important risk factors found in the patients included in our study were hypertension and atherosclerosis. We made correlations between these risk factors and the PCR values. In most cases with these two risk factors were recorded a mean PCR value (5-50 mg / L).For atherosclerosis the results were statistically significant, p = 0.021. Most patients (56%) had CRP levels ranging from 5 to 50 mg / L. These values recorded highest death rates. PCR it is an important marker of inflammation and it is important to be determined in all patients with acute ischemic stroke, especially which is thought to be correlated with the prognosis of these patients.

The Effects of Chronic Electrical Stimulation Evaluation Functional and Electrical Properties of Muscle in a Small Group of Patients with Congenital Muscle Disorders

BackgroundIn the case of Congenital Muscle Disorders like Myotonic Dystrophy type 1 (DM1) the rehabilitative interventions have always been aimed at muscle strengthening, increasing of fatigue resistance and improving of aerobic metabolism efficiency whereas the electrical membrane fault has always been addressed pharmacologically. Neuromuscular electrical stimulation (NMES) is a useful therapeutic tool in sport medicine and in the rehabilitation of many clinical conditions characterized by motor impairment such as stroke, cerebral palsy and spinal cord injury.The aim of our pilot study was to evaluate the effects of chronic electrical stimulation both on functional and electrical properties of muscle in a small group of patients with condenital muscle disorders.Materials and methodsfive DM1 patients and one patient with Congenital Myotonia (CM) performed a home electrical stimulation of the tibialis anterior muscle lasting 15 days with a frequency of two daily sessions of 60 minutes each. Muscle strength was assessed according to the MRC scale (Medical Research Council) and functional tests (10 Meter Walking Test, 6 Minutes Walking Test – MWT and Timed Up and Go Test – TUG test) were performed. We analyzed the average rectified value of sEMG signal amplitude (ARV) to characterize the sarcolemmal excitability.ResultsAfter the treatment an increase of muscle strength in those DM1 patients with a mild strength deficit was observed. In all subjects an improvement of 10 MWT was recorded. Five patients improved their performance in the 6 MWT. In TUG test 4 out of 6 patients showed a slight reduction in execution time. All patients reported a subjective improvement when walking. A complete recovery of the normal increasing ARV curve was observed in 4 out of 5 DM1 patients; the CM patient didn't show modification of the ARV pattern.ConclusionsNMES determined a clear‐cut improvement of both the muscular weakness and the sarcolemmal excitability alteration in our small group of DM1 patients. Therefore this rehabilitative approach, if confirmed by further extensive studies, could be considered early in the management of muscular impairment in these patients. An attractive hypothesis to explain our encouraging result could be represented by a functional inhibition of small conductance calcium‐activated potassium channels expressed 3 (SK3) in muscle of DM1 subjects.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Responsiveness to Change of 5-point MRC scale, Endurance and Functional Evaluation for Assessing Myositis in Daily Clinical Practice.

Manual muscle testing has been widely used for the evaluation of muscle strength in myositis, yet less attention has been devoted to the evaluation of muscle function and endurance. Our objective was therefore to compare the responsiveness to change of muscle strength, endurance and functional testing following induction therapy for severe myositis flare (requiring high-dose corticosteroids and combined immunotherapy) in patients with a diagnosis of dermatomyositis, immune-mediated necrotizing myopathy, or overlap myositis. Muscle status was assessed at baseline and after mean 6.4±1.9 months, using the MRC-5 scale, along with endurance (Barre and Mingazzini maneuvers) and functional evaluation (e.g. chair rise) and responsiveness to change was evaluated using the Standardized Response Mean (SRM) and Standardized Mean Difference. Among the 49 patients included, the strongest responsiveness to change was observed in the muscle testing of the psoas and deltoids (SRM: 1.23 and 1.16, respectively). Noticeably, endurance testing also demonstrated strong responsiveness (SRM: 1.05 and 0.96, respectively), compensating for the poor discriminatory ability of muscle testing and permitting to overcome its ceiling effect. Functional and endurance testing provide simple and reliable measures complementing the testing of select proximal muscle groups to evaluate responsiveness to intervention in myositis patients in daily clinical practice. Interest of functional and endurance testing should be evaluated prospectively as outcome measures in myositis clinical trials.

Virtual reality in upper extremity dysfunction: specific features of usage in acute stroke

Stroke is a leading cause of permanent disability. Being a new technology for neurorehabilitation, virtual reality (VR) allows for intensive trainings with a larger number of repetitions focused on mastering specific skills in patients with upper limb dysfunction. To date, there are insufficient studies evaluating the use of VR in the acute period of a stroke. To investigate the effectiveness and safety of adding VR trainings to standard therapy for improving upper limb function and for enhancing activities in daily life in patients with acute stroke. The investigation enrolled 78 patients with acute stroke (the median time from stroke onset, 3.7 days; median age, 63 (43; 79.3) years), who were randomized into 2 groups: a study group (standard therapy + VR) and a control one (standard therapy only). The patients of the study group underwent a VR training cycle lasting 15 minutes twice daily for 10 days. Before and after the training cycle, the British Medical Research Council scale for muscle strength, the upper extremity motor function sections of the Fugl-Meyer assessment (FMA) scale, hand dynamometry, and the nine hole peg test (NHPT) were used to evaluate upper extremity function in the participants; Sections 6 and 7 of the motor function assessment scale (MAS), the modified Rankin scale (MRS), and the total motor function scores of the functional independence measure (FIM) utilizing a 7-point ordinal scale were employed to assess everyday activity limitations. On completion of rehabilitation measures, the participants in the study and control groups showed a statistically significant improvement in upper extremity function and activities of daily living. According to the ratings of the FMA subscales 'hand' (p=0.034), 'hand (speed)' (p<0,001), and the total score of this scale (p=0.035) and according to those of the FIM scale (p=0.045), the patients of the study group demonstrated a statistically significant improvement compared with those in the control group. Assessments using the MRC scale, FMA subscales 'upper extremity' and 'wrist', NHPT, MAS, the Barthel index (BI), and MRS revealed no differences between the groups. No serious adverse events were recorded in the participants of the study group during the study period. The vast majority of studies evaluating the effect of VR in upper extremity dysfunction are conducted in patients with stroke lasting longer than 3 months. Despite the validity of using VR in the acute period of cerebral lesion, the investigations of this design are not numerous. At the same time, these studies often have limitations, such as a small number of participants (usually less than 10); a small number of training VR sessions; lack of 'blinding'; different types of software and hardware systems that implement VR technology; heterogeneity of participants according to the degree of upper extremity dysfunction; insufficient detailing of the content and scope of conventional therapy; comparison of VR with basic methods of motor rehabilitation, and sometimes the absence of a control group. Thus, the use of VR in addition to standard rehabilitation measures in the acute period of stroke favors improvements in upper extremity function and a reduction in daily limitations and is safe.

Psihometrijske karakteristike srpske verzije Lesterskog upitnika o kašlju kod bolesnika sa sarkoidozome

Introduction: Cough is frequent symptom in sarcoidosis and there are no specifi c tools for measurement of its severity in Serbia. Aim: the goal of this study was to translate and validate the Serbian version of the Leices-ter Cough Questionnaire (LCQ) in a population of sarcoidosis patients. Methods: After the LCQ forward-backward translation process, in the cross-sectional study in 275 (180 female) sarcoidosis patients Serbian version of the LCQ was administered together with other standardized instruments for measurement of Patient Reported Outcomes (PROs)-symptoms of dyspnea (assessed by MRC and Borg scales) and fatigue (measured by Fatigue Assessment Scale and List of Daily Activities), and patients' health status (assessed by generic tool-15D). Pulmonary function tests (spirometry and diff using capacity for carbon monoxide) were also measured. Results: Serbian LCQ version showed excellent internal consistency (Cronbach's Alpha of its diff erent scores ranged between 0.901 for physical domain and 0.951 for the total score). Concurent validity assessed by correlations of all LCQ scores with other PROs and pulmonary function tests was very good, since all these correlations were statistically signifi cant. Conclusions: Our results confi rmed that the Serbian version of LCQ is a valid instrument to monitor the infl uence of chronic cough on quality of life in sarcoidosis patients.

A Clinical Analysis of Repairing the Whole Brachial Plexus Nerve Root Avulsion by Transferring C7 Nerve Root from the Uninjured Side

Objective to perform a C7 transfer from the uninjured side for the patients with whole brachial plexus nerve root avulsion, conduct follow-up observations of the recovery conditions of the affected limb, and discuss the degree of the effect on the limb on the uninjured side and the mechanism. Method The 36 patients with whole brachial plexus nerve avulsion who received a C7 transfer from the uninjured side for repair by stages from January 2011-December 2011 in our hospital were selected as the objects to analyse the data of cases, carry out follow-up visits, evaluate of the limb functions on the uninjured side, and make comprehensive assessment in accordance with U.K. MRC scale for sensation and U.K. amended MRC scale for muscular strength. Result The follow-up visit results regarding the motor functions of the affected limb have indicated that there were 2 patients with effective recovery of supraspinatus muscular strength, 2 patients with effective recovery of deltoid muscular strength, 6 patients with effective recovery of biceps brachii muscular strength, 7 patients with effective recovery of triceps brachii muscular strength, 4 patients with effective recovery of extensor carpi muscular strength, and 5 patients with effective recovery of flexor carpi and flexor digitorum muscular strength. There were 7 patients whose latissimus dorsi muscular strength reached M5-, 7 patients whose triceps brachii muscular strength reached M5-, and 10 patients whose extensor digitorum muscular strength reached M5- 6 months after operation. There were 3 patients whose limb on the uninjured side reached Sensation Grade S4, 12 patients whose limb on the uninjured side reached Sensation Grade S3+, 11 patients whose limb on the uninjured side reached Sensation Grade S3, and 10 patients whose limb on the uninjured side reached Sensation Grade S2 3 days after operation. The sensory functions of the majority of the patients recovered to S4 and their two-point discrimination approximately recovered to normal at the follow-up visit 1 year after operation. Conclusion Repair with C7 transfer from the uninjured side is currently an effective and feasible method to repair the functions of the affected limb in brachial plexus nerve root avulsion.

Validation of the St George’s respiratory questionnaire and risks factors affecting the quality of life of Lebanese COPD and asthma patients

Objective: We aimed to validate the Arabic version of the St George’s Respiratory Questionnaire (SGRQ) for use in Lebanese Chronic obstructive pulmonary disease (COPD) and asthma patients and to identify risk factors that might affect the quality of life in these patients. Methods: COPD (n = 90) and asthma patients (n = 124) were recruited from the outpatient clinics of the Pulmonology department of a university hospital and a medical center in Beirut. They filled out a standardized questionnaire. The total SGRQ score and the component scores (symptoms, activity and impacts) were calculated. To confirm the SGRQ validity in the Lebanese population, factor analyses were applied for the whole sample, only asthma and only COPD patients, respectively. The associations between the total SGRQ score and FEV1% predicted, CCQ score and MRC scale were assessed. Multiple linear regression models were used to evaluate the association between the total SGRQ scores and the socio-demographics and the diseases risk factors. Results: COPD patients had a higher SGRQ total and subscales scores compared to asthma patients. A high Cronbach’s alpha was found for the whole sample (0.802), only COPD patients (0.833) and only asthma patients (0.734). A significant negative correlation was found between FEV1% predicted and the total SGRQ scores. Occupational exposure, BMI and previous waterpipe smoking were among the factors that significantly and positively influenced a higher SGRQ score. Conclusions: The Lebanese version of the SGRQ emerges as a good health-related quality of life evaluative instrument that is reasonable to be used in COPD and asthma patients in Lebanon.

Поєднані ушкодження нервових та сухожилково-м’язових структур на передпліччі, що супроводжуються їх значними дефектами: роль вимушеної транспозиції м’язів у відновленні основних функцій кисті

Мета роботи: оцінити ефективність “вимушених” транспозицій при ушкодженнях сухожилково-м’язових та нервових структур на відновлення основних захватів кисті.&#x0D; Матеріали і методи. Проведено ретроспективний аналіз результатів реконструктивних втручань у 9 пацієнтів (6 чоловіків та 3 жінки) віком від 9 до 70 року (середній вік 36,4 року) із наслідками проксимальних поєднаних ушкоджень довгих нервів та сухожилково-м’язового апарату передньої поверхні передпліччя. Травма сухожилково-м’язового апарату була поєднана із ушкодженням в 4 випадках серединного нерва, в 4 випадках серединного та ліктьового нервів, в одному випадку – серединного нерва та поверхневої гілки променевого нерва. Термін, в який проводились реконструктивні втручання, складав у середньому 5 місяців (від 2 до 11 місяців) після травми. У 6 пацієнтів хірургічна реконструкція нервів полягала у виконанні автологічної пластики, у 2 пацієнтів – невролізу, в одного пацієнта – шва нерва. У 5 випадках “вимушена” транспозиція була виконана з метою відновлення незалежної функції довгого згинача 1 пальця, у 6 випадках – незалежної функції глибоких згиначів 2–3 пальців. Відновлення неврологічних функцій оцінювали за MRC Scale, класифікацією за Seddon, відновленням 4 захватів кисті, власною оцінкою відновлених функцій за Brief Michigan Hand Questionnaire.&#x0D; Результати досліджень та їх обговорення. У всіх 4 пацієнтів із ушкодженням лише серединного нерва відновлення чутливості становило в середньому 3,75 за Seddon. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів відновлення чутливості становило в середньому 3 та 2 за Seddon відповідно. Неефективне відновлення протиставлення першого пальця в 2 пацієнтів скореговано транспозицією за Bunnel. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів ми спостерігали незадовільне відновлення “внутрішніх” м’язів кисті. У 5 пацієнтів «вимушені» транспозиції відновили незалежну функцію довгого згинача 1 пальця, у 6 пацієнтів – незалежну функцію глибоких згиначів 2–3 пальців. У 9 пацієнтів комплексна хірургічна реконструкція відновила функцію поперечного долонного, діагонального долонного та щипкового захватів. У 4 пацієнтів (44 %) не досягнуто відновлення ключового захвату, у зв’язку із незадовільним відновленням “внутрішніх” м’язів кисті (ліктьовий нерв). Середня власна оцінка функції кисті за MBHQ відповідала задовільній у 9 пацієнтів – 70,12 балів в середньому (від 43,75 до 89,6).

Surgical treatment of the consequences of the computed damage of the median nerve in the proximal part of the upper limb

Aim of the study – to assess the efficacy of surgical reconstruction of the combined proximal median nerve injuries, to evaluate the efficacy of the staged orthopedic reconstruction of the thumb opposition. The retrospective analysis of the reconstruction of 14 proximal median nerve injuries was conducted. 11 men and 3 women were enrolled into the study, mean age of participants was 42,3 years. In all cases proximal median nerve injury was accompanied by either axillary (4 cases) or brachial artery (10 cases) injury. 5 patients received direct repair of the median nerve. 9 patients received autologous grafting of the median nerve with mean gap between the stumps 7,5 cm. Both motor and sensory components of recovery were evaluated with MRC Scale and Seddon Scale respectively. Each patient evaluated the recovered median nerve mediated functions with Brief Michigan Hand Questionnaire. 14 cases with poor or no recovery of thenar muscles required tendon transfer (Bunne’sl transfer) to restore thumb opposition in later terms. Mean terms of recovery of the entire muscle-complex of the anterior surface of the forearm in all 14 patients with proximal median nerve injury was 12,9 months (with no reliable dependence on method of reconstruction). Mean MRC Scale score among all 14 patients was: 3,8 points for m. flexor pollicis longus, 4,4 points for mm. flexores digitorum and 4,4 points for m. flexor carpi radialis respectively. The median nerve mediated sensation recovered to 2,8 points on Seddon scale. Not a single patient showed effective recovery of the thenar muscles. Mean Brief MHQ score was 64,2 points – satisfactory recovery. 14 patients received effective thumb opposition within next 2 months post Bunnel’s tendon transfer. Mean Brief MHQ score increased to 78,2 points – good recovery. Surgical reconstruction of proximal median nerve injuries brings satisfying recovery of the entire muscle-complex of the anterior surface of the forearm, as well as the recovery to the median nerve mediated sensory component. Poor or no recovery of the thump opposition is majorly related to the distance between the site of the lesion and thenar’s motor-endplates. Bunnel’s tendon transfer dramatically increases functional outcomes at proximal median nerve injuries.

Surgical management of the proximal injury to the nerves of the upper extremity: strategy at overcoming multiple critical gaps

Aim of the study — to evaluate the outcomes of reconstruction procedures at complete injuries of brachial plexus in subclavicular region. The retrospective analysis of the reconstruction procedures in 3 men and one woman (mean age 36,4 years) with complete injury of brachial plexus in subclavicular region was conducted. Injury to musculocutaneuos, median, ulnar and radial nerves was accompanied by axillary (2 cases) or brachial (2 cases) artery injury. One patient had no injury to musculocutaneous nerve within the injury’s structure. All patients underwent surgical reconstruction of the neural structures 4,8 months (mean term) post initial vascular surgery. The autografting was the main reconstruction procedure of the long nerves of the upper extremity at their critical gap (mean gap 10,5cm) with donor-nerves of the small (sural nerve) and large (ulnar nerve) cross sectional diameter. Both motor and sensory components of recovery were evaluated with MRC Scale and Seddon Scale respectively. Each patient evaluated the recovered median nerve mediated functions with Brief Michigan Hand Questionnaire. It was revealed that one patients showed poor recovery of the entire complex of the muscles of the upper and lower arm (MRSC 2 points or lower). Two patients showed good recovery of the biceps brachii muscle (MRCS score 5 points) on 14th and 13th month respectively. Mean MRC Scale score among three patients for the muscles of the anterior compartment of the forearm was: 3,3 points for m. flexor pollicis longus, 3,6 points for mm. flexores digitorum and 4 points for m. flexor carpi radialis respectively. Mean MRC Scale score among three patients for the muscles of the posterior compartment of the forearm was: 2,6 points for m. extensor pollicis longus, 3,3 points for m. extensor digitorum sublimis and 4 points for radial wrist extensors respectively. The median nerve mediated sensation recovered to 2,3 points on Seddon scale. Only one patient showed effective recovery of the thumb opposition. Loss of ulnar nerve mediated functions was expectable among all 4 enrolled patients, thereafter we observed no recovery of key pinch and diagonal volar grip. Three patients showed recovery of transversal volar grip only. Mean Brief MHQ score was 55,55 points – unsatisfactory recovery. The reconstruction of the ulnar nerve, thereafter recovery of the “intrinsics”, should be the priority in terms of reanimation of the basic grips and pinches of the upper extremity – one should avoid harvesting of the ulnar nerve at multiple nerve injury cases; the expectable loss of functions at the utililization of the radial nerve as a donor nerve, could be easily recompensed with the tendon transfer procedures in later terms.

Physical Inactivity, Functional Status and Exercise Capacity in COPD Patients Receiving Home-Based Oxygen Therapy

ABSTRACTChronic obstructive pulmonary disease (COPD) has systemic consequences that lead to reduced physical activity in daily life (PADL). Little is known about PADL and its associations in individuals with COPD on home-based long-term oxygen therapy (LTOT). The objective of the study was to determine whether there is an association between severe physical inactivity and pulmonary function, fatigue, dyspnea, functional status and exercise capacity in individuals with COPD on home-based LTOT using electric oxygen concentrators and to investigate which of these variables could influence inactivity in these individuals. The population sample included 39 individuals with COPD who were on LTOT (69 ± 8 years, FEV1: 32 ± 14% predicted). They were assessed in terms of PADL (number of steps/day), fatigue (Fatigue Severity Scale – FSS), dyspnea (Medical Research Council – MRC scale), functional status (London Chest ADL scale [LCADL] and Timed Up and Go [TUG] test) and functional exercise capacity (Six-Minute Step test [6MST] and Sit-to-Stand test [STST]). PADL was markedly low (1444 ± 1203 steps/day) and associated with daily duration of LTOT (r = –0.50), fatigue (r = –0.36), LCADL (r = –0.41), 6MST (r = 0.48), and STST (r = 0.53) (p < .05 for all). Multiple linear regression revealed that daily duration of LTOT and STST explained 39% of the variability of PADL. Longer daily duration of LTOT, fatigue, worse functional status and exercise capacity were all associated with physical inactivity in individuals with COPD on LTOT, whereas daily duration of LTOT and the STST were determinants of reduced physical activity.

Excitability of sensory axons in amyotrophic lateral sclerosis

ObjectiveTo evaluate the excitability of sensory axons in patients with amyotrophic lateral sclerosis (ALS). MethodsComprehensive sensory nerve excitability studies were prospectively performed on 28 sporadic ALS patients, compared to age-matched controls. Sensory nerve action potentials were recorded from digit 2 following median nerve stimulation at the wrist. Disease severity was measured using motor unit number estimation (MUNE), the revised ALS Functional Rating Scale (ALSFRS-R) and the MRC scale. ResultsThere were no significant differences in standard and extended measures of nerve excitability between ALS patients and controls. These unchanged excitability measures included accommodation to long-lasting hyperpolarization and the threshold changes after two supramaximal stimuli during the recovery cycle. Excitability parameters did not correlate with MUNE, ALSFRS-R, APB MRC scale or disease duration. ConclusionsThis cross-sectional study has identified normal axonal membrane properties in myelinated sensory axons of ALS patients. Previously described sensory abnormalities could be the result of axonal fallout, possibly due to a ganglionopathy, or to involvement of central sensory pathways rostral to gracile and cuneate nuclei. SignificanceThese results demonstrate the absence of generalized dysfunction of the membrane properties of sensory axons in ALS in the face of substantial deficits in motor function.