Persistent Weakness Research Articles

Gastric inflammatory myofibroblastic tumor presented with severe anemia and inflammation: a case report

BackgroundInflammatory myofibroblastic tumor (IMT) is a rare stromal tumor, often found in children and young adults, and most commonly occurs in the lungs. Surgical resection is considered the standard treatment for localized IMT, although only limited data exist. Gastric IMT in adults is extremely rare, and there are no established guidelines for its treatment.Case presentationA 69-year-old male presented with persistent fatigue and weakness. Laboratory examination revealed severe anemia and inflammation. Upper gastrointestinal endoscopy at admission revealed a 40-mm type I softish tumor in the lesser curvature of the gastric body, without apparent hemorrhage. Repeated biopsies, including partial resection with snare, failed to give a definitive diagnosis. Computed tomography (CT) revealed a massive lesion at the gastric body, protruding into the gastric lumen, which was consistent with the gastric tumor. After admission, the patient developed anemia refractory to frequent blood transfusions despite the absence of apparent gastrointestinal bleeding. In addition, the patient had recurrent fevers of 38 °C or higher, and persistent high inflammatory levels. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT 1 month after the first visit exhibited an increased FDG uptake in the gastric tumor. In addition, this CT scan revealed a rapid increase in tumor size to 75 mm. It was suspected that the undiagnosed gastric tumor caused these serious clinical symptoms, and he underwent distal gastrectomy and cholecystectomy. The gross image of the tumor showed an 80-mm cauliflower-like shape with a gelatinous texture. The histopathological diagnosis was IMT. The postoperative course was uneventful, and the patient’s symptoms subsided drastically, improving both anemia and systemic inflammation. The patient has shown no recurrence or relapse of the symptoms over one and a half years.ConclusionsIn this case, the tumor resection finally enabled the diagnosis of IMT and resolved the clinical symptoms. Despite its predominantly benign morphological nature, some cases of IMT present clinically adverse courses. Surgical treatment may lead to its final diagnosis and improvement of clinical symptoms.

An Adult with Exertional Breathlessness after Cardiac Surgery

Abstract Iatrogenic complications such as phrenic nerve injury are common during cardiac surgery. Sometimes, unilateral phrenic nerve injury during cardiac surgery may result in persistent weakness or paralysis which may manifest as exertional breathlessness months later with mild restrictive ventilatory defect on spirometry and elevated hemidiaphragm on chest X-ray.

Idiopathic Neuralgic Amyotrophy in a Child Treated with Integrated Rehabilitation Program: A Case Report

Idiopathic neuralgic amyotrophy (INA) in children is a rare peripheral neuropathy showing distinctive clinical features. An 8-year-old boy presented with left shoulder pain and weakness lasting 4 weeks. He had learned Taekwondo and swimming before the onset of pain. A fever had developed 10 weeks before onset but had completely resolved after medication. Initially, he was diagnosed with shoulder subluxation and underwent successful reduction. However, he continued to complain of persistent pain and weakness. All the studies indicated normal findings, except for the electrodiagnostic assessment, which revealed partial brachial plexopathy. A rehabilitation program was performed. It consisted of physical and occupational therapy twice a week. After 5-month rehabilitation, the patient remarkably improved in both neurologic and functional status. INA should be considered and evaluated in cases with abrupt onset of shoulder pain and weakness in children. Also, an integrated rehabilitation program during the subacute phase can be helpful to facilitate neurologic and functional recovery and reduce sequelae.

Peroneal tendon injuries

The peroneal tendons work to both evert the foot and stabilize the hindfoot on plantarflexion and push off. The tendons are frequently injured as part of sprains and soft tissue injuries to the ankle joint, but diagnosis and treatment are often delayed. Athletes participating in activities with repetitive ankle motion, particularly those involving cutting and twisting movements, as well as those with certain anatomical features, are prone to peroneal tendon injury. Often synovitis and low-grade tendinopathy of the peroneal tendons can be managed with physiotherapy and bracing. Large longitudinal tears, rupture, and subluxation or dislocation of the tendons from the retromalleolar groove are more likely to be treated operatively, although pre-surgical rehabilitation will still be useful in chronic cases. Other surgical procedures can be combined as part of an effective treatment plan such as ankle arthroscopy, ligament stabilization and realignment procedures such as a lateralizing calcaneal osteotomy and Barouk–Rippstein–Toullec first metatarsal elevation osteotomy for non-neurogenic cavus. Persistent weakness in the peroneal tendons post injury may contribute to worsening hindfoot varus deformity: in turn, this leads to further stress on peroneus brevis which can lead to its rupture and consequently further deformity if untreated.

Prevalence and clinical implications of heterotopic ossification after distal biceps tendon repair.

Complete distal biceps tendon ruptures are relatively uncommon. Conservative treatment may result in persistent pain and weakness. Therefore, surgical repair is usually indicated in order to restore strength. Different surgical techniques and fixation methods have been described. The most reported complications after surgery are iatrogenic nerve damage, heterotopic ossification (HO) and re-rupture. Heterotopic ossification can be variable in size. Significant HO can limit range of motion while minor HO often remains asymptomatic. The overall presence of HO is likely underreported in literature, as imaging is reserved for symptomatic patients. The purpose of this study is to report the prevalence and clinical implications of heterotopic ossification after surgical repair of the distal biceps tendon. This retrospective study assessed the prevalence and clinical relevance of postoperative HO after distal biceps tendon repair. CT-scans were used to evaluate size and location of the HO. VAS scores, DASH scores, MEPI, and range of motion (ROM) were assessed to evaluate pain, patient satisfaction and elbow function. HO was observed on CT images of 19 out of 35 patients (54%). The use of interference screws, timing of surgery after rupture and timing of radiographic assessment postoperatively did not influence the prevalence of HO. The presence of HO had no statistically significant impact on the VAS scores, ROM measurements and MEPI and DASH scores. According to our findings, the overall incidence of HO is higher than previously reported but there are no differences in clinical outcomes when compared to patients without HO.

Who's Afraid of Electrical Stimulation? Let's Revisit the Application of NMES at the Knee.

BACKGROUND: Restoring quadriceps strength is essential for successful rehabilitation of knee injuries, but many athletes return to their previous activity with persisting muscle weakness. Strong evidence supports using neuromuscular electrical stimulation (NMES) to improve quadriceps strength; however, there is a lack of widespread clinical implementation. We believe there is a critical need to provide clinical approaches that promote using NMES to improve patients' quadriceps strength and ensuring clinicians provide high-value rehabilitation care. CLINICAL QUESTION: What is best practice when using NMES to facilitate strength after injury, what are barriers to its use, and how can they be addressed? KEY RESULTS: We discuss the low clinical implementation of NMES, perceived barriers to using NMES, and provide recommendations for setup and dosage parameters for effective use of NMES. CLINICAL APPLICATION: We aim for this commentary, with accompanying videos, to serve as a resource for clinicians who are using commercially available NMES units in clinical practice. J Orthop Sports Phys Ther 2024;54(2):1-6. Epub 31 October 2023. doi:10.2519/jospt.2023.12028.

Dynamical analysis on stochastic two-species models

In this paper, we study three stochastic two-species models. We construct the stochastic models corresponding to its deterministic model by introducing stochastic noise into the equations. For the first model, we show that the system has a unique global solution starting from the positive initial value. In addition, we discuss the extinction and the existence of stationary distribution under some conditions. For the second system, we explore the existence and uniqueness of the solution. Then we obtain sufficient conditions for global asymptotic stability of the equilibrium point and the positive recurrence of solution. For the last model, the existence and uniqueness of solution, the sufficient conditions for extinction and asymptotic stability and the positive recurrence of solution and weak persistence are derived. And numerical simulations are performed to support our results.

Nonlinear dynamics and stochastic optimal control of a Huanglongbing epidemic model with resistance

Citrus Huanglongbing (HLB) epidemic diseases is a destructive threat to the citrus industry worldwide. In this paper, a stochastic epidemic model is proposed for the transmission of Huanglongbing in scenarios between Asian citrus psyllid and the citrus trees host. The influence of insecticide resistance is considered and the dynamical properties of the new model are mathematically analyzed. It is proved that the model is well-posed by obtaining the existence of a single global positive solution. Further, when R 2 > 1, weak persistence in the mean is obtained by developing a suitable Lyapunov function and sufficient criteria R 1 < 1 is derived for the extinction of the disease. Moreover, the analysis of stochastic optimality is used, and a proper strategy is studied to provide a theoretical basis for the prevention and control of HLB. Numerical simulations and examples are carried out to verify the main theoretical results.

The impact of Lévy noise on the threshold dynamics of a stochastic susceptible‐vaccinated‐infected‐recovered epidemic model with general incidence functions

Compartmental systems like the well‐famed SIR, SEIR, SQIR, SVIR, and their variants are efficient tools for the mathematical modeling of infectious illnesses, and they permit us to get a clear picture of how they proliferate. In actuality, the aleatory fluctuations factors present in the natural environment like storm surges, weather changes, and seismic tremors make the dissemination of epidemics susceptible to some randomness. This calls for a stronger mathematical formulation that takes into consideration this stochasticity effect. From this perspective, and in order to highlight in the same time the effect of the vaccination strategy, we survey in this paper an SVIR model with general incidence rates that is disturbed by both Brownian motions and Lévy jumps. Initially, we establish its well‐posedness in the sense that it has a unique positive and global‐in‐time solution. Then, we rely on some assumptions and nonstandard analytic techniques, to derive sufficient and almost necessary conditions for extinction, persistence in the mean, and also weak persistence. More explicitly, we identify firstly under some hypotheses a threshold between extinction and persistence in the mean. In other phrases, if , the infected population dies out while it persists in the mean when . Then, and by modifying the hypothetical framework in order to cover more incidence rates, we prove that can act also as a threshold between extinction and weak persistence. At last, we provide some numerical simulations to corroborate our findings and cover some particular cases of response functions.

Refractory myasthenia gravis: the more we learn, the less we know.

Refractory myasthenia gravis identifies the group of patients that have inadequate symptom control and persistent muscle weakness and fatigability despite the use of multiple immune modulatory therapies. This manuscript highlights what is currently known about refractory myasthenia gravis and underlines major knowledge gaps, drawing attention to the unmet needs in our understanding of this disease subset. This review raises questions about our current understanding of refractory disease and how emerging data as well as therapies may alter our thinking and patients’ disease course.

Ramsay hunt syndrome in an immunocompromised patient

A 37-year-old male presented to the emergency department with headache, confusion, right-sided facial droop, and painful rash. One month prior, he underwent staged resection of an intraventricular neurocytoma and was placed on a postoperative dexamethasone taper. Examination revealed weakness in the right cranial nerve VII distribution (Figure 1A), clustered vesicles with erythema in the right ear canal and conchal bowl (Figure 1B), and scattered vesicles on the preauricular cheek. The right anterior third of his tongue had clusters of pustulovesicles (Figure 1C). The patient was diagnosed with Ramsay Hunt Syndrome (herpes zoster oticus) and urgently started on IV acyclovir. Confirmatory PCR was positive for varicella zoster virus. The patient was discharged with improved mental status. Skin lesions resolved after a 2-week course of IV acyclovir and valacyclovir, but at his 2-year follow-up the patient had persistent facial weakness, vestibular symptoms, and photophobia. Recognizing Ramsay Hunt Syndrome early is crucial as antiviral therapy is most effective when initiated within the first three days of facial paralysis onset. Early treatment may prevent long-term sequelae including permanent facial muscle weakness, hearing loss, corneal scarring, postherpetic neuralgia, tinnitus, vertigo, and taste perception changes. Even with prompt recognition and treatment, immunocompromised patients are likely to have a more severe disease process and less complete recovery.

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

BackgroundPersistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR.MethodsPatients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers.ResultsA total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05).ConclusionIn this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.

#6068 ERYTHROPOIETIN RESISTANCE IN HAEMODIALYSIS PATIENTS POST SARS-COV-2 INFECTION

Abstract Background and Aims During the SARS-CoV-2 pandemic, patients undergoing chronic haemodialysis treatment were at particularly high risk of infection. This was due to their vulnerability given their state of immunosuppression and multiple comorbidities, on the one hand, and the circumstances that limited physical distancing during treatment, on the other. Even after negativation, patients with a previous infection experience symptoms such as persistent asthenia, muscle weakness, widespread pain and deterioration in perceived health status. In our study, we aimed to investigate the parameters of anaemia and the change in the erythropoietin resistance index (ERI) in haemodialysis patients with previous infection. Method We included 25 patients with a dialysis age &amp;gt;6 months, giving a total of 72 measurements. The distribution was assessed with the Kolmogorov-Smirnov test and with a graphical evaluation of the same. We calculated the ERI 3 months before the date of infection and in the 3 and 6 months after. These data were also compared with a control group. Patients were divided into 2 groups: Group A (patients with previous infection) and Group B (control group). Linear mixed models were performed to calculate the slope between the group and the ERI index. Results No statistically significant differences were found. The LMMs showed a significant interaction between the scores obtained at the visits performed and the study group, with a decrease in ERI over time of 0.21 at each visit. Conclusion Our results show that patients with previous Covid 19 infection have higher resistance to erythropoietin and require higher doses even months after infection. The response to erythropoietin in this population should be investigated in studies with larger cohorts, as anaemia is an important factor affecting the quality of life of our patients.

Interlimb Asymmetry in Knee Extension Moment During Double-Leg Squatting Is Associated With Persistent Quadriceps Weakness After ACL Reconstruction

Background: Although double-leg squatting is less dynamic and places less demand on the quadriceps compared with landing tasks, the relationship between double-leg squatting biomechanics and persistent quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is unknown. Purpose: To clarify the relationships between asymmetries in quadriceps strength and lower limb biomechanics during double-leg squatting &gt;1 year after ACLR. Study Design: Controlled laboratory study. Methods: A total of 26 participants (5.5 ± 3.8 years after ACLR) were enrolled. The limb symmetry index (LSI) of isokinetic quadriceps strength was used to divide participants into the high-quadriceps (HQ) group (LSI ≥90%; n = 18) and the low-quadriceps (LQ) group (LSI &lt;90%; n = 8). The knee, hip, and ankle extension moment (relative to body weight and support moment [sum of knee, hip, and ankle moments]) and vertical ground-reaction force during double-leg squatting were analyzed using 3-dimensional motion analysis. The association of quadriceps strength and biomechanical variables was tested using 2-way analysis of variance and univariate regression analysis. Results: A significant group-by-limb interaction was found for the peak knee extension moment and the ratios of knee and hip extension moment to support moment ( P &lt; .001, P = .015 and P &lt; .001, respectively). The LQ group showed a significantly smaller peak knee extension moment and knee to support moment ratio but a larger hip to support moment ratio in the involved limb than in the uninvolved limb (95% CIs: knee extension moment, −0.273 to −0.088 N·m/kg; knee to support moment ratio, −10.7% to −2.2%; hip to support moment ratio, 3.2% to 8.5%). No interlimb difference was found for the HQ group. The LSI of quadriceps strength was significantly associated with the LSI of peak knee extension moment ( R 2 = 0.183), knee to support moment ratio ( R 2 = 0.256), and hip to support moment ratio ( R 2 = 0.233). The mean maximum isokinetic quadriceps strength and peak knee extension moment during squatting on the involved limb of the LQ group were 2.40 ± 0.39 and 0.90 ± 0.16 N·m/kg, respectively. Conclusion: Asymmetrical biomechanics during double-leg squatting was associated with persistent quadriceps weakness after ACLR. The LQ group had reduced knee extensor moment on the involved side during squatting despite loading at approximately half the maximum strength. Clinical Relevance: Quadriceps strengthening exercises, together with interventions to improve neuromuscular control, may reduce asymmetrical biomechanics during double-leg squatting.

Seizure After Ischemic Stroke; A Diagnostic and Management Challenge in a Resource Limited Setting: A Case Report

Background: Poststroke seizures occur in 6-8% of the adult population that suffer an ischaemic stroke. This pathological process increases metabolic stress and cell death, the extent of vascular obstruction in the brain, the mortality rate and long term morbidity. Poststroke seizures represent one of the most important complications of stroke that must be recognised and treated in a timely fashion. These are classified as either early or late depending on the time of onset after stroke. Case Report: A 51 year old woman presented to the Emergency Department of RSUD Dr Murjani following a generalised tonic-clonic seizure 3 hours prior that had lasted for two minutes. On arrival the patient subsequently had two further generalised tonic-clonic seizures with a one hour interval between. Whole body stiffness and a fixed upward gaze were observed. A non-contrast CT Head displayed a diffuse infarct of the left frontotemporoparietooccipital lobes. The patient had a history of stroke one year previously and a second stroke one month ago with resultant persistent weakness of the right upper and lower limbs. This patient was diagnosed with poststroke seizure of late onset and treated in hospital with diazepam 10mg and phenytoin 100mg three times per day. Discussion: Poststroke seizure is described as either early-onset (occurring in the first week after a stroke) or late-onset (occurring after the first week). Based on the International League Against Epilepsy (ILAE) definition, a single unprovoked late-onset poststroke seizure occurring more than seven days after a stroke is considered as epilepsy with a high risk (&gt;60%) of recurrent seizures that may occur for up to ten years thereafter. Hence this risk factor must be identified and treated correctly to prevent significantly increased morbidity for the patient

Cardiorespiratory Response to Six-Minute Step Test in Post COVID-19 Patients-A Cross Sectional Study.

New coronavirus disease 2019 (COVID-19) can cause persistent symptoms and physical weakness that can lead to a limitation in activities of daily living (ADL). There is a lack of evidence about the performance in the six-minute step test (6MST) of post-COVID-19 patients and healthy subjects. The aim of this study is to investigate the cardiorespiratory response induced by the 6MST in post-COVID-19 patients and compare it with the response of the six-minute walk test (6MWT). This cross-sectional study was conducted on 34 post-COVID-19 patients and 33 healthy subjects. The assessment was performed at one month from a non-severe SARS-CoV-2 infection. Both groups were assessed by using the 6MST, 6MWT, and the pulmonary function test (PFT). Post COVID functional status (PCFS) scale was used for the post-COVID-19 group to assess functional status. Physiological responses; heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), blood pressure (BP), and Borg scale for fatigue and dyspnea were recorded before and after the 6MST and 6MWT. the performance of the post-COVID-19 group was worse than the healthy group in both tests. In 6MWT, the distance walked by the post-COVID-19 group (423 ± 7) was 94 m less than the healthy group, and the number of climbed steps in the 6MST (121 ± 4) was 34 steps less than the healthy group. Both results were statistically significant (p < 0.001). There was a moderate positive correlation between the 6MST and 6MWT in walked distance versus steps number (r = 0.5, p < 0.001). In addition, there was a moderate correlation between the two tests in the post (HR, RR, SpO2, systolic blood pressure SBP, diastolic blood pressure DBP, dyspnea, and fatigue) with p < 0.001. Six-minute step tests produced similar cardiorespiratory responses when compared to a 6MWT. The 6MST can be used as an assessment tool for COVID-19 patients to evaluate their functional capacity and ADL.

Solitary Extremity Schwannoma: A 20-Year Review of Outcomes.

Background: Reports on benign peripheral nerve sheath tumour extirpation over the last number of decades describe varying patient outcomes. We present our outcomes following excision of solitary extremity schwannoma over a 20-year period. Methods: A regional histopathology review was conducted for, "benign nerve sheath tumour" and schwannoma between 2000 and 2020. This search provided 131 histologically confirmed schwannomas that were excised from the extremities of 123 patients. Individual charts were reviewed retrospectively to establish presenting features and post-operative outcomes. Results: One hundred and twenty three patients underwent schwannoma excision, including 8 patients with synchronous tumours. The mean age at presentation was 49 years (range 11-92 years). The most common presenting symptoms were the following: palpable mass (88%), pain (70%), paraesthesia (21%), numbness (13%), and motor deficit (4%). Post-operative follow-up ranged from 1 to 168 months (mean 12.3 months) (N = 99). Fifty-eight cases reported complete resolution of symptoms by end of outpatient follow-up (59%). The remaining reported either residual or new numbness (21%), paraesthesia (11%), pain (10%), weakness (4%), hypertrophic or keloid scar (3%), or a combination. Thirty patients (30%) developed new symptoms post-operatively including numbness (13%), paraesthesia (10%), pain (2%), and weakness (2%). There was a trend towards higher risk of post-operative pain, numbness or paraesthesia in patients undergoing excision of schwannomas on larger mixed nerves than in patients undergoing excision on smaller sensory nerves (P = .0531). Conclusion: Surgical excision of benign schwannomas is a successful procedure, especially for pain management, however, complete symptom resolution cannot be guaranteed, and the risk of new or persisting numbness, paraesthesia, pain, and weakness should be highlighted to patients during the consent process.

The role of circulatory chemokines in sepsis-induced myopathy in mice

BACKGROUND: Sepsis is a condition of life-threatening organ dysfunction caused by a dysregulated host response to infection and carries a high risk of mortality. A rapidly growing number of “sepsis survivors” experience persistent and severe skeletal muscle weakness and atrophy (i.e., sepsis-induced myopathy). The myopathy is triggered by the interaction of circulating pathogens, inflammatory factors (e.g., cytokines and chemokines), and myofibers. Currently, there are no treatments for sepsis-induced myopathy partially due to a lack of therapeutic targets. Chemokines are peptides that possess chemo attractant properties and are released by immune cells during infection insult. Circulating levels of chemokines in septic patients are known to be high. However, the role these chemokines play in context of sepsis-induced myopathy is currently unknown. Our goal in this study was to identify the role of circulating chemokines on sepsis-induced myopathy. METHODS: We induced sepsis via cecal ligation and puncture (CLP) or sham control surgeries in a group of young adults (5 mo) male C57BL6 mice. Seven days after surgery, serum was collected from sham and CLP mice. The serum samples were pooled for cell culture experiments. In a subset of healthy mice, we isolated primary myoblasts. The myoblasts were co-cultured in conditioned media containing pooled serum samples collected from sham and CLP mice. We performed a multiplex assay to identify the levels of chemokines on the pooled serum samples. We measured myoblast proliferation, myotube area, and fusion index. In follow-up experiments, we exposed C2C12 myotubes to a selected group of chemokine peptides previously identified in serum samples. RESULTS: Exposure to septic serum attenuated the proliferative capacity of healthy myoblasts by 46% (p &lt; 0.05). In addition, myoblasts exposed to septic serum did not differentiate into healthy myotubes. Multiplex analyses of pooled sham and septic serum revealed a marked elevation of the following chemokines: CXCL-1 (healthy = 173.4 ± 0.1, septic = 69,630 ± 13,732 pg/ml), CXCL-2 (healthy = 1,078 ± 0.1, septic = 3,907 ± 259 pg/ml), CXCL-10 (healthy = 366 ± 0.1, septic = 3,961 ± 293 pg/ml), CCL-2 (healthy = 276 ± 0.1, septic = 1672 ± 362 pg/ml). Exposure of mature C2C12 myotubes to the chemokine peptides for 24 h increased the mRNA expression of atrophy-related genes ( FOXO1, GABARAP, BNIP3, TRIM63, MAP11A3B, FOXO32, FOXO30). CONCLUSION: Circulating chemokines play a regulatory role in sepsis-induced myopathy via attenuation of the proliferative capacity of myoblasts and by altering myotube morphology and the expression of atrophy related genes. Chemokines are potential therapeutic targets to treat sepsis-induced myopathy. Funded by NIH R21AG072011-03 to OL This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Short-Term Complications of Relative Femoral Neck Lengthening Combined with Extra-Articular Osteotomies of the Proximal Femur.

Relative femoral neck lengthening (RNL) is a newer technique to correct coxa breva and coxa vara to relieve a femoro-acetabular impingement and improve hip abductor function without changing the position of the head on the shaft. Proximal femoral osteotomy (PFO) changes the position of the femoral head relative to the shaft. We studied the short-term complications of procedures that combined RNL with PFO. All hips that underwent RNL and PFO using a surgical dislocation and extended retinacular flap development were included. Hips that were treated only with intra-articular femoral osteotomies (IAFO) were excluded. Hips that underwent RNL and PFO, with IAFO and/or acetabular procedures were included. Intra-operative evaluation of the femoral head blood flow was performed with the drill hole technique. Clinical evaluation and hip radiographs were obtained at 1week, 6weeks, 3months, 6months, 12months and 24months. Seventy two patients (31 males, 41 females, 6-52years of age) underwent 79 combined RNL and PFO. 22 hips underwent additional procedures like head reduction osteotomy, femoral neck osteotomy, and acetabular osteotomies. There were 6 major and 5 minor complications noted. Two hips developed non-unions, both with basicervical varus-producing osteotomies. Four hips developed femoral head ischemia. Two of these hips avoided collapse with early intervention. One hip had persistent abductor weakness requiring hardware removal and three hips, all in boys developed symptomatic widening of the hip on the operated side from varus-producing osteotomy. One hip had asymptomatic trochanteric non-union. RNL is routinely performed by releasing the short external rotator muscle tendon insertion from the proximal femur to raise the posterior retinacular flap. Though this technique protects the blood supply from direct injury, it seems to stretch the vessels with major corrections in the proximal femur. We recommend evaluating the blood flow intraoperatively and postoperatively and taking necessary steps early to decrease the stretch on the flap. It may be safer to avoid raising the flap for major extra-articular proximal femur corrections. The results of this study suggest ways to improve the safety of procedures that combine RNL and PFO.

Neuromotor Treatment of Arthrogenic Muscle Inhibition After Knee Injury or Surgery.

Persistent weakness of the quadriceps muscles and extension deficit after knee injuries are due to specific alterations in neural excitability - a process known as arthrogenic muscle inhibition (AMI). The effects of a novel neuromotor reprogramming (NR) treatment based on the use of proprioceptive sensations associated with motor imagery and low frequency sounds have not been studied in AMI after knee injuries. This study aimed to assess quadriceps electromyographic (EMG) activity and the effects on extension deficits in persons with AMI who completed 1 session of NR treatment. We hypothesized that the NR session would activate the quadriceps and improve extension deficits. Case series. Level 4. Between May 1, 2021 and February 28, 2022, patients who underwent knee ligament surgery or sustained a knee sprain with a deficit of >30% of the vastus medialis oblique (VMO) on EMG testing in comparison with the contralateral limb after their initial rehabilitation were included in the study. The maximal voluntary isometric contraction of the VMO measured on EMG, the knee extension deficit (distance between the heel and the table during contraction), and the simple knee value (SKV) were assessed before and immediately after completion of 1 session of NR treatment. A total of 30 patients with a mean age of 34.6 ± 10.1 years (range, 14-50 years) were included in the study. After the NR session, VMO activation increased significantly, with a mean increase of 45% (P < 0.01). Similarly, the knee extension deficit significantly improved from 4.03 ± 0.69 cm before the treatment to 1.93 ± 0.68 after the treatment (P < 0.01). The SKV was 50 ± 5.43% before the treatment, and this increased to 67.5 ± 4.09% after the treatment (P < 0.01). Our study indicates that this innovative NR method can improve VMO activation and extension deficits in patients with AMI. Therefore, this method could be considered a safe and reliable treatment modality in patients with AMI after knee injury or surgery. This multidisciplinary treatment modality for AMI can enhance outcomes through the restoration of quadriceps neuromuscular function and subsequent reduction of extension deficits after knee trauma.