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Cardiac papillary fibroelastoma is a benign and rare primary tumor of the heart that is most frequently located in the aortic or the mitral valves. Papillary fibroelastoma arising from the left atrium is exceedingly rare, comprising less than 7% of all cardiac papillary fibroelastomas. Tumors in this location could be a source of cardioembolic stroke, often in the anterior circulation of the cerebrum. A 66-year-old female presenting with right hemiparesis, central facial palsy, homonymous hemianopia, and dysarthria received intravenous thrombolysis for stroke without apparent improvement. Magnetic resonance imaging of the brain revealed ischemic infarction in the territories of the left middle and posterior cerebral arteries. A tumor with a maximal diameter of 2.3 cm was disclosed during workup for possible cardioembolic stroke with transthoracic echocardiography and computed tomography of the heart. The clinical course was complicated by stroke-in-evolution and hemorrhagic transformation. The patient underwent left atrial tumor excision and left atrium appendage closure. In-patient stroke rehabilitation programs were also initiated after the conditions stabilized. No clinically significant complications developed after the operation. Neurological functions improved and the patient was able to perform most basic daily living activities with some assistance. An exhaustive search for the cause of cardioembolic stroke is paramount, as management strategies may differ from patients with thrombotic stroke.

To investigate how sensory symptoms impact the motor control of hands, in this study we examined the differences in conventional sensibility assessments and pinch force control in the pinch-holding-up activity (PHUA) test between carpal tunnel syndrome (CTS) patients and healthy controls. CTS patients (n = 82) with 122 affected hands and an equal number of control subjects were recruited to participate in the threshold, discrimination, and PHUA tests. The patients showed significantly poorer hand sensibility and lower efficiency of force adjustment in the PHUA test as compared with the control subjects. Baseline pinch strength and the percentage of maximal pinch strength for the PHUA were significantly higher for the subgroup of sensory nerve action potential (SNAP) of <16 μV than for the subgroup of SNAP of ³16 μV. Using a PHUA perspective to analyze the efficiency of force-adjustment could assist the clinical detection of sensory nerve dysfunction. [ABSTRACT FROM AUTHOR]

Study Design: Case-controlled cohort study. Introduction: Sensory function is difficult to observe during nerve regeneration processes. Traditional sensory tests are limited to identifying the level of functioning hand sensation for sensory stimulus is given passively to the cutaneous surface of the hand. Purpose of the Study: To examine the outcome changes in the manual tactile test (MTT), Semmes -Weinstein monofilament (SWM) and 2-point discrimination (2PD) tests for patients with nerve repair and to investigate the concurrent validity of MTT by comparing it with the results of traditional tests. Methods: Fifteen patients with nerve injury of the upper limbs were recruited, along with 15 matched healthy controls. The MTT, SWM, and 2PD tests were used to examine the sensory status of the subjects. Results: Three subtests (barognosis, roughness differentiation, and stereognosis) in MTT showed that the patients improved with time. A moderate and mild correlation was found between the MTT and 2PD results and between the barognosis and SWM results. Conclusions: The MTT provides practical and functional perspectives on detecting nerve progression during the courses of degeneration and regeneration. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a degenerative disorder resulting from loss of joint cartilage and underlying bone and causes pain and loss of function. The treatment of knee OA is still a challenge because of the poor self-regeneration capacity of cartilage. The nonsurgical interventions include control of the aggravating factor (such as weight control and the use of walking aids), symptomatic treatment (such as acetaminophen or nonsteroidal anti-inflammatory drugs), prolotherapy, and viscosupplementation. However, the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) has not been widely used because of lack of clinical evidence and several limitations in patients with severe knee OA. Three patients who suffered from knee pain and poor walking endurance were diagnosed with advanced knee OA. They underwent PRP treatment in association with intra-articular HA injection and showed pain relief and functional improvement. The follow-up standard weight-bearing X-ray images of knees also confirmed the improvement and indicated the possibility of regeneration of the articular cartilage. These cases provide clinical and radiographic evidence for a new therapy for advanced knee OA. This treatment strategy of PRP in association with HA injection can offer a chance to treat severe knee OA, rather than immediate surgery, or a chance for those who cannot undergo surgery. It can also postpone the need of arthroplasty and can significantly improve the daily activity function. [ABSTRACT FROM AUTHOR]

Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is a newly recognized, potentially fatal, but treatable autoimmune disease. Good outcome predictors include milder severity of symptoms, no need for intensive care unit admission, early aggressive immunotherapy, and prompt tumor removal. We report a case of a young girl aged 3 years 2 months and diagnosed as recalcitrant anti-NMDA receptor encephalitis without any underlying neoplasm. The patient had initial symptoms of behavioral changes that progressed to generalized choreoathetosis and orofacial dyskinesia, which resulted in 6 months of hospitalization in the pediatric intensive care unit. One year after initial onset of the disease, she had only achieved the developmental age of an infant aged 6–8 months in terms of gross and fine motor skills, but she resumed total independence in activities of daily living after receiving extensive immunotherapy and 28 months of rehabilitation. Our brief review will help clinical practitioners become more familiar with this disease and the unique rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background To identify the relationship between perceived environmental barriers and disability in community-dwelling elderly. Methods Cross-sectional study in two community service centers in Tainan. We enrolled 200 community-dwelling residents, aged above 65 years, who had resided in the same community for at least 12 months. Basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were assessed using the Hierarchy of Care Required (HCR). There were 59 participants in BADL disability and 109 in IADL disability. Perceived environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors (CHIEF). We used multinomial logistic regression to examine the relationship of perceived environmental barriers and disability. Results The presence of perceived environmental barriers was related to BADL disability (OR = 4.39, 95% CI = 1.01-19.11) and IADL disability (IADL with difficulty in 1-2 tasks: OR = 9.93, 95% CI = 3.22-30.56; IADL with difficulty in more than 2 tasks: OR = 8.40, 95% CI = 1.83-38.51). The presence of physically/structurally perceived environmental barriers was related to BADL disability (OR = 4.90, 95% CI = 1.01-23.86) and IADL disability (IADL with difficulty in 1-2 tasks: OR = 4.61, 95% CI = 1.27-16.76; IADL with difficulty in more than 2 tasks: OR = 17.05, 95% CI = 2.82-103.30). Conclusions Perceived environmental barriers are related to disability in community-dwelling elderly. [ABSTRACT FROM AUTHOR]

Dystonia is a rare manifestation of multiple sclerosis (MS), but it always interferes with the functional performance and quality of life. We report a rare case of long-lasting paroxysmal dystonia associated with MS. The patient was a 40-year-old woman with relapsing- remitting MS for 6 years. During the latest attack of MS, she suffered from long-lasting paroxysmal dystonia in her left hand. Despite treatment with pulse high-dose intravenous methylprednisolone, interferon, and baclofen, along with occupational therapy, the dystonia persisted and significantly bothered her daily activities. Finally, she was treated with oral acetazolamide (250 mg, three times a day for 4 days), which was very effective for the control of her dystonia. The dystonic movement subsided without recurrence in a follow-up of 17 months. We advocate this effective and safe treatment for patients with paroxysmal dystonia associated with MS. [ABSTRACT FROM AUTHOR]

The article discusses a randomised, placebo-controlled trial, evaluating the effect of a topical 5 percent lidocaine patch in the treatment of myofascial pain syndrome (MPS) of the upper trapezius. The results showed that, within a week, the pain intensity assessed using the Verbal Rating scale (VRS) decreased significantly in the treatment group compared to that of the placebo group. However, the range of motion (ROM) and neck disability index (NDI) between the two groups, did not differ.

The article discusses the study which aims to investigate the correlation between the irritability of the myofascial trigger point (MTrP) and the prevalence of endplate noise (EPN) in the MTrP region of human skeletal muscle. Researchers have recruited 20 normal subjects with latent MTrPs and patients with active MTrPs in the upper trapezius muscle. Results of the study show that the prevalence of EPN in the MTrP regions is significantly higher in the active MTrPs than in the latent ones, however, no EPN could be found in the non-MTrP region near the active or the latent MTrPs. In addition, the pain intensity and the pressure pain threshold are highly correlated with the prevalence of EPN in the MTrP region.

Objective: This case report describes a patient with chronic recurrent myofascial pain syndrome in the shoulder/scapular area secondary to teres minor tendinitis. The purpose is to emphasize the importance of treating the underlying pathological lesion in order to eliminate the recurrent trigger points [TrPs] completely and permanently. Methods: This 42-year-old male patient had chronic myofascial pain in the right scapular area. Initially, he was treated conservatively with medication and physical therapy and had only temporary pain relief for few days. Later, he was treated with TrP injections and had better results. However, the effectiveness of pain relief lasted for only two to three weeks. Results: Finally, he was found to have chronic tendinitis of teres minor muscle and received local steroid injection followed by TrP injection with complete pain relief. A follow-up confirmed that he has no pain recurrence up to two years. Conclusion: It is concluded that chronic recurrent myofascial pain syndrome in the shoulder/scapular area may be caused by teres minor tendinitis. It is necessary to eliminate the underlying etiological lesion appropriately in order to avoid the recurrence of myofascial pain. It may also be necessary to inject the TrPS in addition to the treatment of underlying pathology to obtain a complete pain relief. [ABSTRACT FROM AUTHOR]

Objective: One of the important characteristics of myfascial trigger point [MTrP] is spontaneous electrical activity [SEA]. Spontaneous electrical activity is recorded from an active locus [a basic unit] of MTrP and has been considered as an abnormal endplate potential, which might be due to excessive acetylcholine release in neuromuscular junction. This study is designed to test the hypothesis that active loci in MTrPs are related to neuromuscular tranmission disorder. Methods: Twenty-one adult New Zealand rabbits were anesthetized and their biceps femoris were exposed to localize myofascial trigger spot [MTrS, equivalent to MTrP in human]. A monopolar needle electrode was first used for searching SEA in an MTrS region. Then, a single fiber electromyography [SFEMG] electrode was used to collect the neuromuscular jitter at the site where SEA was recorded. The same procedure was performed at the normal muscle site [no SEA recorded] in contralateral limb to collect the neuromuscular jitter as a control. Mean value of consecutive differences [MCD] of 100 successive interpotential intervals was calculated to express the neuromuscular jitter. Results: There was no statistically significant difference [P > 0.05] in MCD of MTrS between the active loci and control sites. Conclusion: It appears that the neuromuscular transmission of endplate in MTrS in rabbits is not impaired based on this SFEMG study using jitter as the sole criteria. Spontaneous electrical activity is not related to neuromuscular transmission abnormality. Further studies are required to clarify the mechanism of dysfunctional endplates in relation to MTrP. [ABSTRACT FROM PUBLISHER]

Objectives: This study is designed to investigate the change of the pressure pain threshold [PPT] of latent myofascial trigger points [MTrPs], immediately after rapid repetitive contraction of the involved muscle. Methods: Forty 8-19 year-old students who had taken piano lessons for longer than one year. Three consecutive measurements of PPT were obtained on the latent MTrPs of bilateral extensor digitorium communis muscles 20 minutes before, immediately before, immediately after, and 20 minutes after continuous piano practice of fast music pieces for 20 minutes. Results: Mean pain threshold was significantly [P < 0.01] reduced immediately after piano practice, and returned to original value 20 minutes after practice. There was no statistically significant difference between the mean value of 20 minutes before practice and immediately before practice [control values]. There was no significant difference between the right and the left hands. Age and experience were not significantly correlated with the changes of pain threshold. Conclusion: A latent MTrP in a muscle may increase the irritability after rapid repetitive use [over loading of that muscle]. Usually, this change is a temporary phenomenon after an adequate rest period. Therefore, adequate rest may be important to reduce the probability in the development of an active MTrP. [ABSTRACT FROM PUBLISHER]

An author's response to the article about myofascial trigger point which was previously published is presented.

Importance: To develop a practical program in the early phase after nerve repair for more rapid return of function., Objective: To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair., Design: An assessor-blinded study with a randomized controlled design., Setting: University hospital., Participants: We recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons., Intervention: The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk., Outcomes and Measures: The Semmes-Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after treatment, and 12 wk after the last treatment., Results: The experimental group showed greater improvements in the results of the pinch-holding-up activity test and the PPT Unilateral Pin Insertion, Bilateral Pin Insertion, and Assembly subtests. However, change on the SWM test revealed no significant difference between the two groups., Conclusions and Relevance: Touch-observation and task-based mirror therapy is an effective but low-cost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)