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麻痺側の前脛骨筋と中殿筋への機能的電気刺激が脳卒中片麻痺者の歩行に与える即時的な運動学的変化を検討することを目的とした。対象は､左片麻痺を呈し脳梗塞発症後101日が経過した70歳代女性、歩行はT 字杖を使用し､自立していた。麻痺側の前脛骨筋のみに対する電気刺激､前脛骨筋に加え中殿筋にも電気刺激を行う２つの刺激条件下で歩行練習を行い､その前後の歩行を比較した。歩行速度､歩行率､ストライド長は２条件ともに改善したが条件間に明らかな差を認めなかった。一方､前脛骨筋のみの刺激に比べ中殿筋への刺激を追加した条件では、麻痺側初期接地時の上部体幹の矢状面における傾斜が正中位に近くなり、股関節の矢状面における運動範囲が増加した。脳卒中の歩行練習では、前脛骨筋に加え中殿筋に電気刺激を行うことで、麻痺側立脚相の体幹と股関節の運動の改善に寄与する可能性が示唆された。PURPOSE: Stroke can cause impairments in gait kinematics, such as drop foot and lateral trunk fluctuation. Although functional electrical stimulation (FES) to the gluteus medius and tibialis anterior is used during gait training to overcome these impairments, its effects on gait kinematics remain unclear. The purpose of this study was to investigate the kinematic effect of FES to the gluteus medius and tibialis anterior during gait in a post-stroke patient. METHODS: The participant was a female patient in her 70s who had experienced a stroke 101 days previously. She was able to walk without the assistance of a cane. The participant had gait training for periods of 20 minutes at a self-selected velocity under two different FES conditions: stimulation to the tibialis anterior during the swing phase (TA) and stimulation to the gluteus medius and tibialis anterior during the swing and early stance phases (TA+GMed). We compared the change in gait velocity, cadence, and stride length, upper trunk angle in the sagittal and frontal plane at initial contact, and the motion range of angle of the affected hip extension-flexion relative to that before training. RESULTS: Gait velocity, cadence, and stride length showed notable increases post-training, although differences between TA and TA+GMed were not as apparent. Upper trunk angle in the sagittal and frontal plane at initial contact showed greater improvement in the TA+GMed condition than in the TA condition. Motion range of angle of the affected hip extension-flexion at post training examination was 40.49 ± 2.12° and 44.14 ± 1.41° in TA and TA+GMed, respectively. CONCLUSION: The results of this study suggest that FES to the gluteus medius and tibialis anterior during gait produces an improvement in hip and trunk kinematics.

Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum and can cause a wide variety of cutaneous manifestations, most commonly, a papulosquamous eruption of the trunk and extremities. Treatment with penicillin is curative. We report a case of a 69-year-old man who presented with recent onset of blurry vision and a non-painful, non-pruritic eruption of pink-to-violaceous dermal nodules on his upper trunk and upper extremities. Biopsies of two separate locations revealed a dense superficial and deep perivascular atypical lymphocytic infiltrate with admixed plasma cells, histiocytes, and eosinophils. Some scattered cells expressed CD30, PD1, BCL-6 and ICOS. TCR-rearrangement showed an identical TCR-gamma clone between both biopsy specimens. The patient was subsequently seen by ophthalmology and diagnosed with acute anterior uveitis. RPR was reactive and CSF studies showed findings consistent with a diagnosis of neurosyphilis. A Treponema pallidum immunostain of the skin biopsies was performed upon re-review, and was diffusely positive for spirochetes at the dermal-epidermal junction and within injured vessels. The patient was treated with penicillin G with near resolution of his skin lesions. This case highlights the unusual ability of syphilis to mimic a T-cell lymphoma with matching clones across two different biopsy sites. This article is protected by copyright. All rights reserved.

Primary cutaneous amyloidoses (PCA) are a group of conditions characterized by deposition of amyloid in previously normal skin, without association with other skin or systemic diseases. We describe a Kazakhstani female with a 30-year history of increasingly spreading hyperpigmented macular as well papular skin lesions on her upper trunk accompanied by pruritus. Moreover, her medical history included intensely rubbing her skin with a cotton towel following bathing and showering. On the basis of the clinical and histopathological findings, the diagnosis of biphasic cutaneous amyloidosis was made. The present unusual case of biphasic cutaneous amyloidosis can be subsumed under mechanically-induced forms of cutaneous amyloidosis. In conclusion, the present case underscores the necessity to explore carefully the patient’s history in order to discover the cause of PCA.

Objectives This study aimed to assess the surgical outcomes of patients with work-related upper extremity musculoskeletal disorders (UE-MSDs) who failed conservative treatment. Material and Methods This was a retrospective study of 17 patients who had work-related UE-MSDs and underwent the following surgeries and follow-up evaluations: decompression, external and internal neurolysis of the upper trunk of the brachial plexus and the long thoracic nerve (LTN), and a partial resection of the anterior and middle scalene muscle. A detailed history of clinical presentation including pain, physical and clinical examinations of the extent of scapular winging (ESW), and upper extremity anatomical postures, such as active forward arm flexion and shoulder abduction, were recorded before and after 3 months of the surgery. Nerve conduction velocity and electromyography examination reports were obtained to assess the sensory or motor loss of the nerve injury before their operation. Results All 17 patients included in this report showed some improvement anatomically in the scapula appearance and functionally in their shoulder movements. More specifically, 9 (53%) patients got a restored to near healthy appearance of the scapula, and 11 (65%) patients recovered a full range of motion, 180° post-surgically. Overall, the mean shoulder flexion and abduction improved to 157±37.5° and 155±40.2° after the surgery from 106±30.2° and 111±34.8°, respectively (p < 0.0001). The ESW score also significantly improved from a mean of 1.5±0.51 to 3.5±0.71 (p < 0.0001). The post-surgical improvements were statistically highly significant (p < 0.0001). Conclusions Decompression and neurolysis of the upper brachial plexus and the LTN, and the partial release of the scalene muscle contracture procedures have fostered improvements in the shoulder anatomical appearance and movements in all 17 patients. Int J Occup Med Environ Health. 2021;34(3):427–35

Madelung disease is a rare, metabolic, malignancy-associated and disfiguring condition of unknown etiology, characterized by potentially debilitating neurological, cardiopulmonary, gastric, musculoskeletal and psycho-social complications. Also known as multiple symmetric lipomatosis (MSL), Benign Lipomatosis (BSL), and Launois-Bensaude syndrome, MSL is characterized by the symmetrical growth of subcutaneous non-encapsulated fat deposits, usually around the neck, but in some cases also around shoulders, the upper trunk, chest and limbs, and hip girdle. These abnormal fat deposits may rapidly grow over a few months or slowly enlarge over several years. Expanding fatty deformations may be disabling, have disfiguring aesthetic consequences, and infiltrate or compress adjacent vital structures. This case illustrates that painful, massive growths may also occur around the knees, re-grow post excision, and present with compressive neurological symptoms necessitating further surgical interventions.

Although recent studies have confirmed that muscles of the upper body are obliquely linked with the muscles of the contralateral lower extremity through posterior oblique sling (POS) system, the upper portion of the POS connected to the lower leg below the hamstring is yet to be determined. In the supine position, the active maximum dorsiflexion (DF) angles of the right and left legs were randomly measured. During passive trunk rotation performed by the therapist, the active maximum DF angles of the right leg (contralateral side) and left leg (ipsilateral side) were measured. In a long sitting position with and without trunk rotation, the active maximum DF angles in both legs were measured. The left upper body was made to rotate rightward in trunk rotation. In the contralateral lower extremity, the DF ROM in the sitting position with trunk rotation was significantly different compared with those in the sitting position without trunk rotation, and in the supine position with trunk rotation. In the comparison between the ipsilateral and contralateral lower extremity, significant differences were found in the DF ROM in the sitting position with trunk rotation. This study indicates that the tensile force generated by trunk rotation is transmitted to the contralateral terminal end by examining changes in DF ROM. Since the upper portion of the POS is connected all the way down to the contralateral calf, the POS must be considered during the clinical treatment of patients with restricted DF mobility.

The aim of this study was to determine the contribution of the upper trunk rotation consisting of roll-pitch-yaw to hand velocity in the forwards-backwards direction during front crawl strokes and to investigate the association of forwards-backwards hand velocity induced by the upper trunk rotation with stroke frequencies. Fifteen skilled swimmers with retro-reflective markers performed front crawl strokes in a swimming pool where a motion capture system was set. Forwards-backwards hand velocity solely induced by the upper trunk rotation was determined during the performance. In the pull and push phases, 28% and 19% of the backward hand velocity was induced by the upper trunk rotation, respectively, while 19% of the forward hand velocity resulted from the upper trunk rotation in the recovery phase. The upper trunk rotation contributed to the forwards-backwards velocity as much as the elbow joint and was the second primary source of backward hand velocity in the pull phase. The forwards-backwards hand velocity created by the upper trunk rotation was associated with the stroke frequencies (r = 0.56, p 0.05). The forwards-backwards hand velocity induced by the upper trunk would influence hand propulsion and stroke frequency so that a swimmer and coach should consider this performance-enhancing variable.

BACKGROUND: Non-neutral postures during computerised device use coupled with increased usage may increase the risk of neck pain. Greater knowledge of postures that individuals with neck pain adopt during computerised device use is warranted. OBJECTIVE: To evaluate neck and upper limb posture while using a tablet, laptop and desktop computer (sitting and standing) in individuals with chronic neck pain. METHODS: Differences in three-dimensional kinematic variables were assessed during four conditions: tablet, laptop, desktop computer (sitting and standing) in 22 individuals with chronic neck pain >3 months. Differences between kinematic variables were determined using one-way repeated measures ANOVA with Bonferroni post-hoc tests. RESULTS: Compared to the desktop (sitting), tablet and laptop use resulted in increased neck flexion (mean difference tablet – 14.42°, 95% CI – 19.88, –8.96, P

Exploration and grafting of the brachial plexus remains the gold standard for post-ganglionic brachial plexus injuries that present within an acceptable time frame from injury. The most common nerves available for grafting include C5 and C6. During the surgical exposure of C5 and C6, the phrenic nerve is anatomically anterior to the cervical spinal nerves, making it vulnerable to injury while performing the dissection and nerve stump to graft coaptation. We describe a novel technique that protects the phrenic nerve from injury during supraclavicular brachial plexus exposure and grafting of C5 or upper trunk ruptures or neuromas in-continuity. A 4-step technique is illustrated: (1) The normal anatomic relationships of the phrenic nerve anterior to C5 is displayed in the face of the traumatic scarring. (2) The C5 spinal nerve stump is then transposed from its anatomic position posterior to the phrenic nerve to an anterior position. (3) The C5 stump is then moved medially for retrograde neurolysis of C5 from its phrenic nerve contribution. The graft coaptation to C5 is performed in this medial position, which minimizes retraction of the phrenic nerve. (4) The normal anatomic relationship of the phrenic nerve and the C5 nerve graft is restored. We have been routinely relocating the C5 spinal nerve stump around the phrenic nerve for the past 10 years. We have experienced no adverse respiratory events. This technique facilitates surgical exposure and prevents iatrogenic injury on the phrenic nerve during nerve reconstruction.

Background The trapezius muscle is often utilized as a muscle or nerve donor for repairing shoulder function in those with brachial plexus birth palsy (BPBP). To evaluate the native role of the trapezius in the affected limb, we demonstrate use of the Motion Browser, a novel visual analytics system to assess an adolescent with BPBP. Method An 18-year-old female with extended upper trunk (C5–6–7) BPBP underwent bilateral upper extremity three-dimensional motion analysis with Motion Browser. Surface electromyography (EMG) from eight muscles in each limb which was recorded during six upper extremity movements, distinguishing between upper trapezius (UT) and lower trapezius (LT). The Motion Browser calculated active range of motion (AROM), compiled the EMG data into measures of muscle activity, and displayed the results in charts. Results All movements, excluding shoulder abduction, had similar AROM in affected and unaffected limbs. In the unaffected limb, LT was more active in proximal movements of shoulder abduction, and shoulder external and internal rotations. In the affected limb, LT was more active in distal movements of forearm pronation and supination; UT was more active in shoulder abduction. Conclusion In this female with BPBP, Motion Browser demonstrated that the native LT in the affected limb contributed to distal movements. Her results suggest that sacrificing her trapezius as a muscle or nerve donor may affect her distal functionality. Clinicians should exercise caution when considering nerve transfers in children with BPBP and consider individualized assessment of functionality before pursuing surgery.

Introduction In brachial plexus injuries, useful recovery of arm function has been documented in most patients after phrenic nerve transfer after variable follow-up durations, but there is not much information about long-term functional outcomes. In addition, there is still some concern that respiratory complications might become manifest with aging. The aim of this study was to report the outcome of phrenic nerve transfer after a minimum follow-up of 5 years. Patients and methods Twenty-six patients were reviewed and evaluated clinically. Age at surgery averaged 25.2 years and follow-up averaged 9.15 years. Results Shoulder abduction and external rotation achieved by transfer of phrenic to axillary nerve (or posterior division of upper trunk), combined with spinal accessory to suprascapular nerve transfer, were better than that achieved by transfer of phrenic to suprascapular nerve, combined with grafting the posterior division of upper trunk from C5, 52.3 and 45.5 degrees versus 47.5 and 39.4 degrees, respectively. There was no difference in abduction when the phrenic nerve was transferred directly to the posterior division of upper trunk or to the axillary nerve using nerve graft. Elbow flexion (≥M3 MRC) was achieved in 5 (83.3%) of 6 cases. Elbow extension M4 MRC or greater was achieved in 4 (66.6%) of 6 cases. All patients, including those who exceeded the age of 45 years and those who had concomitant intercostal nerve transfer, continued to have no respiratory symptoms. Conclusions The long-term follow-up confirms the safety and effectiveness and of phrenic nerve transfer for functional restoration of shoulder and elbow functions in brachial plexus avulsion injuries.

Juvenile xanthogranuloma is a benign histiocytic cell proliferative disorder that occurs in early childhood. The most common presentation occurs within the first 2 years of life with papular or nodular changes to the skin on the head, neck or upper trunk. This case study documents the findings and treatment of a single solitary soft tissue mass in the forefoot of a 17-year-old patient. Unique to this case, the initial diagnosis of tuberous xanthoma was made and, with referral to an outside hospital, changed to a juvenile xanthogranuloma. In addition, unlike most juvenile xanthogranulomas in the literature, there was no superficial dermatological abnormality seen clinically. This change was not a dramatically different diagnosis, but further immunohistochemical staining was necessary for ultimate diagnosis. The soft tissue mass was self-contained to the deeper tissue layers and not the epidermis. The patient was followed for 12 months for possible recurrence and medical workup, without postoperative complications. The purpose of this study was to report on a unique finding and presentation of a xanthogranulomatous soft tissue mass in the forefoot of a pediatric patient.

First described in 1934, eccrine spiradenoma (ES) is a rare, benign adnexal tumour arising from eccrine sweat glands. It commonly presents as a slow-growing nodule on the upper trunk, and head and neck region, mostly in the age bracket of 15-35 years, with no gender preference. While no established guidelines exist for optimal management of malignant ES, some therapies have been studied. The diagnosis of this entity is extremely important as it can harbour a malignant component with disastrous outcomes which may be missed due to its strong resemblance to benign lesions, such as a papilloma. Here, we present the case of a 35-year-old lady who presented with a papilloma-like growth on the upper medial aspect of the thigh which was diagnosed as eccrine spiradenoma upon excision. Keywords: Eccrine Spiradenoma, adnexal tumour, dermal lesion, case report. Continuous...

Becker’s nevus (BN) is an acquired unilateral hyperpigmented hairy macule, whereas morphea is a chronic connective tissue disease of unknown etiology, characterized by skin thickening with increased quantities of collagen in the indurated lesion, usually involving the upper trunk and proximal extremity. The occurrence of both disease in the same anatomical site and individual was not reported previously. We report this rare case in a 17-year-old, Indian girl and was diagnosed after clinical histopathology and dermoscopic correlation. Morphea can be an interesting incidental occurrence within a large plaque of BN.

Objectives Keratosis pilaris (KP) is the condition of the skin with extensive keratin follicular plugging. It may be associated with the erythema. The upper arm extensor area, shoulders, back of neck and thighs, as well as face and the upper trunk are the areas of presentation. Available medications for KP give only symptomatic relief, while some produce serious side effects. There is no proven universal treatment for the disease that can provide complete recovery. Āyuṛveda management of KP is not yet reported. Case presentation A 26-year-old male patient, presented with main complaints started with papular lesions over his right shoulder, chest and upper back along and later with pustular lesions in the past 2 weeks. The condition was associated with redness, mild swelling and itching. The case was diagnosed as Keratosis pilaris based on its presentation, site, and pathogenesis. Also by analyzing the extent of vitiation of doṣas (morbidities), the Vata kapha pitta hara line of treatment was adopted, which was accomplished in two phases i. e. Śodhana Cikitsa and Śamana Cikitsa. Conclusion Both internal and external treatments along with diet restrictions were found effective in arresting the pathogenesis and recovery in a short period. All the symptoms associated with the condition were completely cured with no signs of re-occurrence.

Background Changes in radiation therapy practice and cancer incidence bring into question prior evidence suggesting that radiation therapy predominantly injures the brachial plexus upper trunk, while tumor invasion typically injures the lower trunk. Methods We reviewed electrodiagnostic brachial plexopathy reports in cancer survivors for predominant trunk involvement, injury mechanism (tumor invasion vs radiation), and primary cancer location. Results Fifty-six cases of cancer-associated brachial plexopathy were identified. There was no relationship between injury mechanism and brachial plexus injury level. However, primary cancer location superior/inferior to the clavicle increased the odds of predominantly upper/lower trunk involvement by a factor of 60.0 (95% confidence interval: 7.9, 1401, respectively). Conclusions Cancers superior/inferior to the clavicle increase the likelihood of predominantly upper/lower trunk plexopathy, respectively, regardless plexus injury mechanism. These findings contrast with older work, possibly due to more precise radiation therapy techniques and increased incidence of radiosensitive head and neck cancers.

BACKGROUND Locally advanced malignancies of the upper torso and shoulder girdle (UT-SG) necessitate extensive resection and complex reconstruction. Due to the infrequent nature of these operations, a global reconstructive algorithm has not been defined. METHODS A retrospective review of all patients who received reconstructive surgery following malignant tumor extirpation in the UT-SG from 2008 to 2018 at the University of Texas MD Anderson Cancer Center. Factors predicting the need for flap reconstruction and risk for postoperative complications were evaluated. RESULTS In total, 252 procedures met inclusion criteria. The most common pathology was sarcoma (76%) and 52% were primary tumors. The median defect area was 112 cm2 (range 4-1350 cm2 ). Reconstructive techniques included pedicled flaps (46%), local tissue rearrangement (38%), and free flaps (16%). On univariate analysis, the probability of needing a free flap increased 39% when the defect size increased by 100 cm2 . The strongest independent predictors of requiring a free flap were major vessel exposure (adjusted odds ratio [OR] = 4.92, 95% confidence interval [CI], 1.36-17.84, P = .015) and major peripheral nerve exposure (adjusted OR = 3.2, 95% CI, 1.1-9.2, P = .031). CONCLUSION Despite the aggressive nature of their malignancies, patients requiring an UT-SG resection demonstrate high survival rates and therefore demand a durable reconstruction. Exposed critical structures and defect size were predictive of free tissue transfer.

Guttate psoriasis is a type of psoriasis that presents over the upper trunk and proximal extremities, it is small (0.5 to 1.5 cm in diameter) lesions; it is found frequently in young adults. As per its clinical features we will compare with Kitibha Kushta. The life time prevalence is approximately 2% of individuals with psoriasis. Many treatment modalities have been adopted in medical sciences, but it is having various side effects. So here in this case by using Shodhan, Shaman and Bahirparimarjan chikitsa we successfully treated the case of Kitibha kushtha. It is a single case study, A 22 year male patient approached to Kayachikitsa OPD having complaint of multiple small red lesions over the chest, abdomen, and back region also on both upper limbs and Itching over them since 2 years.The patient was treated with Shodhan and Shaman Chikitsa. Patient got 90% result in chief and associated complaints and during and after the completion of therapy there is improvement in the quality of life of the patient. After Shodhana and Shaman Chikitsa patient got satisfactory relief in symptoms.

Pitch velocity (PV) is important for pitching success, and the pelvis and trunk likely influence pitch performance. The purposes of this study were to examine the differences in pelvis and trunk kinetics and kinematics in professional baseball pitchers who throw at lower versus higher velocities (HVPs) and to examine the relationships among pelvis and trunk kinetics and kinematics and PV during each phase of the pitch delivery. The pitch velocity, pelvis and trunk peak angular velocities, kinetic energies and torques, and elbow and shoulder loads were compared among HVPs (n = 71; PV ≥ 40.2 m/s) and lower velocities pitchers (n = 78; PV P P = .002) and were able to generate greater upper trunk angular velocities (+36.6 m/s,P = .01) compared with lower velocity pitcher. Trunk angular velocity (r = .29) and upper trunk rotation at hand separation (r = .18) and foot contact (r = .17) were weakly related to PV. Therefore, HVPs rotate their upper trunk to a greater degree during the early phases of the pitching motion and subsequently generate greater trunk angular velocities and PV.

We report a 23-year-old woman who presented with generalized scaly erythematous rash predominately on the upper trunk and hemorrhagic stomatitis. The histopathologic and immunopathologic findings were consistent with the diagnosis of paraneoplastic pemphigus. Castleman’s tumor was diagnosed with computed tomography and exploratory laparotomy. A partial clinical improvement was observed after complete tumor removal and intravenous immunoglobulin administration. However, the patient died as a result of septicemia.

Background In the past, a variety of methods have been explored to determine the center of gravity or gravity line, such as the hanging method or force plate analysis. However, these methods possess limitations related to precise location of center of gravity. The aim of this study was to describe a tissue separation method to precisely calculate the center of gravity in upper trunk. Methods Twenty post-operative patients with thoracolumbar kyphosis were retrospectively studied. Center of gravity models were computed: T1–T5 segment, T6–T10 segment and T1–T10 segment. The tissue separation method was used to calculate the center of gravity in each segment. A new center of gravity was composited from T1–T5 segment and T6–T10 segment by composition formula. Similarity and collinearity between center of gravity models was analyzed to verify the reliability of tissue separation method. Correlation between gravity line and theoretic hip axis was compared on pre- and post-operative radiographs to explore their potential application for surgical plan. Findings Composited center of gravity had significant correlation and high similarity with center of gravity in T1–T10 segment. There was high collinearity between center of gravity points. The post-operative included angle between the gravity line and theoretic hip axis significantly decreased to nearly 0°. Interpretation These findings demonstrate the MIMICS can reliably calculate the center of gravity in the upper trunk by a tissue separation method. The pre-operative included angle between the gravity line and theoretic hip axis was suggested as a parameter to improve surgical design for thoracolumbar kyphosis correction.

Progressive supranuclear palsy (PSP) is characterized by supranuclear gaze palsy, dystonic rigidity of the neck and upper trunk, frequent falls and mild cognitive impairment. Cerebellar ataxia is one of the exclusion criteria given by the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy. As a result, pathologically proven PSP patients exhibiting cerebellar ataxia have often been misdiagnosed with spinocerebellar degeneration, specifically multiple system atrophy with predominant cerebellar ataxia (MSA-C). However, more recently, it has been recognized that patients with PSP can present with truncal and limb ataxia as their initial symptom and/or main manifestation. These patients can be classified as having PSP with predominant cerebellar ataxia (PSP-C), a new subtype of PSP. Since the development of this classification, patients with PSP-C have been identified primarily in Asian countries, and it has been noted that this condition is very rare in Western communities. Furthermore, the clinical features of PSP-C have been identified, enabling it to be distinguished from other subtypes of PSP and MSA-C. In this review, we describe the clinical and neuropathological features of PSP-C. The hypothesized pathophysiology of cerebellar ataxia in PSP-C is also discussed.

Eruptive tumor of the follicular infundibulum (TFI) is an extremely rare benign neoplasm that usually presents as asymptomatic multiple hypopigmented macules symmetrically distributed on the head, neck, and upper trunk. Herein, we report a case of eruptive TFI presenting as hypopigmented macules with central and slightly elevated erythematous papules at rarely involved locations of the four extremities, which has not been reported previously. The pathology showed characteristic features that were conclusive of the diagnosis of eruptive TFI. Because hypopigmentation is a common clinical manifestation and malignant transformation is possible with eruptive TFI, correct early diagnosis, and regular follow-ups are recommended.

When people walk on a treadmill, significant differences exist in postural control if compared to walking on the ground. In this paper, a method combining linear and nonlinear analysis is proposed to evaluate the walking postural control ability. In this method, the movements of the upper body and the feet are analyzed separately, because these parts have more capacity to reflect the characteristics of people’s gait. On this basis, the linear and nonlinear indicators of each part are analyzed, and the postural control ability is evaluated. The method is validated by three healthy subjects walking on both the treadmill and the ground. In treadmill walking case, the results show a smaller upper trunk acceleration (UTa) in the anterior-posterior (AP) direction. In the foot movement analysis, there are significant differences in the performance indexes related to the center of pressure (CoP) when people are walking on the treadmill and the ground. When walking on the treadmill, the velocity, acceleration, and jerk of the CoP in the AP direction are smaller than those in the ground walking case. Besides, when people walk on treadmills at uniform speeds, their feet accelerate is less in the vertical direction, and they have shorter stride length (SL) and longer stride time (ST). These results suggest that people have better postural control when walking on a treadmill. This method can be used as a means of assessing people’s behavior when walking on various situations by evaluating their control posture ability.

United States Consumer Product Safety Commission (CPSC) reported a 700% increase in Emergency Department (ED) visits for injuries attributed to unpowered scooter use from January through October 2000. Our objective is to investigate injuries associated with the use of unpowered scooters among adolescents from the age of >9 years to 20 years in the National Electronic Injury Surveillance Study (NEISS) data set from 2007-2017. We analyzed unpowered scooter-related injuries in the NEISS data set using variables: SCOOTER, INJURED, AFTER, OFF, AT and IN; the product code for injuries related to unpowered scooters is 1329, and age ≥9 years and 9 - 19

麻痺側の前脛骨筋と中殿筋への機能的電気刺激が脳卒中片麻痺者の歩行に与える即時的な運動学的変化を検討することを目的とした。対象は､左片麻痺を呈し脳梗塞発症後101日が経過した70歳代女性、歩行はT 字杖を使用し､自立していた。麻痺側の前脛骨筋のみに対する電気刺激､前脛骨筋に加え中殿筋にも電気刺激を行う２つの刺激条件下で歩行練習を行い､その前後の歩行を比較した。歩行速度､歩行率､ストライド長は２条件ともに改善したが条件間に明らかな差を認めなかった。一方､前脛骨筋のみの刺激に比べ中殿筋への刺激を追加した条件では、麻痺側初期接地時の上部体幹の矢状面における傾斜が正中位に近くなり、股関節の矢状面における運動範囲が増加した。脳卒中の歩行練習では、前脛骨筋に加え中殿筋に電気刺激を行うことで、麻痺側立脚相の体幹と股関節の運動の改善に寄与する可能性が示唆された。PURPOSE: Stroke can cause impairments in gait kinematics, such as drop foot and lateral trunk fluctuation. Although functional electrical stimulation (FES) to the gluteus medius and tibialis anterior is used during gait training to overcome these impairments, its effects on gait kinematics remain unclear. The purpose of this study was to investigate the kinematic effect of FES to the gluteus medius and tibialis anterior during gait in a post-stroke patient. METHODS: The participant was a female patient in her 70s who had experienced a stroke 101 days previously. She was able to walk without the assistance of a cane. The participant had gait training for periods of 20 minutes at a self-selected velocity under two different FES conditions: stimulation to the tibialis anterior during the swing phase (TA) and stimulation to the gluteus medius and tibialis anterior during the swing and early stance phases (TA+GMed). We compared the change in gait velocity, cadence, and stride length, upper trunk angle in the sagittal and frontal plane at initial contact, and the motion range of angle of the affected hip extension-flexion relative to that before training. RESULTS: Gait velocity, cadence, and stride length showed notable increases post-training, although differences between TA and TA+GMed were not as apparent. Upper trunk angle in the sagittal and frontal plane at initial contact showed greater improvement in the TA+GMed condition than in the TA condition. Motion range of angle of the affected hip extension-flexion at post training examination was 40.49 ± 2.12° and 44.14 ± 1.41° in TA and TA+GMed, respectively. CONCLUSION: The results of this study suggest that FES to the gluteus medius and tibialis anterior during gait produces an improvement in hip and trunk kinematics.

Spindle cell lipoma (SCL) is a rare, benign subcutaneous neoplasm that typically occurs on the upper trunk or neck of middle-aged men. The diagnosis of SCL is often straightforward due to its characteristic clinical presentation and classic histologic features of admixed mature adipocytes and CD-34 positive bland spindle cells. However, the diagnosis can be elusive when low-fat and free-fat patterns occur. Due to the lack of lipogenic content and morphologic overlap, this rare tumor is often mistaken for other benign and malignant soft tissue tumors. The authors present the case of a middle-aged man with a fat-free SCL of the temporal scalp. To our knowledge, this is the first reported case in the literature of a fat-free SCL involving the temporal scalp. With careful attention to the clinical context, histologic features, immunohistochemical profile, and cytogenetic abnormalities, the proper diagnosis of SCL without a lipogenic component can be achieved.

Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG [Abstract] Introduction: Phrenic nerve transfer has been shown to achieve good nerve regeneration in brachial plexus avulsion. Acellular nerve allografts (ANAs) showed inferior results to autografts, which is why its use with mesenchymal stem cells (MSCs) is currently being studied. The aim is to study the effect of BM-MSCs associated with ANAs in a rat model of phrenic nerve transfer to the musculocutaneous nerve in a C5-C6 avulsion. Material and methods: 42 Wistar-Lewis rats underwent a C5-C6 lesion in the right forelimb by excising a 3 mm segment from both roots, followed by a phrenic nerve transfer to the musculocutaneous nerve associated with the interposition of a three types of nerve graft (randomly distributed): control (autograft) group (n = 12), ANAs group (n = 12), and ANAs + BM-MSCs group (n = 18) After 12 weeks, amplitude and latency of the NAP and the compound motor action potential (CMAP) were measured. Biceps muscles were studied by histological analysis and nerve grafts by electron microscopy and fluorescence analysis. Results: Statistically significant reductions were found in latency of the CMAP between groups control (2.48 ± 0.47 ms) and experimental (ANAs: 4.38 ± 0.78 ms, ANAs + BM-MSCs: 4.08 ± 0.85 ms) and increases in the amplitude of the CMAP between groups control (0.04388 ± 0.02 V) and ANAs + BM-MSCs (0.02275 ± 0.02 V), as well as in the thickness of the myelin sheath between groups control (0.81 ± 0.07 μm) and experimental (ANAs: 0.72 ± 0.08 μm, ANAs + BM-MSCs: 0.72 ± 0.07 μm) and in the area of the myelin sheath between groups control (13.09 ± 2.67 μm2 ) and ANAs (10.01 ± 2.97 μm2 ) (p < .05). No statistically significant differences have been found between groups ANAs and ANAs + BM-MSCs. Conclusions: This study presents a model for the study of lesions of the upper trunk and validates the autologous graft as the gold standard.

A 55-year-old male presented with an eight-month history of erythematous papules and plaques with demarcated areas of spared skin on his trunk, upper extremities, neck, and face. Grover's disease is a rare, acquired disorder of unknown origin, which is classically characterized by the appearance of erythematous papules on the upper trunk that are usually transient. As in the present case, there are reports of atypical disease, with facial involvement, pityriasis rubra pilaris-like lesions, and a more chronic course.