Pairwise association of upper extremity musculoskeletal conditions: large population investigation from PERSIAN cohort study

BACKGROUND

People with one area of upper extremity musculoskeletal conditions (UEMSCs) may have other. We aim to determine how frequent is the ipsilateral coexistence of common UEMSCs apparent on interview and examination.

METHODS

This is a large population cross-sectional study conducted as part of the PERSIAN cohort study int Mashhad University of Medical Sciences (MUMS). The study aimed to evaluate individuals for symptoms and signs of the following conditions: carpal tunnel syndrome (CTS), lateral epicondylitis (LE), trapeziometacarpal osteoarthritis (TMC OA), DeQuervain's tendinopathy, trigger digit (TD), ganglion cyst, and rotator cuff tendinopathy (RCT). The primary outcomes of the study are (1) to determine the side-specific relative risk of each UEMSC coexisting with the second condition, and (2) to identify predictive factors of each UEMSC using side-specific multivariate logistic regression analysis.

RESULTS

We conducted a study involving 4737 individuals from the staff of MUMS and found significant pairwise associations among UEMSCs on a side-specific basis. Women had more chance of having DeQuervain's disease (β = 6.3), CTS (β = 3.5), ganglion cyst (β = 2.5), TMC OA (β = 2.3), and RCT (β = 2.0). Each condition (dependent variable) was associated with others (predictors) as follows: CTS: RCT (β = 5.9), TMC OA (β = 4.7), TD (β = 2.9), and LE (β = 2.5).

TMC OA

LE (β = 6.4), TD (β = 5.4), RCT (β = 4.3), and CTS (β = 4.1). LE: RCT (β = 8.1), TMC OA (β = 6.4), and CTS (β = 2.5). DeQuervain's disease: TD (β = 13.6), RCT (β = 4.5), and LE (β = 3.8). TD: CTS (β = 8.8), ganglion cyst (β = 7.6), DeQuervain's disease (β = 5.7), and TMC OA (β = 4.3). RCT: LE (β = 5.8), TMC OA (β = 5.5), CTS (β = 5.2), and DeQuervain's disease (β = 4.3). Ganglion cyst: TD (β = 4.8).

CONCLUSION

Our study reports significant increased frequency of the UEMSCs among patients who already have one of the diseases, in a large sample size study. Level of Evidence Level II (Differential Diagnosis/Symptom Prevalence Study).

Digital mucous cysts of the finger without osteoarthritis: optimizing outcome of long needle trajectory aspiration and injection

Digital mucous cysts are common, benign and highly recurrent tumors of the distal interphalangeal joints of the fingers and often associated with osteoarthritis. Multiple treatment modalities have been described, but still no consensus is stated. In the absence of degenerative changes, we promote a novel non-surgical approach. The aim of this study was to examine all patients with digital mucous cysts without underlying osteoarthritis, undergoing this injection technique and to assess outcome and complications of this procedure. This was a single center study (2018-2019) of 17 patients who received a long needle trajectory aspiration and injection for treatment of digital mucous cysts. Exclusion criteria were prior surgical treatment, post-traumatic cyst formation and the presence of radiographic distal interphalangeal joint osteophytosis. A total of 15 patients were found eligible for inclusion. The patient reports were retrospectively analyzed with a follow-up of 6 months. The primary study outcome was resolution of the cyst; secondary outcomes were complications of the procedure. Twelve (80%) resolved completely and three (20%) had limited local recurrence at 6 months. No complications were reported. None of the patients with limited recurrence desired further treatment. We believe that this technique offers a non-invasive, low-cost treatment option for digital mucous cysts, particularly in the subset of patients with ample evidence of degenerative articular changes in the distal interphalangeal joint. The described technique can be performed in an office-based setting and avoids typical surgical as well as aspiration-associated complications.

[Professor SHAO Jing-ming's clinical experience of fire needling for surgical diseases]

Professor SHAO Jing-ming's clinical experience of fire needling for bone-joint tuberculosis, tuberculous cervical lymphadenitis, ganglion cyst and thyrophyma is summarized. Professor SHAO used fire needling to treat bone-joint tuberculosis. The acupoints included ashi points and nearby acupoints, particularly local opposite acupoints (Neixiyan [EX-LE 4] and Dubi [ST 35], Yinlingquan [SP 9] and Yanglingquan [GB 34], Xuehai [SP 10] and Liangqiu [ST 34]), and for the patients with severe yin-cold syndrome, Yanghe decoction was additionally used. For tuberculous cervical lymphadenitis, fire needling was used at different stages. In the early stage, the nucleus was punctured with fire needling; in the middle stage, the pustule was punctured with fire needling combined with cupping; in the late stage, the fire needling was inserted into the fistula or sinus tract, and the surrounding granulation tissue was treated with horizontal penetrating needling. For ganglion cyst, fire needling combined with centro-square needling was applied. For thyrophyma, the surrounding needling with filiform was used; for simple thyroid mass and thyroid nodule, the surrounding needling with fire needling was used.

[Degenerative lesions of the anterior cruciate ligament: a frequent but poorly understood phenomenon]

Making more use of MRI, degenerative lesions of the anterior cruciate ligament are more frequently diagnosed. Three separates entities are reported (mucoid degeneration, ganglion cyst and mucoid degeneration with ganglion cysts) but it is probably a continuum of the same degenerative process. In middle aged individuals, it would result of repeated microtrauma in the setting of a narrow intercondylar notch and/or increased posterior tibial slope. In the older patient, it would be part of a whole organ disease with the onset of osteoarthritis. Most cases are incidental findings. For symptomatic patients, a complete resection of the ligament is our first option when conservative treatment failed. It is effective for pain relief and motion recovery. Although it produces postoperative instability, secondary reconstruction is not always required.

Comparative transcriptomics reveals eyestalk ablation induced responses of the neuroendocrine-immune system in the Pacific white shrimp Litopenaeus vannamei

In decapod crustaceans, eyestalk ablation is widely used to expedite ovarian maturation and spawning because of the removal of a gonad inhibiting hormone produced by the X-organ sinus gland. However, eyestalk ablation also results in negative impacts on the immunocompetence of the eyestalk-ablated females. In the current study, we investigated the impact of eyestalk ablation on the transcriptomic responses of three major nervous organs of shrimp, including the eyestalk ganglion, brain and thoracic ganglion, using the Illumina Hiseq™ 4000 platform. A total of 48,249 unigenes with an average length of 1253 bp and a N50 value of 2482 bp were obtained. Following eyestalk ablation treatment, a total of 2,983, 6325 and 6575 unigenes were detected as differentially expressed (log₂Ratio >1 and FDR <0.05) from the eyestalk, brain and thoracic ganglia, respectively. Functional GO and KEGG analysis of these differential expression genes (DEGs) showed that these DEGs were associated with a wide variety of biological processes and pathways. The distribution of DEGs among three comparison groups was similar, and many DEGs were mapped to the phagosome pathway, indicating that eyestalk ablation triggers activation of the neuroendocrine-immune (NEI) system. Interestingly, several important pathways were uniquely enriched in the brain tissue, suggesting that the brain may play a crucial role in the NEI system in response to eyestalk ablation. This is the first report on the transcriptomic regulation of the nervous system in response to eyestalk ablation in L. vannamei. The genes and pathways identified in this study will help to elucidate the molecular mechanisms of neuroendocrine-immune responses to eyestalk ablation in penaeid shrimp.

Sudden onset of temporomandibular joint swelling and limited mouth opening: a rare case of ganglion cyst

Preauricular swelling followed by limited mouth opening can be a challenging diagnosis. All anatomical structures and related pathologies should be examined. A 41-year-old woman presented to the Emergency Room complaining of limited mouth opening, severe pain that was worse on chewing, and swelling over her right temporomandibular joint (TMJ) that had started 3 days previously. Physical examination revealed localized swelling and redness over her right TMJ. Her right masticatory muscles were very painful and tender on palpation. Mouth opening was slightly limited. A computed tomography (CT) scan demonstrated a collection adjacent to her right TMJ, and reactive arthritis was diagnosed. Aspiration and arthrocentesis were performed, leading to immediate improvement. When symptoms returned 6 months later, magnetic resonance imaging (MRI) demonstrated a cystic lesion adjacent to the TMJ. Under general anesthesia an excisional biopsy was performed, and the pathologic examination revealed fibrous connective tissue with pseudocyst-like formation compatible with ganglion cyst. This case report demonstrates that a CT scan might lead to an incorrect diagnosis, whereas MRI scanning led to the correct diagnosis, thereby emphasizing the importance of choosing the right imaging modality. When a pathologic process of the TMJ is suspected, MRI is the gold standard imaging modality to diagnose the exact TMJ pathology. Complete surgical excision of ganglion cyst is recommended to determine a definite diagnosis. The final diagnosis should eventually be made by combining standard histology and MRI findings.

Proprioceptive input to a descending pathway conveying antennal postural information: Terminal organisation of antennal hair field afferents

Like several other arthropod species, stick insects use their antennae for tactile exploration of the near-range environment and for spatial localisation of touched objects. More specifically, Carausius morosus continuously moves its antennae during locomotion and reliably responds to antennal contact events with directed movements of a front leg. Here we investigate the afferent projection patterns of antennal hair fields (aHF), proprioceptors known to encode antennal posture and movement, and to be involved in antennal movement control. We show that afferents of all seven aHF of C. morosus have terminal arborisations in the dorsal lobe (DL) of the cerebral (=supraoesophageal) ganglion, and descending collaterals that terminate in a characteristic part of the gnathal (=suboesophageal) ganglion. Despite differences of functional roles among aHF, terminal arborisation patterns show no topological arrangement according to segment specificity or direction of movement. In the DL, antennal motoneuron neurites show arborizations in proximity to aHF afferent terminals. Despite the morphological similarity of single mechanoreceptors of aHF and adjacent tactile hairs on the pedicel and flagellum, we find a clear separation of proprioceptive and exteroceptive mechanosensory neuropils in the cerebral ganglion. Moreover, we also find this functional separation in the gnathal ganglion.

Ganglion Cyst at the Proximal Tibiofibular Joint in a Patient with Painless Foot Drop

Entrapment neuropathies of the fibular nerve and its branches are often underdiagnosed due to the lack of reliable diagnosis using clinical examination and electrophysiologic evaluation. Most fibular nerve compressions may be classified into 2 broad categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Foot drop resulting from weakness of the dorsiflexor muscles of the foot is a relatively uncommon presentation and closely related to L5 neuropathy caused by a disc herniation. However, we herein describe a rare case of usually painless foot drop triggered by a cyst at the proximal tibiofibular joint compressing the deep fibular nerve. The presence of multilevel disc diseases made the diagnosis more difficult. Foot drop is highly troubling, and health care providers need to broaden their search for the imperative and overlapping causes especially in patients with painless drop foot, and the treatment is variable and should be directed at the specific cause. The magnetic resonance imaging (MRI), including high-resolution and 3D MR neurography, allows detailed assessment of the course and anatomy of peripheral nerves, as well as accurate delineation of surrounding soft-tissue and osseous structures that may contribute to nerve entrapment. Knowledge of normal MRI anatomy of the nerves in the knee and leg is essential for the precise assessment of the presence of peripheral entrapment conditions that may produce painless or painful drop foot. In conclusion, we stress the importance of preoperative anatomic mapping of entrapment neuropathies to minimize neurological complications.Key words: Foot drop, fibular nerve, ganglion cyst, proximal tibiofibular jointFoot drop, fibular nerve, ganglion cyst, proximal tibiofibular joint.

[A novel, unusual (at least for beetles) mode of Kenyon cell production in the diving beetle Cybister laterlimarginalis Deg. (Coleoptera: Dytiscidae)]

Kenyon cell production in the mushroom bodies of Cybister lateralimarginalis is a peculiar process. It has been found that each proliferative center contains one giant neuroblast, which divides unequally, and its smaller daughter cell becomes the 2nd order neuroblast dividing unequally as well. The smaller daughter cell of this neuroblast becomes a ganglion mother cell. The latter, as usual, divides equally producing two Kenyon cells.

[Dendritic projections from meridian-related motoneurons to sympathic preganglion neurons in the spinal cord of rats]

OBJECTIVE

Previous studies indicated a close involvement of reflex activities of motoneurons in the spinal cord in the mechanism of meridian phenomena. The present study was designed to investigate the dendrite projections of meridian-related motoneurons among the motoneurons and sympathetic preganglionic neurons in the spinal cord.

METHODS

A total of 41 Sprague-Dawley rats were used in the present study. Cholera toxin B-subunit conjugated horseradish peroxidase (CB-HRP) containing 1.0% HRP was respectively injected to acupoint "Chengman" (ST 20), "Liangmen" (ST 21), "Guanmen" (ST 22), "Taiyi" (ST 23), "Huaroumen" (ST 24), "Tianshu" (ST 25) and "Wailing" (ST 26) of the Stomach Meridian, and "Ganshu" (BL 18), "Danshu" (BL 19), "Pishu" (BL 20), "Weishu" (BL 21) and "Sanjiaoshu" (BL 22) of the Bladder Meridian, and "Daimai" (GB 26), "Wushu" (GB 27), "Weidao" (GB 28), "Juliao" (GB 29), "Huantiao" (GB 30), "Fengshi" (GB 31), "Zhongdu" (GB 32), "Xiyangguan" (GB 33) and "Yanglingquan" (GB 34) of the Gallbladder Meridian (for labeling preganglionic neurons), and the celiac ganglion and superior mesenteric ganglion for labeling sympathetic preganglionic neurons. Three days after injection, the animals anesthetized were transcardia-cally perfused with 1.5% paraformaldehyde, the spinal cord was removed to be fixed routinely and then cut into sections for observing the labeled cells under microscope.

RESULTS

In the ipsilateral ventral horn of the spinal cord, the motoneurons retrogradely labeled by CB-HRP formed dendritic projections oriented only to those motoneurons innervating the same meridian. In the longitudinal sections of spinal cord, the labeled motoneurons formed a bead-like column with a prominent network of longitudinal dendrites connecting the motoneurons innervating acupoints from the same meridian. In the transverse sections of spinal cord, two groups of dendrites from the labeled motoneurons projected to the identified sympathetic preganglionic regions: one group extended dorsolateraly to the intermediolateral gray, another group extended intermediolateraly toward the central canal. In rats with injection of CB-HRP into both acupoint regions and ipsilateral celiac ganglion, the dendrites originated from the labeled motoneurons projected directly to the labeled sympathetic preganglionic neurons.

CONCLUSION

Each of the ST, BL and GB meridians is innervated by a specific group of motoneurons in the spinal cord. The motoneurons form a column with distinct border in the ventral horn of spinal cord, and the dendritic projections from the motoneurons oriented only to those innervating the same meridian. The dendrites from the meridian-related motoneurons can specifically project to the sympathetic preganglionic neurons at the thoracolumbar level.

Oviduct contraction in Drosophila is modulated by a neural network that is both, octopaminergic and glutamatergic

Fertility is a highly complex and regulated phenomenon essential for the survival of any species. To identify Drosophila fertility-specific neural networks, we used a GAL4/UAS enhancer trap genetic screen that selectively inactivates groups of neurons. We identified a GAL4 line (bwktqs) that has a female sterile phenotype only when it expresses the tetanus toxin light chain (TeTxLC). These flies lack oviduct contraction, lay almost no eggs, sperm accumulate in the oviducts, and fewer than normal are seen in the storage organs. In insects, two neuroactive substances are important for oviduct contraction: octopamine (OA), a monoamine that inhibits oviduct contraction, and glutamate (Glu), a neurotransmitter that induces contraction. It is known that octopaminergic neurons of the thoracic abdominal ganglion (TAG) modulate oviduct contraction, however, the glutamatergic neurons that innervate the oviduct have not been identified yet and the interaction between these two neuroactive substances is not well understood. Immunostaining experiments revealed that the bwktqs line trapped an octopaminergic neural network that innervates the genital tract. We show that wt like oviduct contraction in TeTxLC-inactivated flies can only be rescued by simultaneous application of Glu and OA suggesting that the abdominal bwktqs neurons are both octopaminergic and glutamatergic, the use of an agonist and an antagonist for Glu receptors as well as their direct visualization confirmed its participation in this phenomenon. Our work provides the first evidence that adult abdominal type II visceral innervations co-express Glu and OA and allows us to re-evaluate the previous model of neuronal network controlling insect oviduct contraction.

Experimental and clinical evaluation in man of hexamethonium (C6), a new ganglionic blocking agent

In man, C6, a new ganglionic blocking agent (50 mg. intravenously) produced inhibition of the Valsalva, tiltback and cold pressor vasopressor responses. Marked increases in digital blood flow and skin temperature with inhibition of digital reflexes to "noxious" stimuli were consistently observed (room temperature 70 F.). The increase in skin temperature was greater and more lasting than following Priscoline or tetraethylammonium chloride. Except for severe postural hypotension, side effects were minimal. Clinically the drug may be useful in the evaluation of sympathetic vasoconstriction in peripheral vascular disease as well as in the treatment of acute neurogenic vasospasm.

Ganglion cysts arising in unusual locations

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