Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance

IntroductionA knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance.MethodsA prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge.ResultsEven in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO.DiscussionFor acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO

Localized scleroderma secondary to mixed connective tissue disease during abatacept therapy

A 47‐year‐old woman with mixed connective tissue disease was treated with abatacept. After 2 months, a 3‐cm depression with atrophied surface was observed on her back, which had histopathological consistent with the symptoms of localized scleroderma. Although some cases of paradoxical reaction or cutaneous adverse event have been reported from abatacept, no localized scleroderma has been reported, suggesting this to be a unique case

Brentuximab vedotin treatment for mycosis fungoides with CD30+ large‐cell transformation in the early stage

In this paper, we bring hope to patients with mycosis fungoides (MF) with CD30+ large‐cell transformation (LCT), which is often a histological marker of poor prognosis and is associated with a mean 5‐year survival of <20%. Although skin biopsy is a painful procedure, it is the only test for early diagnosis of LCT. Stage IIB has a significantly worse 5‐year survival rate compared with stage IB/IIA, which often plagues clinicians regarding appropriate treatment selection. In this case, the discovery of LCT by skin biopsy prompted treatment with BV. Thus, proactive rebiopsy is important so that CD30+ LCT is not overlooked in the early stage of MF

Hydroxyzine‐induced fixed drug eruption and cross‐reaction with oxatomide

There are a few reports in the literature implicating them in causing fixed drug eruption, the piperazine derivatives. In this case, although eszopiclone for insomnia medicinehas a piperazine ring, no eruption appeared so far. Oxatomide and hydroxyzine not only shared a piperazine ring but also shared two benzene rings via a methine group (=CH–). It was suspected that this shared structural group became an antigenic determinant and resulted in cross‐reactivity. Such a unique case has not been reported before