A Study of 60 Patients with Low Back Pain to Compare Outcomes Following Magnetotherapy, Ultrasound, Laser, and Electrotherapy with and without Lumbosacral Kinesiotherapy.

BACKGROUND This study of 60 patients with low back pain (LBP) aimed to compare outcomes following magnetotherapy, ultrasound therapy, laser therapy, and electrotherapy, with and without lumbosacral kinesiotherapy, and used the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). This was a randomized actively controlled intervention trial of adding kinesiotherapy to a standard physiotherapy for LBP. MATERIAL AND METHODS The research included 60 participants with a diagnosis of chronic non-specific lumbar pain syndrome (CNSLPS) (mean±SD age 58.3±15.4 years, 37 women) LBP randomly assigned (1: 1) to 2 treatment groups. In Group 1, 30 patients were treated with magnetotherapy, ultrasound therapy, laser therapy, and electrotherapy. In Group 2, 30 patients received the same treatments as in Group 1, and also performed kinesiotherapy exercises affecting the lumbosacral spine and adjacent muscles. At baseline and at the end of the study, all participants completed the RMDQ and the OLBPDQ. RESULTS Both groups had significant improvement after therapy. Repeated-measures ANOVA indicated that at the end of treatment there was significantly greater progress and symptom reduction (P<0.001) in Group 2. Patients in Group 2 had a pain reduction of 52.5%, while Group 1 had 25.4% pain reduction (P=0.009). CONCLUSIONS For treatment of disability caused by CNSLPS, physical therapy combined with kinesiotherapy should be a treatment of choice.

Segmental fibre type composition of the rat iliopsoas muscle.

The iliopsoas of the rat is composed of two muscles - the psoas major muscle and the iliacus muscle. The psoas major muscle arises from all the lumbar vertebrae and the iliacus muscle from the fifth and sixth lumbar vertebrae and ilium. Their common insertion point is the lesser trochanter of the femur, and their common action is the lateral rotation of the femur and flexion of the hip joint. Unlike humans, the rat is a quadruped and only occasionally rises up on its hind legs. Therefore, it is expected that the fibre type composition of the rat iliopsoas muscle will be different than that of humans. The iliopsoas muscle of the rat is generally considered to be a fast muscle. However, previous studies of the fibre type composition of the rat psoas muscle showed different results. Moreover, very little is known about the composition of the rat iliacus muscle. The aim of our study was to examine the fibre type composition of the rat iliopsoas muscle in order to better understand the complex function of the listed muscle. The psoas major muscle was examined segmentally at four different levels of its origin. Type I, IIA, IIB and IIX muscle fibres were typed using monoclonal antibodies for myosin heavy chain identification. The percentage of muscle fibre types and muscle fibre cross-sectional areas were calculated. In our study we showed that in the rat iliopsoas muscle both the iliacus and the psoas major muscles had a predominance of fast muscle fibre types, with the highest percentage of the fastest IIB muscle fibres. Also, the IIB muscle fibres showed the largest cross-sectional area (CSA) in both muscles. As well, the psoas major muscle showed segmental differences of fibre type composition. Our results showed changes in percentages, as well as the CSAs of muscle fibre types in cranio-caudal direction. The most significant changes were visible in type IIB muscle fibres, where there was a decrease of percentages and the CSAs from the cranial towards the caudal part of the muscle. From our results it is evident that the rat iliopsoas muscle has a heterogeneous composition and is composed of all four muscle fibre types. Primarily, it is a fast, dynamic muscle with a predominance of fast type IIB muscle fibres with the largest CSAs. The composition of the rat psoas major muscles changes in a cranio-caudal direction, thus pointing to a more postural role of the caudal part of the muscle.

MRI features of the psoas major muscle in patients with low back pain.

PURPOSE: The purpose was to investigate the changes of the psoas major muscles (PM) cross-sectional area (CSA) and fat infiltration in the PM and to investigate the association between the morphology of the PM and expression of the degenerative changes of lumbar spine in patients with low back pain (LBP). METHODS: T2-weighted scans for measurements of the CSA and analysis of fat infiltration were performed on 42 patients and 49 controls using a 1.5 Tesla MR system. For a quantitative analysis of fat tissue infiltration a 4-grade visual scale was used. RESULTS: Patients had bigger CSA of the PM than controls at the levels of L3/L4 and L4/L5 intervertebral disc (P < 0.05). Patients with apparent degenerative changes of the lumbar spine had smaller CSA of the PM compared to the patients without apparent changes at the levels of L3/L4 and L4/L5 (P < 0.05). At the levels of L4/L5 and L5/S1 patients with present Modic changes in the lumbar vertebral bodies showed smaller CSA of the PM compared to the patients without Modic changes (P < 0.05). However, CSA of the PM in the patients with degenerative changes of lumbar spine and Modic changes was still bigger than the one of the controls. At all analyzed levels correlation between CSAs of the PM and fat infiltration of the lumbar paraspinal muscles was negative. CONCLUSION: Results suggest increased activity of the PM in LBP patients but PM also remains active regardless of the presence of degenerative and Modic changes of the lumbar spine.

A History of the Midwifery Profession in the Republic of Croatia.

INTRODUCTION: It can be said that midwifery is as old as humankind because there has always been someone who accompanied women in childbirth. The purpose of this article is to present the history of midwifery on the present-day territory of the Republic of Croatia, from prehistoric ages to the present. METHOD: Historical methodologies were used for the study. An analysis of available literature and archives was carried out. RESULTS: For many centuries, midwifery was in the hands of formally uneducated but skilled women. Midwives had professional autonomy until the 1960s when obstetricians took full control of maternal care, and midwives became their assistants. DISCUSSION: Although midwives in the Republic of Croatia are more educated today than at any time in history, in practice, they do not have professional autonomy in the field of work that they are entitled to under Directive 2005/36/EC.

Segmental composition of the porcine iliopsoas muscle and influence of the body size and posture on the composition of the iliopsoas muscle.

The iliopsoas muscle (IPM) of the pig consists of the iliacus muscle (IM) and the psoas major muscle (PMM). Due to the differences in posture and size between animal species, the musculoskeletal system is subjected to different functional demands, which affects the morphological characteristics of the musculoskeletal system. The aim of this study was to determine the muscle fiber type composition in pigs IPM, as pigs are large quadrupeds that differ in body size and posture from humans and small mammals, and to determine the influence of body size and posture on the composition of IPM. Muscle samples were collected from the Pietrain Landrace pigs, a sample from IM and a samples at four segments of the PMM. Samples were analyzed with monoclonal antibodies specific for different isoforms of the myosin heavy chain. The percentages and cross-sectional area (CSA) of type I, IIA, and IIX/IIB muscle fibers were calculated. Our studies revealed that in pigs IPM, type IIX/IIB muscle fibers were predominant with the largest CSA. A decrease in the proportion of type IIX/IIB muscle fibers, an increase in type I and IIA muscle fibers, and a decrease in the CSA of all muscle fiber types from the cranial to the caudal part of the PMM were observed. The pig IPM has primarily a dynamic function. The function of the PMM in the cranio-caudal direction changes from a dynamic to a static role. Body size and posture influence the composition of the IPM.

Immunohistochemical analysis of the human psoas major muscle with regards to the body side and aging.

The aim of our study was to explore the age related changes of the fibre type composition of the human psoas major muscle. Moreover, we wanted to compare the fibre type composition of the left and right muscle. Muscle samples were collected from 15 young and 15 old males. Type I, IIA and IIX muscle fibres were typed using myosin heavy chain identification. The serial transverse sections were analysed using a light microscope. Results of our study showed that the age-related atrophy affected all three fibre types. Type IIA fibres were affected most profoundly while type I fibres were affected most weakly. The percentage of the different fibre types did not change during aging. There were no differences in the fibre type composition between the left and right muscle. Human psoas major muscle undergoes normal aging changes with the atrophy of all three fibre types, whereas atrophy most profoundly affects type IIA fibres. No differences in the fibre type composition between the left and right muscle point to the equal engagement of both legs in normal everyday activities of human.

Properties of the celiac trunk--anatomical study.

Although anatomical properties and vessel variations of the celiac trunk are well explored in the literature, there is not so much information on the arterial diameters, and this data is important for surgical procedures and angiographic examinations. The aim of this study was to investigate properties of the celiac trunk in humans by using anatomical dissection. Ninety cadavers were dissected for the celiac trunk identification and arterial diameter measurements. The results of anatomical examination showed that in 72% of all cases the celiac trunk divides into the splenic artery and the common hepatic artery, while the left gastric artery arises as a first branch and had origin between aorta, all over the celiac trunk up to a bifurcation. From the 90 cadavers, 4 presented anatomical variations. Where normal anatomy was present, the mean length of the celiac trunk was 1.9 +/- 0.08 cm and its mean arterial diameter was 0.78 +/- 0.08 cm. The splenic artery had the largest diameter (0.61 +/- 0.05 cm) and the left gastric artery had the smallest diameter (0.38 +/- 0.03 cm). Our data represent original results about anatomical variations and arterial diameter of the celiac trunk and its main branches provided by anatomical dissection.

Fibre type composition of the human psoas major muscle with regard to the level of its origin.

The aim of our study was to explore the fibre type composition of the human psoas major muscle at different levels of its origin, from the first lumbar to the fourth lumbar vertebra, and to compare the muscle fibre size and distribution of different fibre types between levels with respect to its complex postural and dynamic function. Muscle samples were collected from 15 young males (younger than 35 years). Serial transverse sections (5 microm) of the samples were cut by cryomicrotome. Type I, IIA and IIX muscle fibres were typed using myosin heavy chain identification. The serial sections were analysed using a light microscope with a magnitude of 100x. The differences between measurements were evaluated using a repeated-measures anova and Scheffé test for post-hoc analysis. Our study showed that the human psoas major muscle was composed of type I, IIA and IIX muscle fibres. It had a predominance of type IIA muscle fibres, whereas type I muscle fibres had the largest cross-sectional area. Type IIX muscle fibres were present as a far smaller percentage and had the smallest cross-sectional area. Moreover, the fibre type composition of the psoas major muscle was different between levels of its origin starting from the first lumbar to the fourth lumbar vertebra. We conclude that the fibre type composition of the psoas major muscle indicated its dynamic and postural functions, which supports the fact that it is the main flexor of the hip joint (dynamic function) and stabilizer of the lumbar spine, sacroiliac and hip joints (postural function). The cranial part of the psoas major muscle has a primarily postural role, whereas the caudal part of the muscle has a dynamic role.

Reg IV protein and mRNA expression in different rat organs.

The Reg IV gene has been documented in the human colon, small intestine, stomach and pancreas. Expression of the Reg IV in different cell types has been associated with regeneration, cell growth and cell survival, cell adhesion and resistance to apoptosis. Since the distribution of the Reg IV protein in normal rat tissues is unknown, the aim of this study was to reveal the expression of the Reg IV protein in structurally and functionally different rat organs. The expression of Reg IV gene was analyzed by Western blot and reverse transcription-polymerase chain reaction. Immunohistochemistry was used to localize Reg IV protein. Reg IV protein was expressed in pancreas, stomach, small intestine, colon, brain, spleen, kidney and urinary bladder in two-month-old male Wistar rats. In addition, the expression of Reg IV mRNA by reverse transcription-polymerase chain reaction was confirmed. Our study provides detailed information about the expression and localization of Reg IV protein in different rat organs. These findings provide an evidence of Reg IV expression in different rat organs, which may help elucidate a potential role in growth and proliferation of different cells like other members of the Reg family genes which act as growth factors in the different organs.