The effectiveness of telerehabilitation after hip or knee arthroplasty: a narrative review.

Telerehabilitation is defined as a set of tools, procedures, and protocols to deliver rehabilitation programs remotely. It involves the use of various communication technologies to efficiently provide rehabilitation services distantly or via some other remote environment. After an orthopedic procedure, physical rehabilitation is essential to restore joint's function, to improve quality of life as well as to relieve pain, to recovery independence. The effectiveness of telerehabilitation has been studied in literature. The aim of this narrative review is to update the current evidence, evaluate the efficacy of telerehabilitation after hip, and knee prosthesis surgery for end stage arthrosis. Results show that it is useful to integrate traditional interventions with telerehabilitation to accelerate efficiency in existing healthcare delivery systems. Future high-methodological-quality studies should be conducted to evaluate the long-term efficacy and safety of innovative technologies.

Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing. / Complicaciones posoperatorias de fracturas toracolumbares en pacientes con traumatismo múltiple según el momento de la cirugía.

INTRODUCTION AND OBJECTIVES: Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery. As a secondary objective, to estimate which variables were associated with surgery before 72 h. MATERIAL AND METHODS: Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma. Surgically treated in an occupational trauma referral center, by the same surgical team and during the period between January 2013 and December 2019. RESULTS: We analyzed a sample of 40 patients (39 men and 1 woman). The rate of complications was independent of surgical delay (before and after 72 h) (p = 0.827). There were statistically significant differences between early and later surgery groups in the variables age, systolic blood pressure, initial SOFA score and presence of neurological damage (p = 0.014; p = 0.029; p = 0.032; p = 0.012). The overall surgical delay was correlated with the SOFA score (p = 0.007). CONCLUSION: The rate of early postoperative complications did not show significant differences between the early and late surgery groups. We observed that the patients who had been operated before 72 h from trauma were younger, had more association with neurological syntoms, presented higher blood pressure values and less physiological damage. Surgical delay was positively correlated with SOFA score on arrival.

Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing.

INTRODUCTION AND OBJETCTIVES: Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery. As a secondary objective, to estimate which variables were associated with surgery before 72h. MATERIAL AND METHODS: Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma. Surgically treated in an occupational trauma referral center, by the same surgical team and during the period between January 2013 and December 2019. RESULTS: We analyzed a sample of 40 patients (39 men and 1 woman). The rate of complications was independent of surgical delay (before and after 72h) (p=0.827). There were statistically significant differences between early and later surgery groups in the variables age, systolic blood pressure, initial SOFA score and presence of neurological damage (p=0.014; p=0.029; p=0.032; p=0.012). The overall surgical delay was correlated with the SOFA score (p=0.007). CONCLUSION: The rate of early postoperative complications did not show significant differences between the early and late surgery groups. We observed that the patients who had been operated before 72h from trauma were younger, had more association with neurological syntoms, presented higher blood pressure values and less physiological damage. Surgical delay was positively correlated with SOFA score on arrival.

Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial.

OBJECTIVE: To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease. DESIGN: Prospective, single-blinded, randomised controlled trial. SETTING: Outpatients. PARTICIPANTS: Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. INTERVENTIONS: Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. MAIN OUTCOME MEASURES: The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. RESULTS: The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007]. CONCLUSION: These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. CLINICAL TRIAL REGISTRATION NUMBER: NCT02807740.

Laterality in Parkinson's disease may predict motor and visual imagery abilities.

Experimental evidence suggests that motor imagery (MI) engages the same neural substrates supporting actual motor activities and is likely impaired when such substrates are damaged, as in Parkinson's disease (PD). MI intuitively relies on visual imagery (VI), because mental simulations of physical movements depend on the visual retrieval of these movements. Although VI is generally considered a right hemispheric function, the hemispheric dominance of MI is still in dispute. Disparities in sidedness of motor disturbances are a distinctive feature of PD, and recent findings indicate that such disparities may similarly characterize cognition. Specifically, the deficits observed may depend upon which hemisphere is principally involved. Essentially, MI and VI are cognitive tasks subject to differential impairment and reflecting the prevalence of hemispheric impairment in PD. Motor imagery (assessed by the Vividness of Motor Imagery Questionnaire [VMIQ]) and VI (assessed by the Vividness of Visual Imagery Questionnaire [VVIQ] and Test of Visual Imagery Control [TVIC]) were examined in patients with asymmetric PD and in healthy elderly control subjects (HC group). VMIQ scores were similar in PD laterality subsets and the HC group, but VVIQ scores were significantly lower in both PD groups compared with the HC group. TVIC scores were significantly lower in the presence of left motor (right hemispheric) impairment and were predictive of left motor (right hemispheric) impairment. We suspect that MI is strongly reliant on VI and that language may mediate these two functions, to the extent that both are evoked through verbal stimuli. Working memory, both visual and verbal, is also involved in MI and VI tasks. Without due attention to laterality of symptoms, any training incorporating MI and VI may not deliver expected outcomes in the setting of asymmetric PD symptomatology.

Performance and clinical comparison between left ventricular quadripolar and bipolar leads in cardiac resynchronization therapy: Observational research.

AIM: To evaluate Attain Performa (Medtronic, Dublin, Ireland) quadripolar lead performance in clinical practice and, secondarily, to compare its long term clinical outcomes vs bipolar leads for left ventricular (LV) pacing. METHODS AND RESULTS: We retrospectively analyzed clinical, procedural and follow-up data of 215 patients implanted with a quadripolar lead. One hundred and twenty one patients implanted with bipolar lead were selected to compare long-term clinical outcomes. The quadripolar lead was implanted in the target vein in 196 patients (91%) without acute dislodgements. In 50% of patients the chosen final pacing configuration at implant would not have been available with bipolar leads. A dedicated quadripolar pacing vector was chosen more frequently when the LV tip location was apical than otherwise (65.6% vs 42.7%, p=0.003). After a median follow-up of 14 months, the LV pacing threshold was less than 2.5V at 0.4ms in 98 patients (90%) with a safety margin between phrenic nerve and LV pacing threshold >3V in 97 patients (89%). We observed a slight trend toward a lower risk of heart failure worsening and a lower incidence of ventricular arrhythmias and pulmonary congestion in patients implanted with quadripolar leads compared with the control group. CONCLUSION: Quadripolar leads improve the management of phrenic nerve stimulation at no trade-off with pacing threshold and lead stability. Quadripolar leads seems to be associated with a lower incidence of VT/VF and pulmonary congestion, when compared with bipolar leads, but further investigations are necessary to confirm that this positive effect is associated with better LV reverse remodeling.

Principal component analysis of some oxidative stress parameters and their relationships in hemodialytic and transplanted patients.

BACKGROUND: Oxidative stress profoundly influences the biochemistry of proteins and many other molecules in tissues of uremic patients. In three different groups of uremic patients, the concentrations of the free and bound pentosidine and low-molecular-weight-advanced glycoxydation end products (LMW-AGEs), carbonyls (LMW-C), advanced oxidation protein products (AOPP) and the total antioxidant power of serum were studied in order to determine the relationships between these factors in hemodialytic and transplanted patients. PATIENTS AND METHODS: The above-mentioned parameters were determined in 10 subjects who were currently in hemodialysis (HD) treatment, 10 kidney transplanted patients with chronic renal failure (Tx-CRF), 10 kidney transplanted patients with normal renal function (Tx-N) and 10 healthy subjects (Ctr). The data matrix (40x7) was analyzed using the principal component analysis (PCA). RESULTS: AGEs, carbonyls and AOPP were strongly correlated, while the total antioxidative serum capacity was not related to the other oxidative stress parameters. All the oxidative stress-related parameter values (AGEs, AOPP and LMW-C) in the Tx patients were similar to those of the control group, but were higher in the patients with chronic renal failure. CONCLUSIONS: The correlation between early and advanced oxidative stress markers indicates that reactive oxygen species are involved in a common step in the mechanism of protein modification in all the patient examined. The relationships between carbonyls and AGEs (free, bound pentosidine and LMW-AGEs) support the hypothesis of "carbonyl stress". The common mechanism of the formation of oxidation products in healthy and diseased subject suggests their role of detoxification within kidney function. The total antioxidant power of the serum is not related to the other parameters, which indicates a possible role of molecule interfering.

[Acute renal failure, hemolysis and thrombocytopenia]. / Un caso di insufficienza renale acuta associata ad emolisi e piastrinopenia.

A 41-year-old male was admitted because of severe systemic hypertension and acute renal failure (ARF) that required hemodialysis (HD). Also present were hemolytic anemia, thrombocytopenia and increased plasmatic levels of aldosterone and reninic activity. The diagnostic tests performed during the recovery led to the conclusion of malignant hypertension. This case dealt with a cause of ARF, which is not currently so common; physicians should be aware of this condition especially when it is present with hemolytic anemia and thrombocytopenia, which are the microangiopathy markers.

Relationship between autoimmune thyroid disease Rand Alzheimer's disease.

Alzheimer's Disease (AD) is a particular form of degenerative dementia probably due to deposit in the brain cortex of a non soluble protein called beta-A4 amyloid in senile plaque form. beta A4 is an aberrant mutant proteolytic product of Amyloid Protein Precursor (APP) codified on chromosome 21. Trisomy 21 is responsible for Down's Syndrome (DS). Down's patients have been shown to develop a form of Alzheimer's after 50 years of age, and high blood levels of antithyroid antibodies are also present in a significant percentage of these cases. In the present investigation, antithyroid antibody titres have been studied by means of RIA in group of 34 AD patients. As compared to 30 non-demented controls, AD subjects showed a significant increase in the mean values of antithyroglobulin (TgAb) and antimicrosomial (MCSAb) autoantibodies. The physiopathological relationship regarding this association is discussed.

Normalization of oxidative stress parameters after kidney transplant is secondary to full recovery of renal function.

BACKGROUND: It is well-known that hemodialysis patients experience increased oxidative stress, which is believed to cause numerous uremia-related complications. Retention of water-soluble toxins as well as protein-bound toxins is due to renal failure. Kidney transplantation restores, at least partially, the fundamental processes of glomerular filtration which eliminates toxic solutes. The aim of this study was to determine the levels of several different glycoxydative stress-related parameters after kidney transplantation. PATIENTS AND METHODS: A cross-sectional study was carried out on 30 subjects: 10 kidney-transplanted patients with chronic renal failure (Tx-CRF), 10 kidney-transplanted patients with normal renal function (Tx-N) and 10 controls (Ctr). The groups were comparable with respect to age and gender. The following glycoxydative stress markers were determined by HPLC analysis: albumin-bound and free pentosidine, low-molecular weight-advanced glycation end products (LMW-AGEs), advanced oxidation protein products (AOPP) and low-molecular weight carbonyls (LMW-C). The total antioxidant serum capacity was monitored by measuring both the ferric reducing/antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC). RESULTS: With respect to the controls, the Tx-CRF patients had higher levels of pentosidine (2.66 +/- 0.98 vs 1.45 +/- 1.1 pmol/mg), LMW-AGE (47.55 +/- 39.74 vs 15.45 +/- 6.39 a.u./ml), and AOPP (6.71 +/- 0.78 vs 4.81 +/- 0.32 a.u./mg) while Tx patients with normal kidney function had levels of these compounds that were comparable to the controls, except for the LMW-AGEs which were higher. Levels of LMW-AGEs, pentosidine, LMW-C and AOPP were inversely correlated to creatinine clearance. The total antioxidation serum capacity was paradoxically higher in Tx patients than in the controls, regardless of kidney function. FRAP as well as ORAC, were correlated to uric acid (r = 0.62, p < 0.001; r = 0.54, p < 0.01). CONCLUSIONS: The reported data indicate that kidney transplantation seems to restore a nearly normal level of glycoxidative stress markers, but a complete remission is only possible when the renal function is normal. An increase of total antioxidant power of serum in transplanted patients was reported, as probable effect of uric acid high levels.

[Indications for mandibular periosteotomy in the treatment of cancer of the oral cavity]. / Indicazioni alla corticotomia nel trattamento del carcinoma del cavo orale.

Marginal mandibulectomy is a compromise between preserving the mandibular structure and radical oncological surgery. In order to evaluate the correctness of the indications for this operation, a group of 47 patients with oral carcinoma underwent direct surgery or associated chemoradiotherapy and surgery. Surgery was programmed on the basis of clinical and radiological examinations and the specific evaluation of the distance of the tumour mass from the mandibular surface. This approach was justified by the lack of correlation, in anatomic and clinical terms, between tumoral infiltration of the mandible and metastatic recurrence in the cervical lymph nodes. Lastly, the varying pattern of tumoral invasion of the various mandibular regions (thickness of cortical bone, presence of foramen) induced the authors to distinguish the indications for conservative treatment by segments. According to international literature and on the basis of the authors' past experience, marginal mandibulectomy represents an extremely interesting method since it associates a satisfactory aesthetic-functional level with a radical oncological approach, in particular with regard to the symphyseal and parasymphyseal region owing its structural characteristics and reconstructive importance. The indications for this type of surgery are therefore in theory based primarily on oncological aspects, and subsequently on the various anatomic and reconstructive aspects of the various mandibular segments.

[A statistical study of 206 patients suffering from malignant neoplasms of the cervicofacial area]. / Studio statistico su 206 pazienti affetti da neoplasie maligne del distretto cervico-facciale.

This study focuses on the importance of early diagnosis in the oncological resolution of neoplasia of the cervico-facial district. In a sample of 206 patients suffering from neoplasia of the cervico-facial district, the authors found a greater incidence of pathology between the 6th and 7th decades of life, a finding that confirms the enhancement of etiopathogenetic factors over time. The oral cavity represents the site predominantly affected by this neoplasia with an incidence of 57.3%. Epidermoid carcinoma represents 61.7% of the histological types examined. The treatment protocol used in 167 patients depending on the clinical stage and the general conditions of the patient was as follows: multimodal in patients at stage 3 and 4 with a minimum survival rate at 12 months of 75% and 58% respectively, predominantly surgical in patients at stage 1 and 2 with a survival rate of 94.4 and 89.7% respectively.

Cryptococcal arthritis in a patient with acquired immune deficiency syndrome. Case report and review of the literature.

A patient with acquired immune deficiency syndrome (AIDS) and cryptococcal arthritis occurring in the setting of disseminated cryptococcosis is described. The literature of cryptococcal arthritis is reviewed and the association of this unusual infection with AIDS is discussed. To our knowledge, this is the first reported association between AIDS and cryptococcal arthritis.

Oxidation of L-thiazolidine-4-carboxylate by delta1-pyrroline-5-carboxylate reductase in Escherichia coli.

L-Thiazolidine-4-carboxylate (T4C, thiaproline) is a sulfur-containing proline analog that stimulates the immune system in aging mice and inhibits urinary tract pathogens such as Escherichia coli. A constitutive NADP+-dependent T4C dehydrogenase activity was detected in the soluble fraction of a putA::Tn5 mutant of E. coli lacking l-proline dehydrogenase and partially purified by ammonium sulfate precipitation, dye-affinity chromatography on Cibacron Blue 3GA agarose, and ion-exchange chromatography on DEAE-cellulose. At each step in the purification, T4C dehydrogenase activity copurified with Delta1-pyrroline-5-carboxylate (P5C) reductase activity. E. coli strains with greatly reduced P5C reductase activity due to a proC mutation had no detectable T4C dehydrogenase activity. Although P5C reductase did not act on proline, it also catalyzed the oxidation of 3,4-dehydroproline. These results suggest that this biosynthetic enzyme may play a role in the degradation of proline analogs and limit the clinical efficacy of these compounds.

[Computerized tomography and magnetic resonance in radical and reconstructive surgery using pedunculated and revascularized flaps in advanced-stage tumors of the head and neck. Analysis of recurrences. II]. / Tomografia Computerizzata e Risonanza Magnetica nella chirurgia radicale e ricostruttiva con lembi peduncolati e rivascolarizzati nei tumori negli stadi avanzati del capo e del collo. Analisi delle recidive (II parte).

January, 1992, to October, 1995, sixty-four patients with advanced head and neck carcinoma were submitted to reconstructive surgery using pedunculated myocutaneous or revascularized flaps and then to CT and MRI. Myocutaneous flaps were used in 26 cases--12 tubular and 14 linear flaps--and revascularized flaps in 38--14 latissimus dorsi flaps, 12 temporal flaps, 7 jejunal flaps and 5 radial flaps. Twenty-six of 64 cases (41%) relapsed: MRI correctly depicted the recurrence in 24 cases and CT in 19, with 2 false positives and 2 false negatives at MRI and 6 false positives and 7 false negatives at CT. The sensitivity, specificity, accuracy, positive and negative predictive value of CT were 84%, 78%, 73%, 76% and 82%, respectively, while the corresponding MR rates were 95%, 94%, 92%, 92% and 95%. MRI was more accurate than CT in demonstrating postoperative and postirradiation changes (92% for MRI versus 73% for CT) thanks to its higher sensitivity in depicting tumor tissue on T2-weighted and post-Gd-DTPA images. CT is very useful in the early postoperative period, to follow-up poorly collaborative patients, because its acquisition time is short; MRI should be performed when CT findings are questionable and the revascularized flap is used to repair a large defect at the skull base.

[Anatomic changes after radical surgery and reconstruction with pedunculated or revascularized flaps in advanced head and neck tumors: computerized tomography and magnetic resonance findings]. / Modificazioni anatomiche dopo chirurgia radicale e ricostruzione con lembi peduncolati o rivascolarizzati nei tumori cervico-facciali negli stadi avanzati: aspetti con Tomografia Computerizzata e Risonanza Magnetica.

January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps wer used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The postoperative scar around the flap exhibited soft-tissue density with slight post-contrast enhancement at CT and slightly hypodense on T2-weighted MR images. Post-contrast CT and MRI showed slight scar enhancement with no signal changes in the fatty component. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened layers with both imaging methods. Temporal and latissimus dorsi flaps are made basically of muscular tissue, fatty tissue and occasionally skin (used to repair a mucosal defect): consequently, CT showed a structure with mostly parenchymal density in all cases and MRI depicted intermediate signal intensity. MRI was useful to detect 12 revascularized jejunal or radial flaps thanks to its higher contrast resolution and multiplanar capabilities showing even such thin structures as these flaps. Moreover, MRI permitted to study skull base reconstruction with revascularized (latissimus dorsi) flaps in 5 of our patients.