Outcomes Following Arthroscopic Single and Double Bundle Anterior Cruciate Ligament (ACL) Reconstruction Supported by the Comprehensive Early Rehabilitation Program (CERP).

BACKGROUND The aim of this study was to compare the level of functional condition in patients who had rehabilitation with the comprehensive early rehabilitation program (CERP) following either single bundle (SB) or double bundle (DB) anterior cruciate ligament reconstruction (ACLR) using semitendinosus-gracilis tendon graft (ST-G) method. We hypothesized that 12 weeks after reconstruction followed by a rehabilitation program, there would be a difference in clinical results and functional activity between patients. MATERIAL AND METHODS This study included 94 patients who had rehabilitation with CERP after knee surgery for a knee injury from a recreational sport. There were 49 patients in Group 1 (mean age, 36.5 years) who had CERP after SB ACLR, and 45 patients in Group 2 (mean age, 35.6 years) who had CERP after DB ACLR. Functional condition was tested using the Lysholm Knee Scoring Scale, and knee stability was measured using KT-2000. The first examination was performed before CERP and the second examination was performed 12 weeks later. RESULTS The level of functional condition in both groups was similar before rehabilitation with CERP, with no significant difference (P<0.958) and was considered relatively low. In the second examination, 12 weeks after starting CERP, the patients improved in both groups. The improvement was larger in the SB ACLR Group 1 than in the DB ACLR Group 2. The difference was significant (P<0.005). However, the patients in Group 2 achieved better knee stability scores in the KT-2000 examination than the patients in Group 1. The difference was significant (P=0.035). CONCLUSIONS We found that the patients from both groups after 12 weeks of CERP achieved an improvement in stability and functional activity within normal limits. However, SB ACLR was more effective than DB ACLR in terms of the level of functionality achieved with CERP but was less effective in terms of knee stability.

Massive non-Infectious Inflammatory Muscle Infiltrate Following Hip Arthroplasty Confirmed by Magnetic Resonance Imaging.

Arthroplasty is currently a treatment of choice in advanced osteoarthritis. A register published in Sweden in 2017 showed that approximately 40% of hip arthroplasty procedures in patients whose osteoarthritis is secon-dary to childhood diseases are performed in individuals under 50 years of age. We describe the treatment of a 42-year-old female patient after hip arthroplasty with a massive non-in-fec-tious inflammatory muscle infiltrate, who did recreational sports. An individualised treatment and physiotherapy programme made it possible for the patient to fully resume her recreational sports activities.

Corrigendum to "Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data".

[This corrects the article DOI: 10.1155/2015/165908.].

Anti-inflammatory effect on genes expression after four days of Qigong training in peripheral mononuclear blood cells in healthy women.

INTRODUCTION: Some studies have shown the influence of Qigong on gene expression in different cells, but there is little data associated with the influence of this kind of therapy on genes expression in pheripheral monocellucar blood cells. OBJECTIVE: The aim of this study was to evaluate changes in the expression of genes associated with cellular stress response in peripheral mononuclear blood cells (PMBC) in healthy women. MATERIAL AND METHODS: The experiment took place at the Japanese Martial Arts Centre "DOJO" in Stara Wies, Poland, conducted over the course of a 4-day qigong training session. To evaluate the genes effect of this training, blood samples were taken before and after the training period. This experiment involved 20 healthy women (aged 56.2±9.01, body height 164.8±6.5 and mass 65.5±8.2). To determine the expression of HSF-1, HSPA1A, NF-kB, IL10 and CCL2 mRNA, 3 ml of venous blood was collected. The blood samples were placed in tubes allowing for separation (BD Vacutainer CPT TM) before and after the 4 days of qigong training. Isolated PMBC were used to determine gene expression using real-time qRT-PCR (quantitative reverse transcription polymerase chain reaction). RESULTS: Significant decreases in NF-kB and CCL2 mRNA and increases in IL10, HSF1 and HSPA1A m-RNA were detected after 4 days of qigong training. The obtained findings suggest that qigong caused a reduction in the inflammatory and intensified anti-inflammatory gene expression, as well as a higher expression of HSF-1 and HSPA1A. CONCLUSIONS: The adaptive response to qigong training was similar to the adaptive response to physical activity and was detected through gene expression in PMBC. Furthermore, this kind of training is especially indicated for women because of their higher susceptibility to psychosocial stress when compared to men.

Treatment of Primary Hip Arthroplasty Complications. Case Study.

Intraoperative periprosthetic femoral fracture during hip arthroplasty is one of the most serious surgical com-plications. Its consequences can be minimized with correct diagnosis and early institution of appropriate treatment. This paper presents the management of a periprosthetic femoral fracture complicated by infection in a 53-year-old female patient. The patient underwent three revision surgeries. The first one consisted in treating the fracture and was complicated by another fracture and infection. This was followed by a two-stage treatment of the infection with a cementless revision stem arthroplasty. Arthroplasty procedures should be preceded by appropriate preoperative planning. In the treatment of peri-pro-sthetic fractures, it is essential to use appropriate implants and adhere to the AO principles of fracture ma-nagement.

Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience.

BACKGROUND The results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD. MATERIAL AND METHODS A retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed. RESULTS Very good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection. CONCLUSIONS Our study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.

Perioperative Physiotherapy for Total Ankle Replacement in Patients with Inherited Bleeding Disorders: Outline of an Algorithm.

The treatment of end-stage hemophilic arthropathy of the ankle joint remains a controversial problem, and total ankle replacement (TAR) is considered to be a valuable management option. Physiotherapy continues to be an extremely important part of TAR and has a tremendous impact on the outcomes of this procedure. Given the lack of data on the latter, this study details a protocol of perioperative physiotherapy in TAR in patients with inherited bleeding disorders (IBD). The protocol outlined in this paper was devised via consultations within an interdisciplinary group, the authors' own experiences with TAR in hemophilic and non-hemophilic patients, previous reports on this issue in the literature, and patient opinions. Our working group followed the criteria of the International Classification of Functioning, Disability and Health. The algorithm includes 4 physiotherapy phases with specified time frames, aims, interventions, and examples of exercises for each phase. We emphasize the importance of preoperative rehabilitation, and recommend introducing intensive physiotherapy immediately after the surgery, with regard to the wound protection and avoiding full weight-bearing in the first weeks. The intensity of physiotherapy should be adjusted individually depending on individual patient progress. This study details a rehabilitation protocol for TAR in patients with IBDs, which can be equally applicable to clinicians and researchers. Further scientific studies are required to investigate the beneficial effect of different protocols as well as to clarify the effectiveness of various frequencies, durations, and intensities of selected interventions.

Evaluation of the effectiveness of neurofeedback in the reduction of Posttraumatic stress disorder (PTSD) in a patient following high-voltage electric shock with the use of ERPs.

BACKGROUND: The aim of our research was an evaluation of the effectiveness of neurofeedback in reducing the symptoms of Post-trauma stress disorder (PTSD), which had developed as a result of a high-voltage electric burn to the head. Quantitative EEG (QEEG) and Event related potentials (ERPs) were utilised in the evaluation. CASE STUDY: A 21-year-old patient, experienced 4(th) degree burns to his head as a result of a high-voltage electric burn. The patient was repeatedly operated on and despite the severity of the injuries was to recover. However the patient complained of flashbacks, difficulties with sleeping as well as an inability to continue work in his given profession. Specialist tests were to show the presence within him of PTSD. As a result of which the patient was provided with neurofeedback therapy. The effectiveness of this therapy in the reduction (eradication) of the symptoms of PTSD were evaluated through the utilisation of qantitative eeg (Qeeg) and event related potentials (ERPs). RESULTS: It was found that in the first examination that ERPs display the most significant deviations from the reference in the two components: (1) the one component is generated within the cingulate cortex. The pattern of its deviation from the norms is similar to that found in a group of OCD patients. In contrast to healthy subjects the component repeats itself twice; (2) the second component is generated in the medial prefrontal cortex. Its pattern (neuromarker) is similar to that found in PTSD patients. There is a delay in the late part of the component, which probably reflects the flashbacks. In the second examination, after neurofeedback training, the ERPs were similar to the norm. The patient returned to work. CONCLUSIONS: Chronic PTSD developed within the patient as a result of a high-voltage electric burn. The application of a method of therapy (neurofeedback) resulted in the withdrawal of the syndrome symptoms. ERPs in a GO/NOGO task can be used to plan neurofeedback and in the assessment of functional brain changes induced by neurotherapeutic programmes. Funds Collection: Private sources.

Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data.

Total knee arthroplasty (TKA) is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA.

Analysis of trace element in intervertebral disc by Atomic Absorption Spectrometry techniques in degenerative disc disease in the Polish population.

OBJECTIVE: Although trace elements are regarded crucial and their content has been determined in number of tissue there are only few papers addressing this problem in intervertebral disc in humans. Most of the trace elements are important substrates of enzymes influencing metabolism and senescence process. Others are markers of environmental pollution. Therefore the aim of the research was to analyzed of the trace element content in the intervertebral disc, which may be a vital argument recognizing the background of degenerative changes to be the effect of the environment or metabolic factors. MATERIALS AND METHODS: Material consist of 18 intervertebral disc from 15 patients, acquired in surgical procedure of due to the degenerative disease with Atomic Absorption Spectrometry content of Al, Cd, Co, Pb, Cu, Ni, Mo, Mg, Zn was evaluated. RESULTS: Only 4 of the trace elements were detected in all samples. The correlation analysis showed significant positive age correlation with Al and negative in case of Co. Among elements significant positive correlation was observed between Al/Pb, Co/Mo, Al/Mg, Al/Zn Pb/Zn and Mg/Zn. Negative correlation was observed in Al/Co, Cd/Mg, Co/Mg, Mo/Mg, Co/Zn and Mo/Zn. CONCLUSIONS: This study is the first to our knowledge that profiles the elements in intervertebral disc in patients with degenerative changes. We have confirmed significant differences between the trace element contents in intervertebral disc and other tissue. It can be ground for further investigation.

Effects of exercise of different intensity on gut peptides, energy intake and appetite in young males.

UNLABELLED: INTRODUCTION AND RESEARCH AIMS: The aim of the work was an evaluation of the impact of physical exertion on the regulating of food intake and digestive system hormone release as well as the partly connected phenomenon of evaluating the subjective sensation of hunger and the amount of food consumed at various time following physical exercise. MATERIALS AND METHODS: The tests covered 12 young, healthy men, for whom the effects of physical exertion of a moderate and high intensity on the subjective sensation of hunger/satiety, evaluated by means of visual analogue scales, on food intake as well as on the metabolic and hormonal parameters were tested. RESULTS: Physical exertion resulted in a fall in the subjective sensation of hunger, but only following intensive exertion was this statistically significant. The intake of food was greater after exertion when compared to the control group. Moderate exertion resulted in a statistically significant but short-lived increase in the ghrelin level. This effect was not observed after intensive exertion, while in those tests during the post-meal period there occurred a fall in the concentration of ghrelin in the plasma. After exertion a physical fall was observed in the concentration of insulin in the plasma, for the intake of food resulted in a notable increase in its level. CONCLUSIONS: Physical highly intensive exertion, results in a temporary reduction in the subjective sensation of hunger but leads to an increased food intake. The current research suggests that moderate but not intensive physical exertion stimulates the secretion of ghrelin.

Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR).

BACKGROUND: The goal of this study was to evaluate the effect of physiotherapy on the strength of muscles responsible for tibial internal rotation (IR) in male patients after anterior cruciate ligament reconstruction (ACLR) using autografts of the semitendinosus and gracilis muscles (STGR). MATERIAL/METHODS: Fifty-nine males were examined. The first group consisted of 19 patients subjected to 4-stage physiotherapy following ACLR. The second group consisted of 20 males without knee injuries. The third group consisted of 20 males who had not undergone systematic physiotherapy within the last 12 months following lower limb injuries. Moments of maximal strength (MMS), isometric torque (IT), and peak torque (PT) were measured under static and isokinetic conditions using the Humac Norm System. In the first group, IT measurements were performed during the 13th and 21st week of physiotherapy, while PT measurements were performed during the 16th and 21st weeks of physiotherapy following ACLR. In the control groups (II and III) the measurements were performed once. RESULTS: In the first group, the IT (13 weeks) and PT (16 weeks) values of internal tibial rotator muscles, obtained from the operated extremities were significantly lower than the values obtained from the uninvolved knees and the control group results. During the 21st week of physiotherapy, the results obtained for IT and PT in patients after ACLR were similar to the values obtained from the uninvolved knees and the results of the second group subjects. CONCLUSIONS: The 21-week physiotherapy in ACLR patients favorably affected the PT values of tibial rotator muscles of the operated knees. In the third group, the IT values did not indicate a complete improvement after 12 months without systematic physiotherapy.

Analysis of rehabilitation procedure following arthroplasty of the knee with the use of complete endoprosthesis.

BACKGROUND: The use of endoprosthesis in arthroplasty requires adaptation of rehabilitation procedures in order to reinstate the correct model of gait, which enables the patient to recover independence and full functionality in everyday life, which in turn results in an improvement in the quality of life. MATERIAL/METHODS: We studied 33 patients following an initial total arthroplasty of the knee involving endoprosthesis. The patients were divided into two groups according to age. The range of movement within the knee joints was measured for all patients, along with muscle strength and the subjective sensation of pain on a VAS, and the time required to complete the 'up and go' test was measured. The gait model and movement ability were evaluated. The testing was conducted at baseline and after completion of the rehabilitation exercise cycle. RESULTS: No significant differences were noted between the groups in the tests of the range of movement in the operated joint or muscle strength acting on the knee joint. Muscle strength was similar in both groups. In the "up and go" task the time needed to complete the test was 2.9 seconds shorter after rehabilitation in Group 1 (average age 60.4), and 4.5 seconds shorter in Group 2 (average age 73.1)). CONCLUSIONS: The physiotherapy procedures we applied, following arthroplasty of the knee with cemented endoprosthesis, brought about good results in both research groups of older patients.

A case of "borrowed identity syndrome" after severe traumatic brain injury.

BACKGROUND: It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury. CASE REPORT: We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative 'life-story' interviewing was undertaken to explore the mental state of a patient whose subjective, "first person" identity has been disengaged, despite the retention of significant amounts of objective, "third person" information about himself and his personal history (though this was also lost at a later stage in the patient's deterioration). Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory. CONCLUSIONS: The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation.

Early neurorehabilitation in a patient with severe traumatic brain injury to the frontal lobes.

BACKGROUND: It seems to be generally believed that early neurostimulation after severe TBI is useless or even harmful, and neuropsychological intervention should not be initiated until the patient is medically stable. On the other hand, the unstimulated brain can incur irreversible damage. The purpose of the present study is to assess the impact of early neuropsychological rehabilitation on a patient with an extremely severe TBI. CASE REPORT: The patient, a 32-year old male, suffered a massive cranio-facial injury with significant loss of tissue in the right frontal lobes after being struck by a tram. Beginning two weeks after injury, after pharmacological coma, he was attended on a daily basis by a neuropsychologist and a neurolinguist, with the active assistance of his family, when he was still in critical condition and essentially without logical contact. By the time he returned to Scotland 4 weeks later, he was sitting up, writing complete, sensible and grammatical sentences, and making rapid progress every day despite the development of hydrocephalus. Over the course of neurorehabilitation, most of MF's cognitive dysfunctions resolved. Six months later, however, hydrocephalus was increasing and the patient was showing severe frontal syndrome. A personalized version of Community Based Rehabilitation was applied. After two weeks of intensive treatment considerable improvement was achieved and frontal syndrome was reduced. CONCLUSIONS: The present case suggests that the prevailing views regarding the inadvisability of early neurorehabilitation in the acute phase after TBI should be reconsidered.

[Quack medicine--a continual problem in Polish rural communities. Illnes occurring within the musculo-sceletal system]. / Znachorstwo--wciaz aktualny problem polskiej wsi. Na podstawie doswiadczen w chorobach narzadu ruchu.

The work presents the results of a survey that was conducted amongst the inhabitants of the parish of Dabrowa Tarnowska concerning quack medical practices noted in the treatment of the musculo-sceletal system, as well as comments on the subject of the harm caused by the application of folk remedies. Within the group of those surveyed a startling 79% evaluated this form of treatment as satisfactory despite the appearance later of many medical complications.

The application of biofeedback exercises in patients following arthroplasty of the knee with the use of total endoprosthesis.

BACKGROUND: Various methods and means are available for patients in rehabilitation after arthroplasty of the knee with total endoprosthesis, including the use of devices with biofeedback, thanks to which the patient learns conscious control of the given activity in a way adequate to the information received. Therapy with biofeedback is especially effective for individuals for whom pathological afferentation occurs, as a result of the ensuing pathological process affecting the limb. MATERIAL/METHODS: 18 patients following arthroplasty of the knee with total endoprosthesis due to degenerative changes were qualified for participation. The patients were divided into two groups depending on the time that had elapsed after surgery before rehabilitation was commenced. The tests were conducted twice, once before and once after the cycle of physiotherapy procedures. RESULTS: The measurement of the scope of active movements conducted in the first examination showed small differences between the two groups. Times were also analysed: the total time of exercise, time in the marked field, and time outside of it. In group 1 all the average values for these parameters were greater than in group 2. CONCLUSIONS: Commencement of the rehabilitation program within a few weeks after arthroplastry of the knee with total endoprosthesis brought better results than in the case of patients who entered rehabilitation 3 months after surgery.

[The effects of environmental exposure to asbestos dust on health]. / Skutki zdrowotne srodowiskowej ekspozycji na pyl azbestu.

Pleural mesothelioma is an extremely rare neoplasm. Its etiology is related to professional or environmental exposure to asbestos dust. In the present research, the analysis of frequency and causes of death due to asbestos-related cancers in the district polluted with asbestos in comparison with the district free of such pollution has been performed. The increase has been highlighted in the mortality rate because of pleural mesothelioma among inhabitants of the area polluted with asbestos wastes.

Effectiveness of holistic physiotherapy for low back pain.

BACKGROUND: Low back pain is a term used to designate a wide and complete assemblage of symptoms that has become a cause of disability in the 21th century man. Until recently, it was believed that low back pain caused by intervertebral disc disease and degenerative progresses. At present, an increasing number of studies are linking the condition to conditions of osteoarticular and musculoligamentous structures in the spine and the associated statics of the pelvis. MATERIAL AND METHODS: The study compared the outcomes of two different plysiotherapeutic approaches to treatment of low pack pain in group of 60 female patients. In the experimental group, a customised programme of treatment was based on postisometric relaxation of muscles and ligaments, active mobilisation of the spine, Kibler Fold mobilisation, Kinesiology Taping and Maigne's relaxing exercises. the control group underwent electrotherapy procedures and performed a set of exercises usually recommended for low back pain. Intensity of pain and difficulty in performing daily activities were evaluated at baseline and on completion of the treatment: the measurements included mobility of the spine, static balance of the pelvis, tenderness and tension of muscles and ligaments and presence of cell-pain zones. Statistics analysis used basic statistics concerning the distribution of the examined characteristics and a comparison of means in independent groups using the Mann-Whitney U test. RESULTS: As a result of the treatment, low back pain was reduced in about 90% of patients in the experimental group, while static balance of the pelvis, tone of the muscles and ligaments and spinal mobility improved in approximately 80% of these patients. In the control group, radiating pain decreased and ligaments in 25% of participants, white the other parameters did not change significantly. The results were statistically significant at < 0.05. CONCLUSION: These results confirm a high holistic physiotherapy including elements of osteopathy such as post-isometric muscle relaxation, active mobilisation, Kibler Fold mobilisation, customised self-therapy and Kinesiology Taping.