The Effectiveness of Minimally Invasive Techniques in the Treatment of Patellar Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The aim was to determine the effectiveness of minimally invasive techniques (MIT) in patients with patellar tendinopathy. Database searches were performed for randomized controlled trials (RCTs) in electronic databases (WOS, Cochrane Central, SportDiscus, and Medline via PubMed and PEDro). The inclusion criteria used were published in English or Spanish and involving adults with patellar tendinopathy (pain on the inferior pole of the patella for a minimum of 3 months), with at least one group receiving MIT. The quality of the relevant RCTs was evaluated using the PEDro scale. The primary outcome was functionality using the VISA-p questionnaire. Secondary outcome was focused on pain. A total of 1164 studies were screened for possible inclusion in our systematic review. Finally, 10 RCTs were included with a total of 326 individuals. Five RCTs were included in the meta-analysis. The quality assessment revealed that all the studies included were considered to possess high methodological quality. All studies analyzing MIT such as platelet-rich plasma (PRP), dry needling, or skin-derived tenocyte-like cells, when combined with exercise, proved to be effective for patellar tendinopathy. Moreover, the PRP technique with doses greater than 4 mL together and combined with an exercise program lasting over 6 weeks obtained better results in functionality and pain than other treatments in the short term. However, in the long term, dry needling and skin-derived tenocyte-like cells are more effective than PRP. Although the infiltration of drugs was effective at posttreatment, these improvements were not maintained over time and may have secondary effects. Although there are no RCTs analyzing the effectiveness of MIT like percutaneous needle electrolysis, there has been an increasing number of publications achieving excellent results in the last years. However, it is necessary to develop RCTs analyzing not only the effect but also comparing the effectiveness between different MIT such as dry needling and percutaneous needle electrolysis.

Myotonometry as a measure to detect myofascial trigger points: an inter-rater reliability study.

OBJECTIVE: Several diagnostic methods have been used in the identification of mechanical properties of skeletal muscle, including myofascial trigger points (MTrPs), however, they are not suitable for daily clinical use. Myotonometry offers an easy noninvasive alternative to assess these muscle properties. Nevertheless, previous research has not yet studied the mechanical properties of MTrPs by myotonometry. The purposes of this study were (1) to analyze the differences in the mechanical properties between latent MTrPs and their taut bands by myotonometry, (2) to investigate the inter-rater reproducibility of myotonometric measurements, and (3) to examine the association between myotonometry and passive isokinetic dynamometry. APPROACH: Fifty individuals (58% male; age 24.6 ± 7.9 years) with a latent medial MTrP of the right soleus muscle participated. The mechanical properties of this MTrP area of soleus muscle and its taut band area were measured using a myotonometer (MyotonPRO). Additionally, passive resistive torque and extensibility of triceps surae muscle were assessed using a Kin-Com dynamometer. MAIN RESULTS: Statistical analysis indicated higher values for the stiffness parameter in the taut band with respect to the MTrP (P < 0.05). The inter-rater reliability of the myotonometric measurements was good for all variables (ICC3,1 > 0.75). The standard error of measurement (SEM) and minimal detectable difference (MDD) indicated a small measurement error for frequency and stiffness variables (SEM% < 10%; MDD95% < 20%). Significant fair correlations between myotonometric parameters and passive isokinetic parameters ranged from -0.29 to 0.48 (P < 0.05). SIGNIFICANCE: The myotonometer was demonstrated to be a reliable tool and was able to quantify differences in the mechanical properties of myofascial tissues. The potential of this method for the assessment of myofascial pain syndromes requires further investigation.

Irritable bowel syndrome immune hypothesis. Part one: the role of lymphocytes and mast cells.

OBJECTIVE: To review the available evidence on the role of T-lymphocytes and mast cells in the etiopathogenesis of Irritable Bowel Syndrome. METHODS: Bibliographic retrieval on PubMed including the terms "Irritable Bowel Syndrome, "Immune System", "T-Lymphocytes" and "Mast Cells". RESULTS: Twenty-five case-control studies and one randomized controlled trial were retrieved. Noteworthy in the blood is the increase in activated T cells destined to migrate to the bowel in these patients. A high frequency of T-lymphocytes is described in the intestinal mucosa, although the study findings are, at times, contradictory. An evident increase in mast cells (and in their activity) between the terminal ileum and descending colon is also observed. CONCLUSIONS: The heterogeneity of diagnostic criteria and experimentation methods could account for some of the differences in the results found in the selected research. There are indications that give reason to believe these patients have "low-grade intestinal inflammation", and the increase in T-lymphocytes and mast cells has been associated with disorders found in IBS such as the communication between the intestine and the nervous system, the increase in intestinal permeability and changes in the microbiota.

Hipótesis inmune del síndrome del intestino irritable. Segunda parte: papel de las citokinas / No disponible

Objetivo: Revisar la evidencia disponible sobre el papel de las interleukinas en la etiopatogenia del Síndrome del Intestino Irritable. Métodos: Recuperación bibliográfica en PubMed, incluyendo los términos MeSH “Irritable Bowel Syndrome, “Immune System”, “Cytokines” e “Interleukins”. Resultados: Se recuperaron 16 estudios casos-control y un ensayo clínico aleatorizado. A nivel sanguíneo, parece existir una concentración elevada de citokinas proinflamatorias (FNT-alfa, IL- 1Beta, IL-6, IL-8) y disminuida de la IL-10, una citokina antiinflamatoria, si bien los resultados son dispares y heterogéneos. Se han encontrado hasta 33 genes, cada uno con una expresión diferente, y una expresión disminuida de citokinas en la mucosa del colon de pacientes con SII, que no se ha descrito hasta el momento para ninguna otra patología. Conclusiones: En los pacientes con SII, no parece existir un perfil claro de los niveles de citokinas en sangre, si bien, si parece existir un desequilibrio entre ellas. Asimismo, hay indicios que hacen pensar que los distintos subgrupos de pacientes con SII podrían presentar un perfil de citokinas en sangre diferente. Por otro lado, a nivel intestinal, no se detectan niveles elevados de secreción de citokinas, en contra de lo que cabría esperar. Son necesarios más estudios para confirmar estos hallazgos(AU)

Objective: To review the available evidence on the role of interleukins in the etiopathogenesis of Irritable Bowel Syndrome. Methods: Bibliographic retrieval on PubMed including the MeSH terms “Irritable Bowel Syndrome, “Immune System”, “Cytokines” and “Interleukins”. Results: Sixteen case-control studies and one randomised controlled trial were retrieved. The blood appears to have a high concentration of pro-inflammatory cytokines (TNF-alpha, IL-1Beta, IL-6, IL-8) and lower concentration of IL-10, an anti-inflammatory cytokine, even though the findings are disparate and heterogeneous. As many as 33 genes were found, each with different expressions, and a diminished expression of cytokines in the colon mucosa of patients with IBS, which have not been previously described in any other pathology. Conclusions: In patients with IBS, a clear profile of cytokine levels in the blood does not appear to exist, although an imbalance between them can be observed. Moreover, there are indications that give reason to believe that the different subsets of patients with IBS could present cytokine profiles in different blood. On the other hand, in the intestine, high cytokine secretion levels are not detected, contrary to what would be expected. Further studies are required to substantiate these findings(AU)

Hipótesis inmune del síndrome del intestino irritable. Primera parte: papel de los linfocitos y mastocitos / No disponible

Objetivo: Revisar la evidencia disponible sobre el papel de los linfocitos T y mastocitos en la etiopatogenia del Síndrome del Intestino Irritable. de las vías biliares. Métodos: Recuperación bibliográfica en PubMed incluyendo los términos “Irritable Bowel Syndrome, “Immune System”, “TLymphocytes” y “Mast Cells”. Resultados: Se recuperaron 25 estudios casos-control y un ensayo clínico aleatorizado. A nivel sanguíneo destaca el aumento de células T activadas destinadas a migrar al intestino en estos pacientes. En la mucosa intestinal se describe un patrón elevado de linfocitos T, aunque los resultados de los estudios son en ocasiones contradictorios, y un aumento claro de mastocitos (y de su actividad) entre el íleon terminal y colon descendente Conclusiones: La heterogeneidad de criterios diagnósticos y de métodos de experimentación podría explicar algunas de las diferencias en los resultados que se encuentran en las investigaciones seleccionadas. Existen indicios que conducen a pensar que existe una “inflamación intestinal de bajo grado” en estos pacientes, y se ha relacionado el aumento de linfocitos T y de mastocitos con trastornos encontrados en el SII como la comunicación entre el intestino y el sistema nervioso, el aumento de la permeabilidad intestinal y los cambios en la microbiota(AU)

Objective: To review the available evidence on the role of Tlymphocytes and mast cells in the etiopathogenesis of Irritable Bowel Syndrome. Methods: Bibliographic retrieval on PubMed including the terms “Irritable Bowel Syndrome, “Immune System”, “T-Lymphocytes” and “Mast Cells”. Results: Twenty-five case-control studies and one randomized controlled trial were retrieved. Noteworthy in the blood is the increase in activated T cells destined to migrate to the bowel in these patients. A high frequency of T-lymphocytes is described in the intestinal mucosa, although the study findings are, at times, contradictory. An evident increase in mast cells (and in their activity) between the terminal ileum and descending colon is also observed. Conclusions: The heterogeneity of diagnostic criteria and experimentation methods could account for some of the differences in the results found in the selected research. There are indications that give reason to believe these patients have “low-grade intestinal inflammation”, and the increase in T-lymphocytes and mast cells has been associated with disorders found in IBS such as the communication between the intestine and the nervous system, the increase in intestinal permeability and changes in the microbiota(AU)

Capsulitis adhesiva del hombro: una revisión sistemática / Proposal of a practical clinical guideline for physiotherapy after acute achilles tendon rupture using a percutaneous technique with tenolig

Introducción y objetivosElaborar una guía de práctica clínica basada en la evidencia para facilitar la toma de decisiones al profesional, disminuir la variabilidad en su práctica clínica y mejorar la atención de pacientes intervenidos de rotura aguda del tendón de Aquiles.Material y métodoLa inclusión de las recomendaciones en la guía se llevó a cabo mediante: * 1. Revisión de la evidencia disponible a partir de las bases de datos (Medline, PEDro, IME, EnFisPo, Cochrane) desde el año de su creación hasta enero de 2009. * 2. Análisis de la experiencia clínica del grupo de expertos. * 3. Síntesis final de la evidencia, experiencia clínica y razonamiento fisiopatológico.ResultadosSe establecieron 3 fases de tratamiento de fisioterapia determinadas a partir del razonamiento fisiopatológico (semanas: 2.a–8.a, 9.a–14.a, 15.a–17.a). Las recomendaciones que se basaron en la evidencia fueron las siguientes: programa de fisioterapia precoz; aplicación de corrientes BURST de 100Hz; campos electromagnéticos pulsátiles de 27MHz y 1 Gauss; aplicación de ultrasonido continuo de baja intensidad a 0,5w/cm2; programa de ejercicios activos del flexor largo del primer dedo del pie y trabajo excéntrico de la zona lesionada.ConclusionesLa presente guía de práctica clínica recoge el estado actual de conocimiento sobre las recomendaciones terapéuticas que el fisioterapeuta debería incluir en su programación. Once recomendaciones son incluidas, combinando la mejor evidencia con el razonamiento fisiopatológico y la experiencia de un grupo de expertos (AU)

Introduction and objectivesTo elaborate an evidence-based Clinical Practice Guideline to facilitate decision-making to the professional, to diminish the variability in their clinical practice and to improve attention of the patients operated on for acute Achilles tendon rupture.Material and methodInclusion of the recommendations in the Clinical Practice Guideline was carried out by: * 1. Review of the “best evidence” published based on a computerized literature search of Medline, PEDro, IME, EnFisPo and Cochrane, from the year they were created to January 2008. * 2. Analysis of the “best clinical experience” of the experts group. * 3. Final synthesis of the evidence, clinical experience and physiopathology reasoning.ResultsThree treatment phases of physiotherapy were established using the weeks 2nd–8th, 9th–14th, 15th–±17th. The recommendations included and that were based on scientific evidence were: early physiotherapy program; TENS burst 100Hz; pulsed magnetic field of 27MHz and 1 Gauss; application of continuous low intensity ultrasound at 0.5w/cm2; a program of active exercise by flexor hallucis longus and eccentric exercise of the injured area.ConclusionsThe present Clinical Guideline reflects the current status of knowledge on the therapeutic recommendations that physiotherapists should include in their programs. Eleven recommendations have been included, combining the best evidence with the physiopathology reasoning and consensus among a group of experts (AU)

Irritable bowel syndrome immune hypothesis. Part two: the role of cytokines.

OBJECTIVE: To review the available evidence on the role of interleukins in the etiopathogenesis of Irritable Bowel Syndrome. METHODS: Bibliographic retrieval on PubMed including the MeSH terms "Irritable Bowel Syndrome, "Immune System", "Cytokines" and "Interleukins". RESULTS: Sixteen case-control studies and one randomised controlled trial were retrieved. The blood appears to have a high concentration of pro-inflammatory cytokines (TNF- á , IL-1 â , IL-6, IL-8) and lower concentration of IL-10, an anti-inflammatory cytokine, even though the findings are disparate and heterogeneous. As many as 33 genes were found, each with different expressions, and a diminished expression of cytokines in the colon mucosa of patients with IBS, which have not been previously described in any other pathology. CONCLUSIONS: In patients with IBS, a clear profile of cytokine levels in the blood does not appear to exist, although an imbalance between them can be observed. Moreover, there are indications that give reason to believe that the different subsets of patients with IBS could present cytokine profiles in different blood. On the other hand, in the intestine, high cytokine secretion levels are not detected, contrary to what would be expected. Further studies are required to substantiate these findings.