Evaluation of processed cheese viscoelastic properties during sterilization observed in situ.

Sterilized processed cheese is a specific dairy product with a prolonged shelf life intended for regular retail offer but also as food provisions for armies during peacetime, as well as during crisis and emergency situations, and for storage in state material reserves. Storage requirements are usually defined as ≤25°C for at least 24 mo. One of the ways to achieve such a shelf life is sterilization. Therefore, the aim of the work was to describe, for the first time in the available scientific literature, in situ changes in the viscoelastic properties of spreadable melt (34% wt/wt DM content, 45% wt/wt fat in DM content, and 14% wt/wt protein content) during an increase in temperature (target temperature 122°C), holding at sterilization temperature (20 min) and subsequent cooling (to ~30°C). While increasing to the target sterilization temperature, a significant decrease occurred in the storage and loss moduli values. Both moduli started to increase again during the target sterilization temperature period and during the whole cooling phase. The values of the storage and loss moduli were significantly higher at the end of the cooling of the sterilized product, and conversely, the phase angle value was lower compared with the melt before sterilization. As a result of sterilization, an increase occurred in the levels of markers of the Maillard reaction complex and lipid oxidation processes. The value of hardness, corrected stress, and elongational viscosity also increased compared with nonsterilized products. As a result of sterilization, the flavor worsened and sterilized processed cheeses showed darker (brownish) color. However, even after sterilization, the products were evaluated as acceptable for consumers and maintained their spreadability.

Disturbances of mental image processing in post-stroke patients with left and right hemisphere damage.

BACKGROUND: The purpose of this article is to point out significant differences in how mental images are processed by post-stroke patients with left and right hemisphere damage. The issues involved are of theoretical importance because of the light shed on the modularity of cerebral functions, especially the imagination, and of clinical importance due to the better understanding of the underlying pathomechanism. MATERIAL AND METHODS: The research involved 82 right-handed patients with a lesion in the left hemisphere (Group L), 82 right-handed patients with a lesion in the right hemisphere (Group R), and, as a control group, 82 patients with musculo-skeletal disorders not affecting the central nervous system (Group C), matched by age and sex. Image processing of complex notions was examined by using selected items from the Simple Neurolinguistic Test. RESULTS: In the control group, the majority of the patients responded to most of the prompts with polymodal associations of various types. In Group L, responses were dominated by isolated elements of the complex situation, while in Group R the associations were mostly verbal (lexical) and highly restricted in scope. CONCLUSIONS: The results indicate that the loss of LH functions interferes with the ability to assemble pieces of polymodal image information into sensible strings, while the loss of RH functions leaves strings to which little information is attached.

Stabilometric evaluation of equilibrium in patients with damage to the cervical spine.

The purpose of the present article is the stabilometric evaluation of patients with disorders of the cervical spine. The research involved 106 persons with spinal damage in the cervical segment due either to degenerative disease or traumatic injury. The examinations, performed on a Freyss stabilometric platform, involved the evaluation of particular parameters of platform movement. Head torque was also measured by using a special attachment. Improvement in posture coordination was demonstrated in the period from one month to one year after surgical fixation of the spine, as was the negative impact of an orthopedic collar on vestibulospinal reflexes. The results here recorded are associated with changes in cervical proprioception, reliably evaluated by comparing traditional platform movement results with the parameters used to evaluate shifts is head position.

Various surgical techniques in the comprehensive treatment of decubitus ulcers.

Background. Decubitus ulcers (pressure ulcers) resulting from inhibited circulation to body parts under pressure from body weight constitute a particularly difficult problem in the treatment and rehabilitation of patients with tetra- and paraplegia. The present article describes a comprehensive treatment program for decubitus ulcers developed and realized in cooperation between the Rehabilitation Clinic and the Department of Plastic Surgery at the University Hospital of the Bydgoszcz Medical University.
Material and methods. Ten patients of varying age with decubitus ulcers in various parts of the body are described, with particular emphasis on the program of preoperative treatment to reduce infections and prepare the patient for surgery and subsequent rehabilitation, and on the proper choice of surgical technique.
Results. The surgical techniques used to repair decubitus wounds are described. Of the ten patients, six recovered from surgery with no complications whatsoever, while four experienced post-operative infections that delayed healing. In no case, however, was the operation unsuccessful and all the patients eventually returned to rehabilitation.
Conclusion. Effective cooperation between rehabilitation and plastic surgery in cases of decubitus ulcer provides a very good outcome.

Post-coma paraschizophrenia and quality of life in patients with closed-head injuries.

Background. Organic brain damage is traditionally an excluding criteria for a psychiatric diagnosis of mental illness. In fact, however, the neurobehavioral disturbances exhibited by many CHI patients, especially those who have been comatose for more than a month, are strikingly similar to the symptoms of Type II schizophrenia. The authors propose to use the term "post-coma paraschizophrenia" to describe these disturbances and discuss their negative impact on the quality of life of CHI patients.
Material and methods. The experimental group (Group CHI) consisted of 15 CHI patients, 7 males and 8 females, ranging in age from 17 to 58, treated in the Department of Medical Rehabilitation at the Cracow Rehabilitation Center and the Rehabilitation Clinic at the Bydgoszcz Medical University. All these patients had incurred a closed-head injury resulting in a coma lasting at least one month. He control group (Group SCHI) consisted of 15 patients diagnosed with Type II schizophrenia, matched by age, sex, and level of education to the patients in Group CHI, under treatment in the Psychiatry Department at the Wroclaw Medical University and the Bydgoszcz Medical University. The data reported were based on clinical observation, patient and family interviews, standard neuropsychological tests, the Frontal Behavioral Inventory, and the Quality of Life Scale for Patients with Traumatic Brain Injuries.
Results. Standard neuropsychological tests showed similar dysfunctions in general intelligence and memory, with a tendency in both groups to lower scores in non-verbal parameters. Some interesting qualitative differences in performance are presented. All the CHI patients showed significant signs of frontal syndrome, with a profile resembling fronto-temporal dementia, while the test results from the SCHI patients were more similar to those associated with severe clinical depression. All of the patients in the CHI group exhibited at least some of the symptoms traditionally regarded as indicative of schizophrenia. Positive (formative) symptoms of schizophrenia were found much more often in the patients from Group SCHI, whereas the percentages for the occurrence of particular negative (defective) symptoms are quite similar in both groups.
Conclusions. Patients with closed-head injuries may present with quasi-psychotic symptoms, here termed "post-coma paraschizophrenia". Among the most significant common features of the two syndromes are disorganized behavior, apathy, and disturbances of executive functions. Post-coma paraschizophrenia, which mostly remains untreated because of the lack of neuropsychiatric diagnosis, has a significant negative on the quality of life of CHI patients, and should receive further attention in both theoretical research and clinical practice.

A strategic approach to the rehabilitation of patients with cervical SCI.

Background. This article presents an evaluation of the strategic approach to managing rehabilitation for patients with high spinal cord injuries. The strategic approach is founded on the assumption that particular rehabilitation procedures should be applied in accordance with a strategic plan, which is developed in terms of the overarching goal of rehabilitation, understood as enabling the appropriate mechanism of adaptation and compensation. Consistent pursuit of this goal, instead of merely reacting to successive crises and problem situations as they arise, enables the patient to achieve greater independence, and thus a better quality of life. In order to adjust the strategic plan to the individual needs of the patient, it is developed in a series of steps: 1) comprehensive analysis of the patient's current status and situation; 2) establishment by negotiation of a target situation (overarching goal); 3) selection of subordinate goals leading systematically to the realization of the overarching goal; 4) establishment of a schedule for the realization of subordinate goals; 5) regular monitoring of goal performance and performobility.
Material and methods. The effectiveness of the strategic approach was evaluated in a clinical experiment involving 68 patients wit tetraplegia, who underwent surgery subsequent to spinal cord injury (SCI) at the level of the cervical vertebrae (C2-C7), and were treated in the centers represented by the authors. The patients were divided by matching for age and sex into two groups: a control group (K) of 34 patients whose rehabilitation was conducted without reference to a strategic plan, and an experimental group (E)of 34 patients who had such a plan. The methods used to measure the outcomes obtained by the patients in rehabilitation included clinical observation, the Polish version of the standard Functional Independence Measure (FIM), and a Self-Evaluating Scale of Progress in Rehabilitation. The patients were tested twice, once before beginning rehabilitation, and again 6 months later.
Analysis of results. In both group similar progress was recorded in certain parameters of the FIM scale, which points up the effectiveness of the therapeutic procedures used in comprehensive rehabilitation; in group E, however, much greaterprogress was noted in terms of functional independence and psycho-social functioning. The patients from group E were much more content with the results they had achieved in rehabilitation.
Conclusions. The results reported here justify the assertion that the strategic approach to the rehabilitation of patients with high cervical SCI makes the most of the benefits provided by the procedures applied, without the necessity to make fundamental changes in procedures or employ additional personel, acquire new equipment, etc. The strategic approach helps the patient attain better results in becoming independent, and gives grounds for greater satisfaction with the results obtained in rehabilitation, which in run increases motivation to take an active part in exercises and other procerdures. It also assures the patient the basic right to make fundamentally important decisions in the course of his own treatment, which is consistent with the Patient Bill of Rights and the requirements of 21st-century medicine.

"Towards a Better Life": a program of comprehensive rehabilitation for elderly patients following revision hip arthroplasty.

Introduction. The aim of the research was to evaluate the quality of life of patients recovering from revision hip arthroplasty, who underwent rehabilitation under the "Towards a Better Life" program (TBL). In the TBL Program, appropriate physical exercises, relaxation techniques, seminars, and panel discussions are combined to support general improvement in both physical and psychological condition, thus improving the patients' quality of live.
Material and methods. The effectiveness of the TBL approach was evaluated in a clinical experiment involving 36 patients recovering from revision hip arthroplasty, treated under the standard rehabilitation program in general use at the centers represented by the authors. The patients were divided into two equal groups, matched by age and sex: an experimental group E (n = 18), with patients who received additionally the "Towards a Better Life" Program, and a control group K (n = 18), consisting of patients who did not receive this program. The methods used to evaluate the outcome of rehabilitation included clinical interview and observation, the Medical Outcomes Study (MOS-100) and the Self-Evaluating Quality of Life Scale (QOL). The patients were tested before rehabilitation commenced and re-tested two months later.
Analysis of results. On the Physical Index of the MOS-100 scale considerably greater progress was observed in patients from Group E in terms of reduced pain, increased coordination and fluency of movement, improved respiratory capacity, regulation of blood pressure and pulse, functioning of the digestive system, reduced body weight, and improved walking distance. In this group somewhat greater improvements were noted on the Psychological Index of the MOS-100, especially in cognitive functions (perception and attention) and emotional factors (increased satisfaction with life, reduced anexiety, depression, and irritability). The QOL parameters most sensitive to the difference between the TBL Program and the standard program were pain management, independence and self-care, and especially improved self-image and reduced anxiety. The improvements noted by Group E were in many subtest two or three times higher than in Group K.
Conclusions. The greater improvements recorder by patients participating in the "Towards a Better Life" Program in all measured parameters indicates that the program is highly effective in comparison to the standard model. The patients from Group E were much more satisfied with the results they had achieved in rehabilitation, and attained a higher degree of independence and self-determination. The TBL Program can be used to improve the quality of life of patients recovering from revision hip arthroplasty.

An evaluation of the effectiveness of patient - physician communication following traumatic brain injury.

Despite the enormous importance of patent-physician communication for treatment and rehabilitation, the topic of interpersonal communication does not find a place in the curriculum of most medical schools. Medical practice in this respect is dominated by improvised solutions emerging from the individual physician's personal communication style, which in many cases leads to breakdowns in communication with patients. The purpose of this article is to describe the general principles governing patient communication and the problems encountered in this regard. Communication is discussed as a social process, which on the one hand runs its course in accordance with certain generally binding rules, and on the other hand is governed by the purposes (both open and hidden) and inclinations of the persons involved in the conversation. Several key concepts in communication are explained, including sender and receiver; text, subtext, and context; verbal and non-verbal communication. A simplified model of the communication process is presented. The research material consisted of a group of 36 TBI patients who underwent treatment at the various centers represented by the authors. The research results are presented on the basis of the assumptions described earlier as pertains to the effectiveness of physicians communication with patients. An example conversation is presented, involving two physicians and a patient, recorded as party of the research project. In order to illustrate the basic errors committed by the various speakers for the needs of specialist in orthopedics, traumatology and rehabilitation, the authors have discussed this conversation according to the qualitative method known as "conversation analysis". Patient drawings are also presented, illustrating their experiences in communication with physicians, along with an in-depth analysis of the messages found in these drawings, using the authors' own methodology of qualitative analysis of patient's self-expression. The results obtained points out some of the causes and effects of communication problems, including the divergent goals of physician and patient, the lack of sensitivity to the context and to the particular problems faced by the other parties involved in the conversation, and physicians' failure to control subtext and non-verbal signals. The conclusions presented by the authors emphasize the complexity of the problems researched here and the necessity to take steps to remedy them.

The rehabilitation of executive functions in patients with closed-head injuries.

One of the most difficult problems in the rehabilitation of patients with closed-head injuries is posed by executive function disturbances, that is, difficulty in making the transition from thinking to acting. This article presents the working hypotheses and a description of a rehabilitation program developed by the authors, oriented directly towards training executive functions, in contract to the existing standard program, based on physical therapy with the addition of neuropsychological exercises directed towards training particular cognitive functions. The program consists of exercises supporting the development of not only cognitive and emotional-motivational elements, but also mediating metaprocesses and behavioral processes. In their own research involving 24 patients the authors confirmed the existence of objective disturbances of executive functioning in all subjects. The patients were divided into two groups: a control group of 12 patients treated with the standard program, and an experimental group of 12 patients who received the new rehabilitation program. The results obtained clearly indicate the superior effectiveness of the new program, not only in terms of executive functions per se, but also in transfer to other neurosychological parameters not treated separately. The authors discuss the etiology of executive function disturbances and the significance of the results obtained for rehabilitation. The authors' Clinical Test of Executive Functions is also presented.

[The influence of laser radiation on blood flow in patients with ischemia of the lower limbs (based on the analysis of the hyperemia reactive test)]. / Wplyw promieniowania laserowego na krazenie krwi w konczynach dolnych chorych z niedokrwieniem miazdzycowym (na podstawie analizy testu przekrwienia reaktywnego).

The aim of this paper was to assess the influence of low power infra red laser radiation on blood flow in patients with atherosclerotic disease of the lower limbs. The investigations were based on the hyperemic reactive test and the ankle/brachial pressure index. Analysis of the hyperemic reactive test allows to evaluate microcirculation mechanisms. The results obtained indicate that treatment of low power laser radiation allows to improve microcirculation mechanisms and blood flow in the lower limbs.

[Effect of laser biostimulation on leg blood flow in the course of arteriosclerosis]. / Wplyw biostymulacji laserowej na ukrwienie konczyn dolnych w przebiegu miazdzycy.

Blood flow pattern (maximum moment velocity, mean velocity, artery diameter and minute flow) in the superficial femoral artery and in the foot artery was evaluated in 30 patients, subjected to laser biostimulation for symptoms of atherosclerotic ischemia of the lower limbs. The blood flow examination was performed before the treatment and immediately afterwards (20 procedures) and 6 months following the therapy. It was found that laser biostimulation had a favorable effect on the blood flow pattern, particularly in the initial stage of ischemia (Io), and may be a useful method of medical treatment in atherosclerotic ischemia of the lower limbs.

[Laser biostimulation]. / Biostymulacja laserowa.

The paper presents a characteristics of the new therapeutic method of laser radiation biostimulation. It presents modern views on the mechanism of action of laser biostimulation, it reports the biological effects of the stimulation as well as the areas of clinical use.

[Analysis of military service disability due to discopathy and spondylosis]. / Analiza przyczyn niezdolnosci do zawodowej sluzby wojskowej z powodu dyskopatii i zmian zwyrodnieniowych kregoslupa.

One hundred medical certificates issued by the Local Military Medical Commission and which served as a basis for discharging the military from the Polish Army were used for the analysis of discopathy and spondylosis observed in this group of population. The age of subjects, length of military service and service conditions were taken into consideration. It was revealed that over 30% of active military men had been discharged from the army due to discopathy and spondylosis. The largest group of the military suffering from these diseases (about 60%) was found in troops of the line.