Relationships between Physical Activity and Selected Chronic Diseases among Functionally Independent Long-Term Care Residents during the Post-Lockdown Period in Croatia.

The aim of this observational study was to investigate the level and association of physical activity and selected chronic diseases in functionally independent LTC residents after prolonged physical and social isolation during COVID-19 in Croatia. Adhering to the inclusion criteria, 180 functionally independent residents were included in the study. Assessment of physical activity was carried out by 7-day motor monitoring. Prolonged physical and social isolation negatively affected the achieved level of physical activity of LTC residents (x¯ = 5058.74). Major depressive disorder resulted in significantly lower residents' physical activity scores, demonstrating a shrinking effect ranging from 0.42 to 0.45. A significant negative impact on the residents' physical activity was also found in the presence of osteoarthritis and iron deficiency anemia, where a downward effect was present in the range from 0.66-0.72 and 0.64 to 0.66. The presence of comorbidities has a significant negative impact on the residents' physical activity, where a downward effect is present in the range from 0.91-0.92.

Whole-Body Vibration Effects on Flexibility in Artistic Gymnastics-A Systematic Review.

It is well documented that whole body-vibration training has effects on muscle strength and flexibility, blood circulation, decreases pain perception and strengthens bone and tendon. Although whole body-vibration has benefits in athletes' flexibility, we are not sure what its actual effects are in artistic gymnastics (since they already have stunning flexibility). Hence, the aim of this study was to analyse the studies on whole-body vibration in artistic gymnastics and to present the effects on flexibility. The search and analysis were carried out in accordance with PRISMA guidelines. The databases search (PubMed, Scopus, Google Scholar, Cochrane Library, ProQuest, EBSCOhost and Science Direct) yielded 18,057 potential studies. By the given inclusion criteria (studies from 2005 to 2022; full-text published in English; the study included male and female gymnasts as samples, and that participants were tested for evaluation of flexibility by whole-body vibration method), a total of 9 full-text studies were included, with a total of 210 participants, both male and female. As far as the measured flexibility tests conducted, front split, sit and reach and bridge were evaluated, while obtained results were 9.1-39.1%, 2.79-6.7%, 6.43-7.45%, respectively. All studies have conducted same vibration frequency (30 Hz) with same amplitude of displacements (2 mm), except for the one study who did not show the information of implemented amplitude. After analysing the obtained results, it can be concluded that the usage of whole-body vibration platform shows flexibility improvements in artistic gymnasts, both male and female. In addition, a combination of whole-body vibration and traditional static stretching may enhance the flexibility in artistic gymnasts. However, these results should be taken with caution. Since this review did not reveal the optimal vibrational protocol, it is necessary to invest time during the implementation of various vibrational experimental protocols, so future research is required.

Heterotopic ossification vs. fracture healing: Extracellular vesicle cargo proteins shed new light on bone formation.

Fibrodysplasia ossificans progressiva (FOP) is an extremely rare disease in which bone tissue forms in extraskeletal sites, which is known as heterotopic ossification (HO). Extracellular vesicles (EVs) are small phospholipid-enclosed particles released by various cells which have an emerging, but not completely understood role in various (patho)physiological processes. In order to further study the pathophysiology of FOP we conducted a small observational study comparing the proteomic profiles of EV cargo, derived from pooled plasma of four patient groups: FOP patient (N = 1) during active disease phase (flare-up), FOP patients during remission (N = 2), patients after long bone fracture (N = 20) and healthy controls (N = 10). After isolation of EVs - their protein cargo was determined using liquid chromatography / mass spectrometry, after which a functional gene enrichment analysis was performed. Our results show a sizeable difference of the proteomics profiles in which EVs from the bone fracture group show significant activity of integrin interactions, Wnt, VEGF, IGF-1 and PDGF pathways; conversely, FOP patients' EVs indicate that HO occurs via processes of innate immunity and the Ephrin B signaling pathway. We hypothesize that the Ephrin B signaling (expressed in EVs) contributes to HO by aiding in mesenchymal stem cell recruitment and osteogenic differentiation, as well as by contributing to the inflammatory response, including macrophage chemotaxis and activation. This is, to our knowledge, the first published analysis of EV protein cargo in FOP.

A novel autologous bone graft substitute comprised of rhBMP6 blood coagulum as carrier tested in a randomized and controlled Phase I trial in patients with distal radial fractures.

Bone morphogenetic proteins (BMPs) are known to induce new bone formation in vivo but treating trabecular bone defects with a BMP based therapeutic remains controversial. Here, we evaluated the safety and efficacy of a novel Autologous Bone Graft Substitute (ABGS) comprised of recombinant human BMP6 (rhBMP6) dispersed within an autologous blood coagulum (ABC) as a physiological natural carrier in patients with a closed distal radial fracture (DRF). We enrolled 32 patients in a randomized, standard of care (SoC) and placebo (PBO) controlled, double-blinded Phase I First in Human (FiH) clinical trial. ABGS was prepared from peripheral blood as 250 µg rhBMP6/mL ABC or PBO (1 mL ABC containing excipients only) and was administered dorsally via a syringe injection into the fracture site following closed fracture fixation with 3 Kirschner wires. Patients carried an immobilization for 5 weeks and were followed-up for 0 to 26 weeks by clinical examination, safety, serial radiographic analyses and CT. During the 13 weeks follow-up and at 26 weeks post study there were no serious adverse reactions recorded. The results showed that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 32 patients at 13- and 26-weeks following treatment. Pharmacokinetic analyses of plasma from patients treated with ABGS showed no detectable rhBMP6 at any time point within the first 24 h following administration. The CT image and radiographic analyses score from patients treated with AGBS showed significantly accelerated bone healing as compared to PBO and SoC at 5 and 9 weeks (with high effect sizes and P = 0.027), while at week 13 all patients had similar healing outcomes. In conclusion, we show that intraosseous administration of ABGS (250 µg rhBMP6/mL ABC) into the distal radial fracture site demonstrated a good tolerability with no serious adverse reactions as well as early accelerated trabecular bone healing as compared to control PBO and SoC patients.

The patterns of phalangeal fractures in children and adolescents: a review of 512 cases.

INTRODUCTION: Fractures of the phalanges in children can often be underappreciated by the physician of first contact. Therefore it is necessary to point out which of these fractures, because of the risk of possible future complications, need special mention. MATERIALS AND METHODS: A retrospective review of 512 fractures of the phalanges in children and adolescents during an one year period. Fractures were subdivided into the following categories - physeal fractures, intraarticular (phalangeal neck and condylar) fractures, shaft fractures, tuft fractures, "mallet finger" fractures, volar plate avulsion injuries and collateral ligament avulsion injuries. Main outcome measures was the necessity for operation while the average age at which the injury has occured, the cause of the injury, the frequency of injury of each finger, the necessity for reduction, and the duration of splinting were the secondary outcome measures. RESULTS: Collateral ligament avulsion injuries and intraarticular (phalangeal neck and condylar) fractures were injuries which most often necessitated operative treatment. Physeal injuries were the most common injuires with avulsions of the volar plate being the second most common. Accidents during sport was by far the most common cause of injuires in all categories apart from tuft injuries. CONCLUSION: The findings regarding the incidence and the cause of these injuries in this study support the already published dana in the literature. The physician of first contact has to be capable to recognise the problematic fractures - intraarticular (phalangeal neck and condylar), significantly displaced Salter-Harris type III and IV fractures and collateral ligament avulsion injuries and Seymour fractures.

Evaluation of stability of osteosynthesis with K-wires on an artificial model of tibial malleolus fracture.

BACKGROUND: Paediatric ankle fractures comprise approximately 4% of all paediatric fractures and 30% of all epiphyseal fractures. Integrity of the ankle "mortise", which consists of tibial and fibular malleoli, is significant for stability and function of the ankle joint. Tibial malleolar fractures are classified as SH III or SH IV intra-articular fractures and, in cases where the fragments are displaced, anatomic reposition and fixation is mandatory. METHODS: Type SH III-IV fractures of the tibial malleolus are usually treated with open reduction and fixation with cannulated screws that are parallel to the physis. Two K-wires are used for temporary stabilisation of fragments during reduction. A third "guide wire" for the screw is then placed parallel with the physis. Considering the rules of mechanics, it is assumed that the two temporary pins with the additional third pin placed parallel to the physis create a strong triangle and thus provide strong fracture fixation. To prove this hypothesis, an experiment was conducted on the artificial models of the lower end of the tibia from the company "Sawbones". Each model had been sawn in a way that imitates the fracture of medial malleoli and then reattached with 1.8mm pins in various combinations. Prepared models were then tested for tensile and pressure forces. RESULTS: The least stable model was that in which the fractured pieces were attached with only two parallel pins. The most stable model comprised three pins, where two crossed pins were inserted in the opposite compact bone and the third pin was inserted through the epiphysis parallel with and below the growth plate. CONCLUSION: A potential method of choice for fixation of tibial malleolar fractures comprises three K-wires, where two crossed pins are placed in the opposite compact bone and one is parallel with the growth plate. The benefits associated with this method include shorter operating times and avoidance of a second operation for screw removal.

The clinical use of bone morphogenetic proteins revisited: a novel biocompatible carrier device OSTEOGROW for bone healing.

PURPOSE: The purpose of this study was to revise the clinical use of commercial BMP2 (Infuse) and BMP7 (Osigraft) based bone devices and explore the mechanism of action and efficacy of low BMP6 doses in a novel whole blood biocompatible device OSTEOGROW. METHODS: Complications from the clinical use of BMP2 and BMP7 have been systemically reviewed in light of their role in bone remodeling. BMP6 function has been assessed in Bmp6-/- mice by µCT and skeletal histology, and has also been examined in mesenchymal stem cells (MSC), hematopoietic stem cells (HSC) and osteoclasts. Safety and efficacy of OSTEOGROW have been assessed in rats and rabbits. RESULTS: Clinical use issues of BMP2 and BMP7 have been ascribed to the limited understanding of their role in bone remodeling at the time of device development for clinical trials. BMP2 and BMP7 in bone devices significantly promote bone resorption leading to osteolysis at the endosteal surfaces, while in parallel stimulating exuberant bone formation in surrounding tissues. Unbound BMP2 and BMP7 in bone devices precipitate on the bovine collagen and cause inflammation and swelling. OSTEOGROW required small amounts of BMP6, applied in a biocompatible blood coagulum carrier, for stimulating differentiation of MSCs and accelerated healing of critical size bone defects in animals, without bone resorption and inflammation. BMP6 decreased the number of osteoclasts derived from HSC, while BMP2 and BMP7 increased their number. CONCLUSIONS: Current issues and challenges with commercial bone devices may be resolved by using novel BMP6 biocompatible device OSTEOGROW, which will be clinically tested in metaphyseal bone fractures, compartments where BMP2 and BMP7 have not been effective.

Unilateral spinal anaesthesia in a patient with Osteogenesis Imperfecta with a lower leg fracture: a case report.

Osteogenesis Imperfecta is a rare, genetically determined disease with several possible complications in anaesthesia. Anaesthesiologists therefore pay special attention to the treatment of patients suffering from Osteogenesis Imperfecta since they commonly suffer from a difficult airway and intraoperative positioning difficulties. We report here the case of unilateral spinal anaesthesia in a patient suffering from Osteogenesis Imperfecta type I. A 28-year-old patient diagnosed with Osteogenesis Imperfecta type I was admitted to the hospital due to lower leg fracture requiring surgical treatment. The patient had blue sclerae, triangular-shaped face, macroglossia, scoliosis of thoracic and lumbar parts of the spine, pectus carinatum and thrombocytopenia. Upon the correction of thrombocytopenia, unilateral spinal anaesthesia with hyperbaric levobupivacain was chosen in order to avoid possible complications typical for general anaesthesia. Consequently, unilateral spinal anaesthesia with a customized local anesthetic could be consdered as a safe anesthetic method for such patients.

The latent structure of soccer in the phases of attack and defense.

With the aim of establishing the latent structure of tactical elements in the attack and defense phases of soccer 117 tactical elements of soccer were defined and their importance assessed by means of 30 variables that determine the basic segments of the game of soccer. 93 attack and 24 defense tactical elements were chosen as the entity sample and described by the 15 variables of the attack phase and 15 variables of the defense phase. Ten competent soccer experts determined the characteristics of the aforementioned entities by means of 30 variables. The experts graded from 0 to 5 the impact of every entity (tactical technique) on the individual variables that describe soccer in its phases of either attack and defense. A high level of inter-expert agreement was reached in regard to the properties of attack and defense techniques, as demonstrated by the objectivity coefficients. According to principal component factor analysis and the Kaiser and Guttman rule a total of five significant latent dimensions were obtained: finishing efficiency, ball possession performance, counter-attack efficiency, combined defense performance, and obstruction and redirection of the opposing team's attack build-up. The research partly resolved the issue of the hypothetical structure of tactical techniques in soccer by dividing the game into phases and sub-phases, attack and defense players'positions, and types (styles) of play in the attack and defense. If it is clear which movement structures have the most significant influence on the efficiency on a particular playing position and performance in the sub-phases and styles of play, it would be possible to create such training operators that will facilitate the formation of the most important motor skills in soccer.

Injuries of the tarsometatarsal joints: treatment and outcome.

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.

Significance of opening the medullar canal in surgical treatment of simple bone cyst.

Fifty patients up to 15 years of age with simple bone cysts were treated at the Department of Pediatric Surgery at the Children's Hospital Zagreb. There were 35 boys and 15 girls with 26 humeral cysts, 15 femoral cysts, 8 tibial cysts, and 1 radial cyst. There was one case of multilocularity of a simple bone cyst (in the humerus and femur). Among those cysts, 19 were multicameral (in the femur and humerus). The size of cysts was determined with regard to the length of the affected bone. Cysts involving up to one tenth of the bone length were defined as small, those up to one fifth as medium, and those exceeding one fifth of the bone length as large. Small cysts were followed up, medium ones were treated surgically in case they did not heal after pathologic fracture, and large cysts were treated surgically without delay. The surgery included opening the cyst wall, curetting the wall epithelium, rinsing with peroxide, opening the medullar canal, and filling the cavity with lyophilized bone. If necessary, a thin "old" Küntscher nail was inserted to achieve stability of fragments and to keep the medullar canal free. The medullar canal was opened in 38 surgically treated patients, and there were 36 good results. In the patients who had the medullar canal opened during surgery, there were fewer recurrences. Healing time was shorter than reported in the literature, even more so if the thin Küntscher nail was used.