Management of Upper-Limb Spasticity Using Modern Rehabilitation Techniques versus Botulinum Toxin Injections Following Stroke

Our purpose is to emphasize the role of botulinum toxin in spasticity therapy and functional recovery in patients following strokes. Our retrospective study compared two groups, namely ischemic and hemorrhagic stroke patients. The study group (BT group) comprised 80 patients who received focal botulinum toxin as therapy for an upper limb with spastic muscle three times every three months. The control group (ES group) comprised 80 patients who received only medical rehabilitation consisting of electrostimulation and radial shockwave therapy for the upper limb, which was applied three times every three months. Both groups received the same stretching program for spastic muscles as a home training program. We evaluated the evolution of the patients using muscle strength, Ashworth, Tardieu, Frenchay, and Barthel scales. The analysis indicated a statistically significant difference between the two groups for all scales, with better results for the BT group (p < 0.0001 for all scales). In our study, the age at disease onset was an important prediction factor for better recovery in both groups but not in all scales. Better recovery was obtained for younger patients (in the BT group, MRC scale: rho = -0.609, p-value < 0.0001; Tardieu scale: rho = -0.365, p-value = 0.001; in the ES group, MRC scale: rho = -0.445, p-value < 0.0001; Barthel scale: rho = -0.239, p-value = 0.033). Our results demonstrated the effectiveness of botulinum toxin therapy compared with the rehabilitation method, showing a reduction of the recovery time of the upper limb, as well as an improvement of functionality and a reduction of disability. Although all patients followed a specific kinetic program, important improvements were evident in the botulinum toxin group.

Intermittent physical recovery has similar benefits to continuous physical recovery in patients in the acute and early sub‑acute stages following a stroke

Stroke is one of the most important causes of death and disability worldwide. The recovery of stroke survivors represents a real challenge for healthcare services. The aim of the present pilot study was to evaluate and compare the efficiency of two different approaches of physical rehabilitation in patients in the acute and early sub-acute stages following a stroke. Two groups of patients consisting of 48 and 20 patients, respectively, underwent continuous and intermittent physical recovery, and were assessed through electromyography and clinical evaluation. After 12 weeks of rehabilitation, no significant differences were identified between the outcomes obtained from the two groups. Due to the added value of intermittent physical recovery, this method of rehabilitation could be considered an approach that needs to be further studied for the treatment of patients in the acute and early sub-acute stages following a stroke.

Colchicine versus Physical Therapy in Knee Osteoarthritis

Background: The treatment of osteoarthritis remains a major challenge due to the unavailability of a disease-modifying medication and the limitations of current therapeutic perspectives, which mainly target the symptoms, not the disease itself. The purpose of our study is to compare the efficacy of colchicine treatment versus physical therapy. Methods: The study included 62 patients diagnosed with knee osteoarthritis (KOA) according to the American College of Rheumatology (ACR) criteria, hospitalized within the time frame of October 2020−March 2022 in the Department of Rehabilitation Medicine and Physical Therapy of the Emergency Clinical County Hospital of Craiova. The participants were randomly divided into two groups. The observation period was 16 weeks long. The first group (31 patients) received colchicine at a dosage of 1 mg/day together with analgesics (acetaminophen < 2 g/day), while the second group (31 patients) received analgesics (acetaminophen < 2 g/day) together with a 16-week plan of physiotherapy. Results: Group II, in which patients underwent physical therapy, demonstrated a statistically significant decrease in both left (p < 0.001) and right (p = 0.012) knee VAS and WOMAC (p = 0.038) scores at 16 weeks, compared to the group treated with colchicine. Regarding the MSUS examination at 16 weeks, there were no significant changes in the structural abnormalities and no improvement in cartilage aspect or thickness. Higher BMI was associated with higher WOMAC score (p = 0.012), but not with higher VAS score (p = 0.062). Cholesterol and triglyceride levels were associated with high WOMAC (p < 0.001; p = 0.021) and high VAS (p = 0.023; p < 0.001) scores. Conclusions: Our study monitored VAS and WOMAC scores in two groups of patients with KOA, showing that physical therapy is more effective than colchicine in reducing symptoms. We found no statistically significant difference in musculoskeletal ultrasound (MSUS) feature improvement during the 16-week study.

Calcium fructoborate coating of titanium-hydroxyapatite implants by chemisorption deposition improves implant osseointegration in the femur of New Zealand White rabbit experimental model

BACKGROUND

The identification of biocomposites that improve cell adhesion and reduce bone integration time is a great challenge for implantology and bone reconstruction.

AIM

Our aim was to evaluate a new method of chemisorption deposition (CD) for improving the biointegration of hydroxyapatite-coated titanium (HApTi) implants. CD method was used to prepare a calcium fructoborate (CaFb) coating on a HApTi (HApTiCaFb) implant followed by evaluation of histological features related to bone healing at the interface of a bioceramic material in an animal model.

METHODS

The coating composition was investigated by high-performance thin-layer chromatography/mass spectrometry. The surface morphology of the coating was studied by scanning electron microscopy (SEM), before and after the in vitro study. We implanted two types of bioceramic cylinders, HApTi and HApTiCaFb, in the femur of 10 New Zealand White (NZW) rabbits.

RESULTS

The release of CaFb from HApTiCaFb occurred rapidly within the first three days after phosphate-buffered saline immersion; there was then a linear release for up to 14 days. SEM analysis showed similar morphology and particle size diameter for both implants. Around the porous HApTiCaFb implant, fibrosis and inflammation were not highlighted.

CONCLUSIONS

Easily applied using CD method, CaFb coatings promote HApTi implant osseointegration in the femur of NZW rabbits.

Sildenafil and tadalafil reduce the risk of contrast-induced nephropathy by modulating the oxidant/antioxidant balance in a murine model

The aim of the study was to evaluate the potential protective role of sildenafil and tadalafil in contrast-induced nephropathy (CIN) by modulating oxidative stress. Thirty Wistar male rats were equally assigned into five groups: sham, CIN, CIN + sildenafil (10 mg/kg bw/day), CIN + tadalafil (5 mg/kg bw/day) and CIN + N-Acetyl Cysteine (NAC) (100 mg/kg bw/day) as a positive control. CIN was induced by 12 h dehydration and administration of indomethacin (10 mg/kg bw), N-ω- nitro-L-arginine methyl ester (10 mg/kg bw), and iopromide (3 g/kg bw iodine). Blood was drawn prior to and 24 h after CIN induction for evaluating renal function and oxidative stress. In the CIN group, total antioxidant capacity (TAC), reduced glutathione (GSH) and catalase (CAT) levels were significantly decreased; and protein carbonyl (PROTC) and thiobarbituric reactive species (TBARS) were significantly increased compared to the sham group. Pre- Sildenafil and tadalafil pre-treatment reduced CIN risk and reversed oxidative stress almost to the sham group levels. These results suggest that PDE5Is can be good candidates for preventing CIN based on their ability to modulate the oxidant/antioxidant balance.

Vitamin B12 Blood Level is Correlated with Drug-Induced Extrapyramidal Symptoms in Schizophrenic Patients

The extrapyramidal symptoms (EPS) are commonly associated with antipsychotic treatment of schizophrenic patients. Accumulated evidence has shown that pathways of homocysteine and folate metabolism are linked to neurodegeneration and schizophrenia. The purpose of our study was to evaluate the homocysteine, vitamin B12 and folate serum levels in relation to drug-induced EPS in schizophrenic patients. The blood levels of homocysteine, vitamin B12 and folic acid were measured by chemiluminescent and electrochemoluminescence immunoassay methods in 34 patients diagnosed with schizophrenia (19 patients with severe EPS and 15 controls without EPS), recruited from Clinical Hospital of Neuropsychiatry Craiova, Romania. A significant association has been observed between EPS and vitamin B12 levels, the patients with severe EPS showed a reduced vitamin B12 levels (p=0.02). No correlation was observed between severe EPS and homocysteine or folate levels (p=0.2, respectively p=0.37). Our study suggests that deficiency of vitamin B12 blood levels is correlated with severe EPS in schizophrenic patients. Further studies included more patients and functional experiments are required to clarify the role of these biomarkers in relation with antipsychotic-induced EPS in schizophrenia.

The Fructoborates: Part of a Family of Naturally Occurring Sugar-Borate Complexes-Biochemistry, Physiology, and Impact on Human Health: a Review

Sugar-borates (SBs) are mono- or di-sugar-borate esters (SBEs) comprised of one or two monosaccharide molecules linked to a boron (B) atom. SBEs occur naturally in commonly consumed herbs, vegetables, fruits, seeds, and nuts and, other than greatly varying levels of B found in local drinking water, are the primary natural dietary sources of B-containing molecules in humans. To date, the most studied SBE is calcium fructoborate (CaFB). CaFB represents an important example of how organic B-containing molecules are significantly distinct from their inorganic counterparts. During these past two decades, CaFB has been researched for its physical and biochemical characteristics, safety, and clinical outcomes. Results of these researches are presented and discussed herein. CaFB has been characterized using Fourier-transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), high-performance thin-layer chromatography (HPTLC), nuclear magnetic resonance (NMR), liquid chromatography-multistage accurate mass spectrometry (LC-MSn), X-ray diffraction (XRD), Raman spectroscopy, and inductively coupled plasma (ICP) in non-biological and biological specimens. Potential health benefits of CaFB have been clinically investigated in pilot and efficacy studies demonstrating (i) significant reductions in knee discomfort and improved flexibility within 7, 14, and 90 days and (ii) significant effect on blood levels of inflammatory, cardiovascular, and other biomarkers. These studies support the use of CaFB as a dietary supplement for the management of joint discomfort. CaFB is presented here in order to illustrate how physiological benefits are imparted by distinct organic boron-containing molecules rather than solely by the element B itself. Considering recent National Health and Nutrition Examination Survey (NHANES) data reporting increases in age-related joint pain and an increasing elderly demographic, SBEs offer potential for safe, natural, and effective management of joint discomfort and improved mobility in human and animal health applications. Several of these studies may also open new opportunities for use of SBEs for health benefits beyond joint health.

Assessment of Clinicopathological Features in Infants and Children with Cow�s Milk Protein Allergy

The aim of our study was to evaluate the clinicopathological features in infants and young children with cow�s milk protein allergy. Cow�s milk protein allergy (CMPA) is one of the most common food allergy in children. Thus, we conducted a descriptive observational study, which was carried out in the First Pediatric Clinic of the Craiova County Emergency Clinical Hospital, in the period 2015-2017, which included 138 infants and young children diagnosed with cow�s milk protein allergy. An improvement in digestive symptomatology during the status period of the disease was observed, especially in what diarrheal stools are concerned as their incidence has decreased. In fact, gastroesophageal reflux is the most common manifestation in infants and children with CMPA, while mean acute otitis is present only in a small number of patients. In conclusion we can say that a good knowledge of the clinicopathological features in children with allergy to cow�s milk proteins allows a superior therapeutic attitude and ensures a normal life for children and infants suffering from this type of allergy.

Complex regional pain syndrome as a paraneoplastic disorder associated with metatypical basal cell carcinoma

Metatypical basal cell carcinoma (MTBCC) is a rare form of tumor, which associates the clinical and histopathological (HP) characteristics of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), with a 5% chance for the development of metastases. The reference diagnosis remains the HP confirmation from the lesional tissue. The current report illustrates the case of a 74-year-old patient, diagnosed with MTBCC consequently to the biopsy from the clinically malignant lesion with HP and immunohistochemical examination, currently in clinical remission following surgical treatment. The musculoskeletal symptoms represent the patient's admission reason to the Clinic of Rheumatology, where he was diagnosed with paraneoplastic type I complex regional pain syndrome (CRPS-I). The onset was six weeks prior with intense pain in the upper limb, burning sensation and nondermatomal distribution, exacerbated by lowering the position of the upper limb. The clinical evaluation revealed vasomotor disorders: color changes on the skin of the upper limb, venous turgescence on the back of the hands, and local increased temperature. Also, there were evident sudomotor modifications with hyperspiration and fluffy edema. The presence of clinical manifestations associated with the HP confirmation of MTBCC and the information provided by the imaging tests regarding the evaluation of tumor extension advocates for the diagnosis of paraneoplastic CRPS, consequently to both the primary tumor and the pulmonary metastasis. Diagnosis of CRPS-I is generally established on the basis of clinical criteria after excluding other conditions that may explain the degree of pain and the existing dysfunction. The therapist should be aware of the clinical manifestation of CRPS, as early recognition and aggressive treatment often leads to the best response.

Complex evaluation in patients with knee osteoarthritis

Knee osteoarthritis (KOA) is a very common, slowly progressive and incurable articular disease resulting in the breakdown of cartilage and bone in the joint, which causes significant discomfort, pain and disability, with a significant socio-economic impact. The aim of our observational study for patients with symptomatic KOA was to investigate the changes of C-terminal telopeptide of type II collagen (CTX-II) in serum pre and post a complex rehabilitation program and to establish the correlation between all studied parameters [clinical, functional, serum CTX-II (sCTX-II) and histological aspects obtained through arthroscopy]. During 2016-2017, we performed an observational study including 24 patients, between 59 and 76 years old, diagnosed with KOA. Studied patients were completely assessed before (T1) and four months after a complex rehabilitation program (T2). The measured parameters were stiffness, pain, and physical function and we used the Visual Analogue Scale (VAS) for pain, with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), sCTX-II value obtained by enzyme-linked immunosorbent assay (ELISA) test, histological assessment of knee cartilage after arthroscopy. In the histological assessment of our patients, we observed that the cells of the superficial areas were round and hypertrophic, the cartilage tissue had few proteoaminoglycans and glycosaminoglycans, with an airy aspect of the matrix and degenerate cells, numerically reduced. After positive diagnosis, the complete treatment, including the rehabilitation program, seems to be the ideal option for improving the CTX-II values, as well as the quality of life in KOA patients.

Assessing Factors that Influence the Level of Glycated Hemoglobin in Children and Adolescents with Type 1 Diabetes

The aim of our study was to assess the factors that influence the level of glycated hemoglobin in children and adolescents with type 1 diabetes (T1D). This study included 122 children and adolescents suffering from T1D who were in the evidence of the First Pediatric Clinic of the Clinical Emergency County Hospital of Craiova between 2003 and 2017. If HbA1c was less than 7.50%, we included patients in the glycemic equilibrium group, and if HbA1c was greater than 7.50%, we considered patients as suffering from unbalanced diabetes. By correlating the glycosylated hemoglobin level with the different parameters used in the study, we observed large/strong positive correlations between HbA1c and duration of diabetes mellitus and also between HbA1c and patient age, HbA1c negative correlation between physical activity, medium/moderate positive correlations between HbA1c and body mass index, weight of the patients and daily insulin dose and the height of the patients included in the study did not show significant correlations. Child and adolescent diabetes management has major adult differences in both insulin and drug treatment, in general, but especially in the need of understanding, counseling and integration specific to these ages.

Boswellia Derivates and Rehabilitation Program in Knee Osteoarthritis Patients

In the present study, we aim to highlight the role of Boswellia derivates in the rehabilitation of the clinical and functional status of patients with knee osteoarthritis. Probably, the judiciously association between herbal products and rehabilitation methods (ultrasound and physical exercise) will give the optimal healthcare for this type of patients.

The incidence of skin lesions in contrast media-induced chemical hypersensitivity

Contrast agents are used in radiology to increase the sensibility and specificity of radiological techniques. Some of these compounds have side effects that include organ toxicity (with kidney being the most affected organ) and hypersensitivity reactions. We performed multiple PubMed searches from January, 2008 to January, 2018 for studies regarding adverse reactions to compounds used as contrast agents in imagistic techniques. The initial research identified 929 records written in English. After further excluding 223 non-human studies, 292 articles that had irrelevant designs as reviews, meta-analysis, commentaries, editorials and case reports, 414 studies were selected for retrieval. After reading the abstracts, we excluded 363 studies as they had little relevance to the study. In total, 51 full-articles were assessed for eligible studies to be included. Finally, 20 articles were included in the analysis. In our systematic literature search the incidence of overall skin immediate reactions to iodinated contrast media (ICM) had an incidence between 1.15 and 0.12%, depending on the cohort analyzed in the studies. The percentage of cutaneous manifestations in the cohort that experienced immediate hypersensitivity reactions was between 33.33 and 87.7%. The most frequent skin manifestations were urticaria, rashes, pruritus and limited facial edema. Non-iodinated contrast agents have a safer profile compared with ICM, the incidence of immediate adverse reactions being very low in gadolinium-based contrast agents and other agents used for contrast-enhanced ultrasound. The incidence of delayed reactions was between 10.1 and 0.03%. In the studies analyzed by us the main adverse reactions due to delayed hypersensitivity phenomena were cutaneous manifestations that were present between 70.27 and 100% of the cases. Regarding the risk factors for developing immediate adverse reactions, being female was a predisposing factor accompanied by history of allergy and history of reactions to contrast media. An accurate anamnesis of the patients and a correctly conducted pretreatment can limit the incidence and the severity of the adverse reactions and also can avoid the life occurrence of life-threatening reactions.

Effects of boron-containing compounds on cardiovascular disease risk factors - A review

Boron is considered to be a biological trace element but there is substantial and growing support for it to be classified as an essential nutrient for animals and humans, depending on its speciation. Boron-containing compounds have been reported to play an important role in biological systems. Although the exact biochemical functions of boron-containing compounds have not yet been fully elucidated, previous studies suggest an active involvement of these molecules in the mediation of inflammation and oxidative stress. Chronic inflammation and oxidative stress are known to amplify the effects of the main cardiovascular risk factors: smoking, diet, obesity, arterial hypertension, dyslipidemia, type 2 diabetes (as modifiable risk factors), and hyperhomocysteinemia and age (as independent risk factors). However, the role of boron-containing compounds in cardiovascular systems and disease prevention has yet to be established. This paper is a review of boron-containing compounds' existence in nature and their possible functions in living organisms, with a special focus on certain cardiovascular risk factors that may be diminished by intake of these compounds, leading to a reduction of cardiovascular morbidity and/or mortality.

Incidence of Osteoporosis and the Risk of Fracture in Patients with Rheumatoid Arthritis Undergoing Corticosteroid Treatment

Rheumatoid arthritis (RA) is the most widespread inflammatory rheumatic disease with about 10% of all rheumatic diseases and a global prevalence of about 1%. Through its features - joint proliferation, articular panic, articular cartilage degradation and bone erosion � RA has a destructive and disabling character and a major socio-economic impact. Osteoporosis is a bone system disease characterized by loss of bone mass and alteration of bone architecture, with consequences on bone fragility correlated with an increased fracture risk. With a major socio-economic impact, the World Health Organization (WHO) has declared osteoporosis as a public health problem, third on cardiovascular and oncological.

Association of cytokine gene polymorphisms with osteoarthritis susceptibility

Osteoarthritis (OA) is a multifactorial disease characterized by low-grade inflammatory processes that are mediated initially by the cells and factors of the innate immune system. In addition to their key role in inflammation, cytokines contribute to the pathogenesis of OA through angiogenesis and chemotaxis. The purpose of the present case-control study was to investigate a possible association of four cytokine single nucleotide polymorphisms (SNPs), IL-4R -3223C>T (rs2057768), IL-8 -251T>A (rs4073), IL-10 -1082A>G (rs1800896) and TNF -A-308G>A (rs1800629) with OA susceptibility. Genomic DNA was isolated from blood samples collected from 305 Romanian subjects (90 patients with OA and 215 controls) and the genotyping of the SNPs was performed by TaqMan allelic discrimination polymerase chain reaction using predesigned assays. Our data indicated a significant association for IL-4R rs2057768 C>T SNP. The subjects that carried the CT genotype were at a higher risk for OA (OR 2.03, 95% CI: 1.21-3.42, P=0.007) compared with those that had the CC genotype. Furthermore, the carriers of the T allele were at a 1.9 fold higher risk for OA (OR 1.92; 95% CI, 1.17-3.17; P=0.009) in a dominant model. The association remained significant only for knee OA in the subgroups analysis. No correlations were observed between the other remaining SNPs and OA. The results suggested that the IL-4R rs2057768 SNP could contribute to OA susceptibility in the Romanian population, providing novel evidence for the involvement of IL-4/IL-4R pair in the pathogenesis of OA.

Hand enchondroma - complete evaluation and rehabilitation

Enchondroma, the most frequently reported primary tumor in the long bones of the hand, is a common benign cartilaginous tumor, defined more exactly as a benign mature hyaline cartilaginous tumor that is located into the medullar space of the tubular bones. Between 2012 and 2018, we performed an observational study on six patients (two males and four females), aged 16 to 49 years old (mean 29.5 years), who were diagnosed during routine physical examinations with isolated enchondroma in their hand. The tumor was more frequently located in their proximal phalanges (four patients), while two patients had middle phalange tumors. The most common digit involved was the little finger (five patients), followed by the ring finger (one patient). The symptoms, which prompted surgical interventions, were: enlargement without fracture (two patients), pain or limitation of mobility (four patients), pain without pathological fracture (six patients). Studied patients were completely assessed before the treatment program (surgical intervention and rehabilitation program). The measured parameters and scales used were Visual Analogue Scale (VAS), Health Assessment Questionnaire (HAQ) scale for functional status and histological exam. For both VAS and HAQ, we observed a statistically significant difference between the initial and final evaluations, with p=0.03 and p=0.035, respectively. Histological assessment and differential diagnosis are essential for the post-surgical treatment and rehabilitation program.

Immunohistochemical analysis of bone metabolism in osteonecrosis of the femoral head

Osteonecrosis of the femoral head occurs because of the suppression of blood circulation. At the level of the area affected by the ischemic phenomenon, there are two types of events, in the first stage there is necrosis of the cellular elements, followed by a reparatory phase of the spongy bone tissue. The objective of the study was the histological and immunohistochemical (IHC) analysis of bone metabolism in the repair phase. We observed the action of the main cells involved in the remodeling, the osteoblasts and the osteoclasts, following the reaction of the markers of their activity: osteoprotegerin, osteonectin, osteopontin. We included 23 patients diagnosed with femoral head osteonecrosis, stage II, Ficat and Arlet classification, biological material required for histological and IHC analysis being obtained during hip arthroplasty. Regardless of the age or presence of risk factors, the reaction to osteoprotegerin was mildly positive, being only highlighted at the level of the reactive dividing line, being absent in the other areas, indicating a reduced activity of inhibiting differentiation and activation of osteoclasts, also highlighted with classical histology methods, the affected area being well-defined and we could observe the necrotic tissue resorption by osteoclasts. The intense positive reaction of osteopontin and osteonectin, especially at the line of demarcation, is due to the increase in the number of osteoblasts required for the synthesis of neoformation bone tissue. We believe that the aspects revealed by our study can be a track in finding new-targeted therapies useful in stopping the development of the disease.

Microglia morphology in the physiological and diseased brain - from fixed tissue to in vivo conditions

First mentioned almost 100 years ago, neuroresearch has linked microglia to the initiation and/or maintenance of most central nervous system pathologies. Since their discovery, we learned that the microglia immune status is often correlated directly to their morphology. However, only recently, have we realized that, in vivo microglia are extremely dynamic cells capable to respond within minutes. Therefore, the name "resting" microglia is replaced slowly with surveilling microglia. Even more recent, it has been shown that microglia change their morphology and/or immune status depending on the way the tissue is obtained, processed and imaged, making labeling microglia, based on their morphology alone, as active or surveying even more difficult. All these observations correlated with a better understanding of cellular and subcellular process that microglia undergo in pathological conditions, could have profound implications on the time window and/or targets used to ensure the best outcome, when treating brain disease.

Left gluteal metastasis from a hepatocellular carcinoma - an unusual finding

Hepatocellular carcinoma (HCC) is the primary malignant tumor of the liver that is directly derived from parenchymal cells. It is usually encountered in patients already suffering from a long-established liver disease that has evolved past the stage of liver cirrhosis. It is usually associated with viral liver infections, alcohol consumption or other dietary habits that lead to liver damage. Metastases are not rare and are usually found incidentally after a period of monitoring the main liver disease. We present here a rare case of HCC metastasis found in the right gluteal region, in a hepatitis C virus-infected patient also displaying lung tumor lesions. Diagnosis of both the metastasis and of the primary tumor were found during the same hospital visit, employing contrast-enhanced computed tomography, magnetic resonance imaging and ultrasound (US), with positive biopsy of the metastatic lesion, performed under US guidance. The patient received oncological treatment, with good prognosis and stable evolution during the next eight months since diagnosis.

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

Basal cell carcinoma develops in contact with the epidermal basal cell layer - a three-dimensional morphological study

Basal cell carcinoma is the most common malignant tumor of the skin, and it develops most frequently on the areas of the body that make its treatment and care extremely difficult, especially in cases of neglecting or aggressive growth and invasion. Both typical mild cases as well as locally aggressive tumor types do not tend to metastasize, and it has been postulated that they should share some common biological and morphological features that might explain this behavior. In this study, we have utilized a high-resolution three-dimensional reconstruction technique on pathological samples from 15 cases of common aggressive (fibrosing and adenoid types) and mild (superficial type) basal cell carcinomas, and showed that all these types shared contact points and bridges with the underlying basal cell layer of the epidermis or with the outmost layer of the hair follicle. The connections found had in fact the highest number for fibrosing type (100%), compared to the superficial (85.71%) and adenoid (55%) types. The morphology of the connection bridges was also different, adjacent moderate to abundant inflammatory infiltrate seeming to lead to a loss of basaloid features in these areas. For the adenoid type, tumor islands seemed to be connected also to each other more strongly, forming a common "tumor lace", and while it has been showed that superficial and fibrosing types have higher recurrence risks, all together these data might iterate a connection between the number of bridging points and the biological and clinical manifestation of this skin tumor.

Rheumatoid nodules and quality of life in rheumatoid arthritis females - complex assessment

Rheumatoid arthritis (RA) represents the most commonly diagnosed arthropathy that affect many tissue types and organs, characterized by a clinical, functional and therapeutic pathogenic complexity and it affects especially diarthroidal joints. Rheumatoid nodules (RNs) are one of the most frequent extra-articular manifestations of RA, and usually reflect an advanced stage of the disease and a poor prognosis. The complexity of histological, clinical and functional aspects in RA has a real impact on the quality of life in all patients diagnosed with this disorder. Our prospective study presents the RNs involvement in the rehabilitation program performed in order to enhance the quality of life in the 25 RA female patients. We made a complex assessment and realized a correlation between pain, disability and histological aspect of RN, before and after the rehabilitation program. Also, we evaluated the clinical and functional effectiveness of a complex rehabilitation program and changes in impairment and activity limitation in women with RA and RNs. The immunohistological complexity of RNs reflects the intensity of the inflammatory-immune process and completes the assessment of RA patients with RNs. It allows for medical assistance quantification, even for patients that have a poor evolution prognosis.

Predictive model of synovial membrane degradation using semi-automated morphometry and artificial neural networks

Gonarthrosis is a degenerative disease that affects mainly older people, but whose incidence has increased significantly in the last decade in population under the age of 65. The main objective of this study was developing a predictive model of synovial membrane degradation in relation to local nerve structures in patients with knee osteoarthritis, based on advanced morphometry and artificial neural networks (ANNs). We present here a pilot test of the method, describing preliminary findings in analyzing a pre-set number of images. We tested the system on a pre-defined set of 50 images from patients suffering of gonarthrosis in different stages. Biological material used for the histological study was synovial membrane fragments. We included 50 anonymized images from 25 consecutive patients. We found significant differences between mean fractal dimensions (FDs) of histological elements of normal and pathological tissues. In the case of immunohistochemistry, we found statistically relevant differences for mean FDs of all antibodies. We fed the data to the ANN system designed to recognize pathological regions of the examined tissue. We believe that further study will have an important contribution to the development and will bring new local targeted therapies. These could slow or reverse joint damage and pain relief in patients with osteoarthritis.

Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis

INTRODUCTION

Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract.

PATIENTS AND METHODS

30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena.

RESULTS

The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions).

CONCLUSIONS

The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer.

Imaging and histopathological aspects in aseptic osteonecrosis of the femoral head

Aseptic osteonecrosis causes various clinical manifestations, depending on its location, but has in common a histopathological and radiological substrate. Aseptic osteonecrosis of the femoral head is a condition whose pathogenesis remains unclear despite many theories developed so far, and the discovery of numerous risk factors. The objective of this study is to emphasize the role of imaging techniques and correlating histology and immunohistochemistry methods in order to more accurately stage the disease. This retrospective study was performed on a total of 103 patients with clinical and radiological suspicion of unilateral or bilateral osteonecrosis. For the diagnosis criteria, we used clinical information, pelvic X-ray images, magnetic resonance imaging (MRI) or computed tomography (CT). For the inclusion of patients in a disease stage, we used the Association Research Circulation Osseous (ARCO) classification system. For patients diagnosed at an advanced stage, who underwent hip arthroplasty, we harvested biological material necessary for the histopathological study. There were differences in the appearance and extent of the lesion on the histological samples compared to macroscopic examination and even those obtained through imaging means, particularly for patients in evolutionary stage III. Aspects such as the extension of the area of fibrosis, bone tissue remodeling, the density of the newly formed vascular network and degree of impairment of the cartilage, are determined more accurately using histology and immunohistochemistry techniques. Before classifying patients in a certain stage, after correlating clinical and imaging data, histopathological aspects have to be considered, particularly in patients in stages III and IV, in which total hip arthroplasty could be delayed.