Fascia--Current knowledge and future directions in physiatry: narrative review.

Fascia can be considered part of the connective tissues that permeates the human body. However, in medical training its definition is not clear, and even among specialists its role is not completely understood. Physiatrists have a unique opportunity to add to the growing scientific and clinical knowledge about fascia, particularly about how this connective tissue network may apply clinically to musculoskeletal disorders. In this narrative review, the structure and function of fascia is discussed from the perspective of physiatry.

Inter-rater reliability of the Active Straight-Leg Raise and One-Leg Standing tests in non-pregnant women.

OBJECTIVE: To determine the inter-rater reliability of the Active Straight-Leg Raise and One-Leg Standing tests. DESIGN: Cross-sectional pilot study. SUBJECTS: Thirty-one women who were either not pregnant or at least 9 months post-partum. METHODS: Subjects completed a questionnaire and standardized pain and disability assessments. The Active Straight-Leg Raise and One-Leg Standing tests were assessed by 3 independent, blinded examiners. Inter-rater reliability was determined, and relationships with assessments were explored. RESULTS: For the Active Straight-Leg Raise test, the kappa coefficient was 0.87, sensitivity 71%, and specificity 91%. Relationships with various pain and disability assessments were demonstrated, including the Functional Pelvic Pain Scale (r = 0.77) and Roland-Morris Disability Questionnaire (r = 0.70). For the One-Leg Standing test, kappa coefficients were -0.02 and 0.14 for the left and right sides, respectively, and thus no further analyses were performed. CONCLUSION: In women with a spectrum of low-back and pelvic pain, the Active Straight-Leg Raise test had good inter-rater reliability, whereas the One-Leg Standing test did not. Further studies are required regarding the validity of the Active Straight-Leg Raise test.

Amphotericin B disposition after aerosol inhalation in lung transplant recipients.

BACKGROUND: Bronchopulmonary fungal infections continue to be a major cause of morbidity and mortality in lung transplant recipients, and amphotericin B remains the drug of choice for prophylaxis of most fungal infections. Unfortunately, intravenous amphotericin B has numerous serious adverse effects; thus, nebulized amphotericin B could decrease the incidence of adverse effects seen with the intravenous formulation and provide high local concentrations in the lung tissue. We performed a prospective pilot study to characterize the bronchoalveolar lavage (BAL), lung tissue, and plasma concentrations of amphotericin B following inhalation administration to lung transplant recipients. METHODS: Amphotericin B 30 mg was administered by nebulizer prior to a routine bronchoscopy. Amphotericin B concentrations in BAL samples from the upper and lower lobes, transbronchial biopsies, and plasma (obtained by drawing a blood sample 30 min after the amphotericin B inhalation) were analyzed by HPLC. RESULTS: Eight patients were enrolled in the study (mean age 50.0 +/- 16.1 y; number of years posttransplant 3.0 +/- 1.9; type of transplant 5 double-lung, 3 single-lung). The mean amphotericin B concentration in the upper and lower lobe BAL samples were 0.68 +/- 0.36 and 0.50 +/- 0.31 microgram/mL, respectively. Amphotericin B concentrations, detected in only 2 of 5 biopsy samples, were 0.118 and 0.03 microgram/g. Amphotericin B was detected in the plasma of only 1 patient (0.19 mg/L). CONCLUSIONS: This pilot study demonstrated that detectable concentrations of amphotericin B can be attained in both the upper and lower BAL samples following aerosol administration. However, the frequency of the dose and duration of treatment still need to be determined in a larger study.