Extraction of a 6-year-old leadless pacemaker (MICRA transcatheter pacing system) using commercially available removal tools: A case report.

INTRODUCTION: Leadless pacemakers are associated with a low risk of infection, so indications for their removal are rare. One can expect that the dwell time of the device correlates with a more difficult removal, but it has not been proved so far. METHODS AND RESULTS: We present a case of a patient in whom MICRA transcatheter pacing system was successfully removed with nondedicated commercially available tools, 70 months after implantation. CONCLUSION: A successful removal of the MICRA leadless pacemaker is possible, and may be safe even many years after the device implantation, despite a lack of dedicated tools. Due to the potential risk of complications, the benefits and risks of the procedure should be weighted before making a final decision.

The influence of 15-weeks climbing program on the static and dynamic balance of young adults with mild and moderate intellectual disabilities.

BACKGROUND: The aim of the study was to assess the effect of climbing on static and dynamic balance and to determine the usefulness of such training in supporting the fitness of young adults with mild and moderate intellectual disabilities. METHOD: The study involved 47 men and 21 women aged 18-25 years. The experimental group participated in classes on an artificial climbing wall for 15 weeks. At that time, the control group did not participate in any organised sports activities. The balance was assessed twice using tests: a bench walk, a functional reach, a single leg stance with the eyes open and closed, and a BTS P-WALK baroresistive platform. RESULTS: In the experimental group there were improvements in functional reach test by 7.79 cm (p < .001), balance walk test by 0.47 pts (p = .003), improvements in frontal and sagittal plane stability, and tilting area in the closed eyes test. The changes that were observed in the control group were not statistically significant. CONCLUSIONS: Climbing activities can be part of a rehabilitation program to improve balance.

Early Smartphone App-Based Remote Diagnosis of Silent Atrial Fibrillation and Ventricular Fibrillation in a Patient with Cardiac Resynchronization Therapy Defibrillator.

Due to distressing statistics concerning cardiovascular diseases, remote monitoring of cardiac implantable electronic devices (CIED) has received a priority recommendation in daily patient care. However, most bedside systems available so far are not optimal due to limited patient adherence. We report that smartphone app technology communicating with CIED improved the patient's engagement and adherence, as well as the accuracy of atrial and ventricular arrhythmias diagnosis, thus offering more efficient treatment and, consequently, better patient clinical outcomes. Our findings are in concordance with previously published results for implantable loop recorders and pacemakers, and provide new insight for heart failure patients with an implanted cardiac resynchronization therapy defibrillator.

Selected hallmarks of hallux valgus in older women with symptomatic hallux valgus compared to middle-aged women with and without deformation of the forefoot.

The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in older women with hallux valgus versus middle-aged women with and without this deformation to identify the presence of features which correlate particularly strongly with hallux valgus, and on which prophylaxis and conservative treatment should focus. The study involved 201 women: 92 aged 60-84 years with hallux valgus of both toes, 78 aged 38-59 with hallux valgus of both toes, and 31 aged 38-57 years with correctly shaped feet. The intensity of pain in the foot, the valgus angle of the big toe and fifth toe, the longitudinal and transverse arches of the foot, the symmetry of foot load with body weight, toe joint mobility and muscle flexibility were analysed. Both groups of women with hallux valgus differed from women with normal feet in the height of the transverse arch, the extent of dorsal extension in the first metatarsophalangeal joint and plantar flexion in the first interphalangeal joint. Older women were additionally characterised by reduced plantar flexion in the metatarsophalangeal joint of the big toe, limited flexibility of the soleus and gastrocnemius muscles as well as less pain in the toe area than in the foot itself. The most characteristic changes which were observed in older women with hallux valgus are a limited range of motion in the MTP and IP joints of the big toe, a reduced transverse arch and increased restriction of calf muscle flexibility.

The Scores and Manner of Performing the Stand and Reach Test in Girls and Boys of Different Body Weight.

INTRODUCTION: Flexibility is one of the components of Health-Related Fitness. The range of flexion has been the participant of numerous publications, but research into the quality of flexibility is lacking. The aim of the study has been to compare the scores and the quality of the stand and reach test in both overweight girls and boys and girls and boys with normal body weight. We have checked whether the forward bend movement is symmetrically distributed over the hip joints and the lumbar and thoracic spine and how it influences the position of the knee and ankle joints. MATERIAL AND METHODS: 100 girls and 100 boys aged 10-14 years were examined. Flexibility was measured using the stand and reach test. The quality of the bend was assessed by examining the range of movement in individual body segments: the range of flexion of the thoracic and lumbar spine (linear measurements), the range of flexion of the hip joint, and the position of the knee and ankle joints at maximum flexion (angular measurements). The results were subjected to statistical analysis. RESULTS: The participants, especially boys, had poor flexibility. A poor stand and reach test result correlated with a lower range of flexion of the thoracic and lumbar spine, greater flexion of the hip and knee joints, and greater plantar flexion at maximum torso bend position. Although the mean stand and reach score was slightly greater for the girls, gender did not significantly differentiate the way in which the stand and reach test was performed. Being overweight also did not affect the quantity or quality of the stand and reach test. CONCLUSIONS: Limitation of flexibility is common in 10-14-year-old children and results mainly from limited mobility of the spine. The compensation for this is excessive movement in the joints of the lower extremities.

Recall devices: Defects at initial visit and during remote monitoring supported follow-up.

BACKGROUND: In March 2021, Biotronik informed about the risk of premature battery depletion in a group of implantable cardioverter-defibrillators. Following the manufacturers' recommendation, our center executed a recall and introduced remote monitoring (RM) in patients with susceptible devices. This study reports the rate of premature battery depletion in our center and events found in RM-supported follow-up. METHODS: Single-center observational study. RESULTS: Out of the 206 susceptible implanted devices, 125 patients appeared for the visit and RM was introduced in 107 (83%) patients. Until the visit, three (2.4%) devices required replacement due to battery depletion, and a further three (2.4%) devices had unexpected battery depletion during follow-up. CONCLUSIONS: The recalled devices had a higher rate of battery exhaustion than expected, while other device or lead defects were less common.

Complications of cardiac resynchronization therapy implantation: De novo implants versus upgrades.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a well-established treatment of patients with advanced heart failure and electrical dyssynchrony. Implantation of those devices is in some cases associated with intervention on a formerly implanted system. The aim of this analysis was to compare the rate and type of complications of de novo implants and upgrades to CRT-D. METHODS: Retrospective data were collected from medical records, including 326 patients treated with CRT-D between 2015 and 2020. The following data were analyzed: procedure data including complications, demographics, co-morbidities, pharmacotherapy, and laboratory tests. The primary endpoint of the study was all-cause mortality. RESULTS: A total of 326 procedure were included, of which 53% (n = 172) were de novo implants and 47% (n = 154) were upgrades. The groups did not differ in the incidence of complications: in the de novo group: 25.5% (n = 44); in the upgrade group: 30.5% (n = 47), p = 0.78. The incidence of complications was also similar in respect of the following: early (p = 0.98) and late (p = 0.45), infectious (p = 0.38) and non-infectious (p = 0.82), surgical (p = 0.38) and device or lead related (p = 0.6). The most common complication in the upgrade group was pocket hematoma (n = 9, 5.8%) and in the de novo group pneumothorax (n = 8, 4.7%). CONCLUSIONS: Upgrade procedures of are not associated with a higher percentage of complications than de novo implantations of CRT-D. Previously implanted cardiac implantable electronic device should not limit the implantation of CRT-Ds.

Follow-up and characteristics of recipients of cardiac resynchronization therapy with and without a defibrillator.

BACKGROUND: Cardiac resynchronization therapy defibrillator (CRT-D) and pacemaker (CRT-P) are treatment options for patients with advanced heart failure and electrical dyssynchrony. Current guidelines provide only factors favoring, not specific recommendations as to implant CRT-D or CRT-P. This analysis aimed to compare and contrast populations of CRT-D and CRT-P recipients. METHODS: Retrospective data were collected from medical records, including 231 patients treated with either CRT-D or CRT-P between 2015 and 2019. Following data were analyzed demographics, co-morbidities, pharmacotherapy, laboratory tests, and data related to the procedure of implantation. The primary endpoint of the study was all-cause mortality. RESULTS: A total of 231 patients were included (mean age [standard deviation, SD], 64.1 [12.3] years, 76% male), of these, 13.6% (n = 32) with CRT-P and 86.4% (n = 199) with CRT-D. Mean New York Heart Association (NYHA) class did not differ between the groups: 2.23 (0.9) in CRT-P and 2.35 (0.6) in CRT-D group (P = 0.42). Mean left ventricular ejection fraction was lower in patients eligible for CRT-D: 27.1% vs. 38% (P < 0.001). Patients were followed for a median (interquartile range [IQR]) of 29 (13-44) months and survival in the CRT-P group was 84%, in CRT-D - 82% (P = 0.74). Patients in the CRT-P group were older, and more often after atrioventricular node ablation. The CRT-P group had tendency towards higher Charlton Comorbidity Index, reaching a mean of 4.66 (1.5) points vs. 3.96 (1.5) points in CRT-D (P = 0.06). CONCLUSIONS: Populations with CRT-P and CRT-D differ in terms of comorbidities; however, they have similar survival. Further studies are required to identify a group of patients, who derive a benefit from adding a defibrillator.

Organization of Post-Transplant Care and the 5-Year Outcomes of Kidney Transplantation.

The outcomes of kidney transplantation depend on numerous factors and vary between transplant centers. The aim of this study is to assess the relationship between selected organizational factors, comorbidities, and patient and graft survival. This is a retrospective analysis of 438 renal transplant recipients (RTR) followed for 5 years. Patient and graft survival were evaluated in relation to hospitalization length, distance from the patient's residence to the transplant center, the frequency of outpatient transplant visits, and the number and type of comorbidities. Five-year patient and graft survival rates were 93% and 90%, respectively. We found significant associations of patient survival with the prevalence of pre-transplant diabetes, cardiovascular diseases, malignancies, the number of comorbidities, and the first post-transplant hospitalization length. The incidence of infections, cardiovascular diseases, and transplanted kidney diseases was 60%, 40%, and 33%, respectively. As many as 41% of RTR had unknown etiology of primary kidney disease. In conclusion, the organization of post-transplant care needs to be adapted to the multi-morbidity of contemporary RTR and include multi-specialist care, especially in the context of current problems related to the COVID-19pandemic. The high proportion of patients with undetermined etiology of their primary renal disease carry the risk for additional complications during their long-term follow-up.

The relationship between the manifestations of mobbing and reactions of mobbing victims.

BACKGROUND: The study concerned workplace mobbing, a phenomenon affecting about 3-20% of the Polish population. The aim of the article is to distinguish the manifestations of mobbing, to study the coexistence of mobbing manifestations, and to search for the relationships between the symptoms of mobbing, reactions to mobbing and methods of dealing with mobbing used by victims. MATERIAL AND METHODS: Information on the above variables was obtained using a questionnaire on mobbing, risk factors, and responses to mobbing. The questionnaire was completed by 781 people (women: 66%, men: 34%). The average age of the respondents was 29 years. The current statistical analysis included: distinguishing the manifestations of mobbing by means of a confirmatory factor analysis, studying the coexistence of mobbing manifestations by means of a cluster analysis, and detecting the relationships between mobbing manifestations, reactions to mobbing and ways of dealing with it based on the system of structural equations. RESULTS: The results of the research revealed 3 categories of relationships: a co-occurrence of mobbing manifestations, a relationship of mobbing manifestations with reactions to mobbing, and a relationship of mobbing reactions with methods of dealing with mobbing. CONCLUSIONS: Mobbing was found in 22% of the examined group. The study revealed the existence of 5 clusters of mobbing manifestations (i.e., subgroups of respondents characterized by experiencing at least 1 of the mobbing manifestations). In the most numerous clusters in which the symptoms of mobbing were diagnosed, unfriendly working conditions prevailed. In the context of mobbing, people were found to more often react with passivity or with using interpersonal coping methods. However, they rarely turned to institutions for help or used aggression against the mobber. Med Pr. 2022;73(1):1-12.

The influence of myofascial release on pain and selected indicators of flat foot in adults: a controlled randomized trial.

Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF-myofascial release, E-the exercise program, MFE-myofascial release and the exercise program, C-no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.

Impact of Cervical Spine Rehabilitation on Temporomandibular Joint Functioning in Patients with Idiopathic Neck Pain.

OBJECTIVE: The aim of this study was to assess the effectiveness of a 3-week rehabilitation programme focusing only on the cervical region, pain intensity, range of motion in the cervical spine, head posture, and temporomandibular joint (TMJ) functioning in subjects with idiopathic neck pain who did not report TMJ pain. DESIGN: A parallel group trial with follow-up. METHODS: The study included 60 participants divided into 2 groups: experimental: n = 25, 27-57 years old, experiencing idiopathic neck pain and who underwent a 3-week rehabilitation programme, and the control, n = 35, 27-47 years, who were cervical pain-free. At baseline and after 3 weeks of treatment in the experimental group and with a 3-week time interval in the control group, pain intensity, head posture in the sagittal plane, range of motion in the cervical spine, and TMJ functioning were evaluated. RESULTS: After 3 weeks of rehabilitation, there was a significant decrease in pain intensity, improved range of motion of the cervical spine and head posture, and improved clinical condition of TMJ in participants with idiopathic neck pain who did not report TMJ pain. CONCLUSION: The study suggested that idiopathic neck pain is associated with limited range of motion in the cervical spine, incorrect head posture, and TMJ dysfunction. Our data suggests that therapy focusing only on the cervical region may improve the clinical condition of the TMJ in subjects with idiopathic neck pain who do not report TMJ pain. These observations could be helpful in physiotherapeutic treatment of neck and craniofacial area dysfunctions. This trial is registered with ISRCTN Registry ISRCTN14511735.

Parental stress and indifference and the parent's withdrawal from the relationship with their child: a structural approach. / Stres rodzicielski, obojetnosc i wycofywanie sie rodzica z relacji z dzieckiem: ujecie strukturalne.

OBJECTIVES: The aim of the study was to test the theoretical model assuming that parental indifference arises as a result of the parent experiencing stress in the relationship with their child. Therefore, we tested the model describing the relations among the variables of: (a) parent's experience of stress in the relationship with their child, (b) formation of a negative mental representation of the child in the parent's mind, (c) indifference toward the child, and (d) withdrawal of the parent from the relationship with their child. Subsequently, it was tested whether parental indifference was related to the development of emotional and social competences, as well as school readiness of children. METHODS: The first study was carried out on a sample of 154 parents of preschool-age children (3 to 6 years old). The sample included 85 parents of boys and 69 parents of girls. The second study was conducted on 80 children between 6 and 10 years of age who were attending school and on their parents. Analyses were performed using the system of structural equations, data mining algorithms and the artificial neural network. RESULTS: The results demonstrated that the model fits the data accurately and the relations between the variables ranged from moderate to high. Parents with the highest level of withdrawal from the relationship with their child and of indifference were characterized primarily by negative mental representation of their child. CONCLUSIONS: Based on the variables described in the model, it is possible to predict at a good level the degree of parental withdrawal from the relationship with their child. Parental indifference is associated with the child's lower performance in the development of emotional and social competences, as well as school readiness.

The relationship between the position of the spine in the sagittal plane and longitudinal arching of the feet in school-age girls and boys - cross-sectional study.

Introduction: Discoveries concerning the role of connective tissue and myofascial chains require a change in thinking about the functioning of the human body and verification of the approach to correcting posture defects. The aim of the study was to evaluate the relationship between the shape of the spine in the sagittal plane and longitudinal arching of the feet. Material and methods: 271 girls and 241 boys aged 10-12 years were examined. Height and body weight were measured. The BMI was calculated and the status of body weight was estimated. The depth of thoracic kyphosis and lumbar lordosis as well as the sagittal trunk inclination were assessed using the Zebris Pointer ultrasound system. Arching of the feet was determined on the basis of the Arch Index on BTS P-walk platform. Statistica v13 software was used to analyse the data. Results: Both sexes showed a tendency to have deeper thoracic kyphosis and lumbar lordosis. About 15% of the participants had flatfeet. Hollow and correct arching of the feet was observed with a similar frequency (38-43%). Hollow feet arching was accompanied by shallower lumbar lordosis and a shift of the body's general centre of gravity backwards. The participants with flat foot arching tend to have deeper lumbar lordosis. A greater depth of physiological curvatures of the spine and lower longitudinal arching of the feet were observed in boys. BMI was positively correlated with decreased arching of the feet and deepened lumbar lordosis. Conclusions: Longitudinal arching of the feet significantly correlates with the depth of lumbar lordosis and trunk balance.

Effect of Three Months Pilates Training on Balance and Fall Risk in Older Women.

This study assessed the effect of Pilates exercises on balance and fall risk in older women. Participants comprised 50 older women aged over 60 years, divided randomly into two groups: the experimental group (n = 30), which took part in Pilates sessions two times per week for three months, and the control group (n = 20). The control group did not participate in such sessions but also did not participate in any other rehabilitation programs or additional physical activity except everyday activities. Before and after the training cycle, all women underwent an assessment using Timed Up and Go (TUG), the One Leg Stance Test (OLST), a test performed on a Freestep baropodometric platform, and the tests performed on a Biosway platform. After the training, significantly decreased values of the surface of the ellipse (p = 0.0037) and mean values of velocity (p = 0.0262) for the right foot in the experimental group were observed. The Limits of Stability (LoS) test (p = 0.005) and the Modified Clinical Test of Sensory Interaction on Balance (m-CTSIB) performed on an unstable surface with eyes closed (p = 0.0409) indicated statistically significant changes in the experimental group. None of the above changes were statistically significant in relation to the control group. Pilates training affected the participants' balance by improving LOS and reducing fall risk.