Effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions: A scoping review.

BACKGROUND: In the field of orthotics, the use of three-dimensional (3D) technology as an alternative to the conventional production process of orthoses is growing. PURPOSE: This scoping review aimed to systematically map and summarize studies assessing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions, and to identify knowledge gaps. METHODS: The Cochrane Library, PubMed, EMBASE, CINAHL, Web of Science, IEEE, and PEDro were searched for studies of any type of 3D-printed orthoses for traumatic and chronic hand conditions. Any outcome related to the effectiveness of 3D-printed orthoses was considered. Two reviewers selected eligible studies, charted data on study characteristics by impairment type, and critically appraised the studies, except for case reports/series. RESULTS: Seventeen studies were included: four randomized controlled trials, four uncontrolled trials, four case series and five case reports. Only three studies had a sample size >20. Impairments described were forearm fractures (n = 5), spasticity (n = 5), muscle weakness (n = 4), joint contractures (n = 2) and pain (n = 1). Four poor to fair quality studies on forearm fractures supported the effectiveness of 3D-printed orthoses on hand function, functionality, and satisfaction. One good quality study on spasticity demonstrated the effectiveness of 3D-printed orthoses on hand function. One poor quality pain study reported limited positive effects on satisfaction. Studies on muscle weakness and joint contractures showed no benefits. CONCLUSION: Current literature addressing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions consists primarily of small and poor methodological quality studies. There is a need for well-designed controlled trials including patient-related outcomes, production time and cost analyses.

Cannabis use in cancer: a survey of the current state at BC Cancer before recreational legalization in Canada.

Background: Cancer patients experience multiple symptoms throughout their illness, and some report benefit from the use of cannabis. There are concerns that many patients are accessing products inappropriate for their situation and potentially putting themselves at risk. In the present study, we aimed to capture the prevalence of cannabis use among cancer patients at BC Cancer before recreational legalization in Canada and to identify the reasons that patients take cannabis, the various routes of administration they use, and the reasons that prior users stopped. Methods: Patients were eligible if, on the selected study day (15 August 2018), they were scheduled for an appointment at any of the 6 BC Cancer sites. Eligible patients were mailed a survey. Results: Of surveys sent to 2998 patients, 821 (27.4%) were returned and included in analysis. Of those respondents, 23% were currently using cannabis-based products, almost exclusively for medical purposes, and an additional 28% had been users in the past (most often recreationally). Of the patients currently using cannabis, 31% had medical authorization. The most common symptoms that the current users were targeting were pain, insomnia, nausea, and anxiety; many were also hoping for anticancer effects. Conclusions: More than half the respondents had tried cannabis at some time, and almost one quarter of respondents were currently taking cannabis to help manage their symptoms or treat their cancer, or both. Many more patients would consider use with appropriate guidance from a health care professional. More research is needed to inform physicians and patients about safe uses and doses and about the potential adverse effects of cannabis use.

Reverse remodeling in Dilated Cardiomyopathy: Insights and future perspectives.

Dilated Cardiomyopathy (DCM) has been classically considered a progressive disease of the heart muscle that inexorably progresses towards refractory heart failure, ventricular arrhythmias and heart transplant. However, the prognosis of DCM has significantly improved in the past few years, mostly as the result of successful therapy-induced reverse remodeling. Reverse remodeling is a complex process that involves not only the left ventricle, but also many other cardiac structures and it is now recognized both as a measure of therapeutic effectiveness and as an important prognostic tool. Nevertheless, several aspects of reverse remodeling remain unclear, including the best timing for its quantification, its predictors and its interaction with individual genetic backgrounds. In this review, we summarize our current understanding of reverse remodeling in patients with DCM and provide practical recommendations for the clinical management of this challenging patient population.

Safe core-satellite magneto-plasmonic nanostructures for efficient targeting and photothermal treatment of tumor cells.

Magneto-plasmonic nanostructures functionalized with cell targeting units are of great interest for nanobiotechnology applications. Photothermal treatment of cells targeted with antibody functionalized nanostructures and followed by magnetic isolation, allows killing selected cells and hence is one of the applications of great interest. The magneto-plasmonic nanostructures reported herein were synthesized using naked gold and magnetite nanoparticles obtained through a green approach based on laser ablation of bulk materials in water. These particles do not need purifications steps for biocompatibility and are functionalized with a SERRS (surface enhanced resonance Raman scattering) active molecule for detection and with an antibody for targeting prostate tumor cells. Quantitative results for the cell targeting and selection efficiency show an overall accuracy of 94% at picomolar concentrations. The photothermal treatment efficiently kills targeted and magneto-selected cells producing a viability below 5% after 3 min of irradiation, compared with almost 100% viability of incubated and irradiated, but non targeted cells.

Consenso GEDOS-SECOT sobre el proceso de atención a pacientes con artrosis de rodilla e indicación de artroplastia / GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty

Objetivo. Desarrollar recomendaciones sobre el proceso de evaluación y manejo del paciente con artrosis de rodilla e indicación de artroplastia basadas en la mejor evidencia científica disponible y la experiencia de un panel de expertos. Métodos. Se seleccionó un grupo multidisciplinar de 12 expertos que definieron: alcance, usuarios, apartados del documento, revisiones sistemáticas a realizar y a quienes se asignaron tareas. Se realizaron 3 revisiones sistemáticas en pacientes con indicación de artroplastia de rodilla sobre: 1) eficacia y seguridad de los protocolos de fast-track; 2) papel de las intervenciones cognitivo-conductuales en sujetos con catastrofismo, y 3) efecto del control del dolor agudo posquirúrgico en los resultados. Se realizaron 2 revisiones narrativas sobre la sensibilización central en este grupo y sobre la eficacia de la rehabilitación preoperatoria. Los expertos redactaron los apartados y generaron las recomendaciones. Estas recomendaciones se consensuaron mediante la metodología Delphi en un grupo multidisciplinar de 85 expertos. Se estableció también el nivel de evidencia de cada recomendación. Resultados. Se generaron 20 recomendaciones. Todas alcanzaron un nivel de acuerdo mayor del 80%. El mayor acuerdo se alcanzó en la necesidad de realizar informe de alta completo, en informar adecuadamente al paciente sobre el proceso y en seguir las recomendaciones de las guías clínicas disponibles. Conclusiones. Existe consenso entre los responsables del manejo de los pacientes con artrosis de rodilla e indicación de artroplastia en que es necesario protocolizar el proceso de sustitución articular, realizando una correcta evaluación y seguimiento del paciente, de forma integral y coordinada y con especial atención al procedimiento quirúrgico y al postoperatorio (AU)

Objective. To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. Methods. A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (I) efficacy and safety of fast-tracks; (II) efficacy and safety of cognitive interventions in patients with catastrophic pain, and (III) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. Results. A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. Conclusions. There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period (AU)

Scoring systems for Oral Lichen Planus used by differently experienced raters.

BACKGROUND: Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. MATERIALS AND METHODS: Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall's W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. RESULTS: Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS. CONCLUSION: All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain.

GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty. / Consenso GEDOS-SECOT sobre el proceso de atención a pacientes con artrosis de rodilla e indicación de artroplastia.

OBJECTIVE: To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS: A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS: A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS: There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.

Melatonin intake since weaning ameliorates steroidogenic function and sperm motility of streptozotocin-induced diabetic rats.

Melatonin may be used as an antioxidant in therapy against systemic sequelae caused by oxidative stress in diabetes. However, as melatonin has a major role in regulating reproductive activity, its consequence on reproductive parameters under diabetes needs to be better clarified. We have studied whether prior and concomitant treatment of juvenile Wistar rats with low doses of melatonin interferes in reproductive damage induced by experimental diabetes after 1 and 8 weeks. The consequences of melatonin administration since weaning on reproductive parameters of healthy rats at adulthood were also evaluated. Melatonin was provided in drinking water (10 µg/kg b.w./day) after weaning (5-week-old). Diabetes was induced by streptozotocin injection (4.5 mg/100 g b.w.) at 13-week-old rats, and rats were euthanized 1 and 8 weeks after disease onset. Diabetes decreased circulating testosterone levels (~35% to 1 week; ~62% to 2 months; p < 0.01) but did not affect testes sperm counts. Two months of diabetes reduced the sperm reserve and led to atrophy of epididymal cauda. Both 1-week and 2-month diabetes impaired sperm motility, decreased the number of spermatozoa with progressive movement, and increased the number of immotile sperm. Melatonin intake reduced serum testosterone levels ~29% in healthy 14-week-old and ~23% in 21-week-old rats and reduced daily testicular sperm production ~26% in the latter disease stage, but did not interfere in sperm reserves and transit time for both experimental periods. Exogenous melatonin prevented the serum testosterone decrease and damage to sperm motility in diabetic rats and attenuated reduction in sperm counts and transit time induced by 1-week diabetes but did not avoid this decrease at 2-month diabetes. Low doses of melatonin administered prior to and during experimental diabetes attenuated damage to testicular steroidogenic activity and preserved sperm motility, but not sperm reserves in the rat. Our data indicated a differential action of melatonin in normoglycemic and hyperglycemic conditions, particularly in sperm motility and testosterone production by Leydig cells.

Evaluation of nutritional status in head and neck radio-treated patients affected by oral mucositis: efficacy of class IV laser therapy.

PURPOSE: To retrospectively evaluate the role of class IV laser therapy in the amelioration of nutritional status of patients affected by oral mucositis due to radiotherapy of the head and neck region during oncological treatment. METHODS: Sixty-three oncological patients were included in this study. All patients were affected by tumors in the head and neck region and had developed oral mucositis during radiotherapy. Forty-two patients had been treated by high-power laser therapy whereas 21 patients had been managed with traditional medications. Data collection included weight measurement (kilogram) and body mass index (BMI) calculation (mass (kilogram)/(height) (square meter)) on the first and last day of radiotherapy. In addition, gender, age, pathology, and the kind of oncological treatment have been considered. RESULTS: Laser-treated patients decreased less in BMI during radiotherapy (p=0.000). Patients treated by combined oncological treatments (radiotherapy and/or chemotherapy and/or surgery) had a higher weight loss during radiotherapy (p=0.015). According to a multivariate regression analysis, the only variable which significantly influenced the reduction of BMI was laser treatment (p=0.000). CONCLUSIONS: Laser therapy is actually considered one of the recommended remedies for the healing of oral mucositis due to cancer treatments. Healing of mucositis can deeply influence the feeding capacity of patients, through reduction of pain and improvement of chewing and swallowing capacities. It also allows lowering the costs for hospitalization and supportive care. Laser therapy should become part of nutritional interventions in oncological patients affected by oral mucositis.

Validity of the ankylosing spondylitis disease activity score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme.

OBJECTIVES: To evaluate the validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in early spondyloarthritis (SpA) in comparison with conventional clinical measures of disease activity. METHODS: Six hundred and seventy-six incident cases of early SpA from the Esperanza programme were included. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and on the physician's decision to start treatment with a disease-modifying antirheumatic drug or tumour necrosis factor blocker. The discriminant ability of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) was tested using standardised mean differences between patients with high and low disease activity. Convergent validity was tested by Pearson correlation between ASDAS versions and other measures of disease activity. RESULTS: ASDAS-ESR and ASDAS-CRP showed good correlation with BASDAI (r=0.79 and 0.74, respectively). Both indices correlated well with the patient global assessment (r=0.70 in both indices) and moderately with the physician global score (r=0.46 and 0.47, respectively). CRP and ESR showed poor correlation with patient- and physician-derived measures. ASDAS performed similarly across the global SpA sample, ankylosing spondylitis (AS), non-radiographic axial SpA and peripheral SpA. CONCLUSIONS: ASDAS performed as a valid activity score even being slightly better than the Bath Ankylosing Spondylitis Disease Activity Index in its ability to discriminate between high and low disease activity in early SpA. ASDAS performed similarly in AS, early forms of SpA, non-radiographic axial SpA and peripheral SpA.

Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste.

OBJECTIVES: The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS: Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS: Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS: The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.

Extra-torque of human tibialis anterior during electrical stimulation with linearly varying frequency and amplitude trains.

This work aimed to characterise the whole human muscle input/output law during electrical stimulation with triangular varying frequency and amplitude trains through combined analysis of torque, mechanomyogram (MMG) and electromyogram (EMG). The tibialis anterior (TA) of ten subjects (age 23-35 years) was investigated during static contraction obtained through neuromuscular electrical stimulation. After potentiation, TA underwent two 15s stimulation patterns: (a) frequency triangle (FT): 2 > 35 > 2 Hz at Vmax (amplitude providing full motor unit recruitment); (b) amplitude triangle (AT): Vmin > Vmax > Vmin (Vmin providing TA least mechanical response) at 35 Hz. 2 > 35 Hz or Vmin > Vmax as well as 35 > 2 Hz or Vmax > Vmin were defined as up-going ramp (UGR) and down-going ramp (DGR), respectively. TA torque, MMG and EMG were detected by a load cell, an optical laser distance sensor and a probe with two silver bar electrodes, respectively. For both FT and AT, only the two mechanical signals resulted always larger in DGR than in UGR, during AT extra-torque and extra-MMG were present even in the first 1/3 of the amplitude range where EMG data presented no significant differences between DGR and UGR. Our data suggest that extra-torque and extra-displacement are evident for both FT and AT, being mainly attributed to an intrinsic muscle property.

Energy metabolism during activity-promoting video games practice in subjects with spinal cord injury: evidences for health promotion.

BACKGROUND: Activity promoting video game (APVG) practice significantly affects energy metabolism through energy expenditure (EE) increase and has been recently included in strategies for health promotion. It is not known if the APVG practice provides similar outcomes in subjects with spinal cord injury (SCI). AIM: Aim of the study was to evaluate cardio-pulmonary and metabolic adaptations during APVG practice and to find whether EE increase above resting condition could suggest the inclusion of this exercise in a more general strategy for health promotion and body weight control in subjects with SCI. DESIGN: Repeated measures study. SETTING: Rehabilitation Institute. POPULATION: Ten male subjects with SCI (lesion levels from C7 to L1) age 26 to 55 years. METHODS: We recorded pulmonary ventilation (VE), oxygen consumption (VO2) for EE esteem and heart rate (HR) at rest and while playing virtual bowling, tennis and boxing games using a portable metabolimeter equipped with ECG electrodes. The standard metabolic equivalent of task (METs) was calculated offline. The metabolic and functional parameters were referred to the 10th minute of each activity. RESULTS: Metabolic and functional parameters increased significantly from rest to bowling, tennis and boxing. METs exceeded in average 3 during boxing. One hour of APVG can increase daily EE by about 6% (bowling), 10% (tennis) and 15% (boxing). CONCLUSION: These considerable results suggest that physical exertion during APVG practice in subjects with SCI could contribute to health promotion as well as caloric balance control, especially when boxing is considered. This can be safely achieved at home with regular activity. CLINICAL REHABILITATION IMPACT: These findings substantiate the potential for novel exercise modalities to counteract deconditioning due to inactivity in subjects with SCI by promoting physical activity through implementation of APVG exercise programs.

Acneiform rash due to epidermal growth factor receptor inhibitors: high-level laser therapy as an innovative approach.

Acneiform rash associated with epidermal growth factor receptor inhibitors frequently presents facial manifestations. The treatment modality for such lesions still needs to be elucidated. The aim of this original report was to evaluate the effectiveness of high-level laser therapy in reducing the severity of facial acneiform rash induced by cetuximab, an epidermal growth factor receptor inhibitors. Four patients with metastatic colorectal cancer and two patients with head and neck cancer showing cetuximab-induced facial rash were treated by high-level laser therapy in two 8-min-long consecutive sessions/day over a 4-day treatment. Patients wore protective glasses to prevent eye damage related to laser light. Subsequently, patients were seen once a week for up to 21 days and after 180 days. During each day of treatment and each follow-up recall, patients were asked to complete a questionnaire about the onset and progression of their acneiform rash (for a total of eight sessions). Cetuximab-related toxicity and general discomfort visual analogue scales were also recorded in each of these eight sessions in the treated and control areas in each patient. After the fourth session of high-level laser therapy, the patients showed a noteworthy decrease in both cetuximab-related toxicity and visual analogue scales, up to a complete regression of the lesions at the end of the follow-up in all treated areas. The high-level laser therapy was effective in the healing of acneiform rash associated with epidermal growth factor receptor inhibitors with no side effects.

Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response.

The aim of the study was to investigate the influence of two different transcutaneous neuromuscular electrical stimulation procedures on evoked muscle torque and local tissue oxygenation. In the first one (MP mode), the cathode was facing the muscle main motor point and stimulus amplitude was set to the level eliciting the maximal myoelectrical activation according to the amplitude of the evoked electromyogram (EMG); in the second one (RC mode), the electrodes were positioned following common reference charts for electrode placement while stimulus amplitude was set according to subject tolerance. Tibialis Anterior (TA) and Vastus Lateralis (VL) muscles of 10 subjects (28.4 ± 8.2 years) were tested in specific dynamometers to measure the evoked isometric torque. The EMG and near-infrared spectroscopy probes were placed on muscle belly to detect the electrical activity and local metabolic modifications of the stimulated muscle, respectively. The stimulation protocol consisted of a gradually increasing frequency ramp from 2 to 50 Hz in 7.5 s. Compared to RC mode, in MP mode the contractile parameters (peak twitch, tetanic torque, area under the torque build-up) and the metabolic solicitation (oxygen consumption and hyperemia due to metabolites accumulation) resulted significantly higher for both TA and VL muscles. MP mode resulted also to be more comfortable for the subjects. Based on the assumption that proper mechanical and metabolic stimuli are necessary to induce muscle strengthening, our results witness the importance of an optimized, i.e., comfortable and effective, stimulation to promote the aforementioned muscle adaptive modifications.

Prevalence of Strongyloides stercoralis infection among HIV-positive immigrants attending two Italian hospitals, from 2000 to 2009.

In patients with Strongyloides stercoralis infection, a dysregulation of host immunity can lead to hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), characterized by high fatality rate. HS has been reported in HIV-positive patients following use of corticosteroids or during immune reconstitution inflammatory syndrome (IRIS). A retrospective study was conducted to estimate the prevalence of S. stercoralis infection among HIV-positive immigrants, attending two Italian hospitals. From January 2000 to August 2009, 138 HIV-positive immigrants were systematically screened for strongyloidiasis, as a part of their routine care, with an indirect immunofluorescent antibody test (IFAT) developed at the Centre for Tropical Diseases, Sacro Cuore Hospital of Negrar, Verona. The majority were also submitted to stool examination. Fifteen (11%) resulted infected by S. stercoralis, of whom four (27%) had a negative serology (diagnosis made with stool examination). A higher eosinophil count (0·94 versus 0·24×10(9)/l, P<0·01) and more frequent gastrointestinal and cutaneous symptoms (odds ratio: 4·8 and 5·8, respectively) were found in patients with strongyloidiasis compared with controls. The IFAT is more sensitive than direct parasitological methods. The proportion of false negative results was higher than expected based on the theoretical test sensitivity. Considering the high prevalence detected and the apparent, lower sensitivity of serology, we propose a systematic screening for Strongyloides infection, with both serology and stool culture, for all HIV-positive immigrants coming from endemic areas.