Wound Microbiota and Its Impact on Wound Healing.

Wound healing is a complex process influenced by age, systemic conditions, and local factors. The wound microbiota's crucial role in this process is gaining recognition. This concise review outlines wound microbiota impacts on healing, emphasizing distinct phases like hemostasis, inflammation, and cell proliferation. Inflammatory responses, orchestrated by growth factors and cytokines, recruit neutrophils and monocytes to eliminate pathogens and debris. Notably, microbiota alterations relate to changes in wound healing dynamics. Commensal bacteria influence immune responses, keratinocyte growth, and blood vessel development. For instance, Staphylococcus epidermidis aids keratinocyte progression, while Staphylococcus aureus colonization impedes healing. Other bacteria like Group A Streptococcus spp. And Pseudomonas affect wound healing as well. Clinical applications of microbiota-based wound care are promising, with probiotics and specific bacteria like Acinetobacter baumannii aiding tissue repair through molecule secretion. Understanding microbiota influence on wound healing offers therapeutic avenues. Tailored approaches, including probiotics, prebiotics, and antibiotics, can manipulate the microbiota to enhance immune modulation, tissue repair, and inflammation control. Despite progress, critical questions linger. Determining the ideal microbiota composition for optimal wound healing, elucidating precise influence mechanisms, devising effective manipulation strategies, and comprehending the intricate interplay between the microbiota, host, and other factors require further exploration.

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation.

Haematopoietic stem cell transplantation (HSCT) is a treatment option for many haematological conditions in patients of all ages. Nutritional support is important at each stage of treatment, but particular nutritional needs and dictated support occur during the preparatory (conditioning regimen) and post-transplant periods. Patients may require nutritional treatment by the enteral or parenteral route. The quantitative and qualitative composition of meals may change. Vitamin requirements, including vitamin D and vitamin C, might also be different. An adequately composed diet, adapted to the needs of the patient, may influence the occurrence of complications such as graft-versus-host disease (GvHD), gastrointestinal disorders, infections, and reduced survival time. Haematological diseases as well as transplantation can negatively affect the intestinal flora, with negative consequences in the form of mucosal inflammation and disorders of a functional nature. Currently, aspects related to nutrition are crucial in the care of patients after HSCT, and numerous studies, including randomized trials on these aspects, are being conducted. This study serves the critical analysis of current scientific evidence regarding nutritional support for patients after HSCT.

The Influence of the "Straighten Your Back" Command on the Sagittal Spinal Curvatures in Children with Generalized Joint Hypermobility.

Objectives. The aim of the study was to assess the change of sagittal spinal curvatures in children with generalized joint hypermobility (GJH) instructed with "straighten your back" command (SYB). Methods. The study included 56 children with GJH. The control group consisted of 193 children. Sacral slope (SS), lumbar lordosis (LL), global thoracic kyphosis (TK), lower thoracic kyphosis (LK), and upper thoracic kyphosis (UK) were assessed with Saunders inclinometer both in spontaneous positions (standing and sitting) and after the SYB. Results. Children with GJH after SYB presented the following: in standing, increase in SS and decrease in TK, LK, and UK (P < 0.01), with LL not significantly changed; in sitting: decrease in global thoracic kyphosis (35.5° (SD 20.5) versus 21.0° (SD 15.5), P < 0.001) below the standards proposed in the literature (30-40°) and flattening of its lower part (P < 0.001). The same changes were observed in the control group. Conclusions. In children with generalized joint hypermobility, the "straighten your back" command leads to excessive reduction of the global thoracic kyphosis and flattening of its lower part. Therefore, the "straighten your back" command should not be used to achieve the optimal standing and sitting positions.

The examination of the musculoskeletal system based only on the evaluation of pelvic-hip complex muscle and trunk flexibility may lead to failure to screen children for generalized joint hypermobility.

OBJECTIVE: The aim of the study was to evaluate whether the clinical assessment of the pelvic-hip complex muscle and trunk flexibility is sufficient for diagnosing generalized joint hypermobility (GJH). DESIGN: A cross-sectional study. SETTING: Center of Body Posture in Olsztyn, North East Poland. PARTICIPANTS: The study included 136 females and 113 males aged 10-13 years. MAIN OUTCOME MEASURES: In order to assess muscle flexibility, the straight leg raise (SLR) test (for hamstring) and modified Thomas test for one- (O-JHF) and two-joint (T-JHF) hip flexors were performed. To evaluate trunk flexibility the fingertip-to-floor (FTF) and lateral trunk flexion (LTF) tests were used. The GJH occurrence was assessed with the use of nine-point Beighton scale (threshold value ≥5 points for females, ≥4 for males). The analysis was carried out separately for females and males. RESULTS: There were no significant differences between females with versus without GJH, and males with versus without GJH regarding SLR (p = 0.86, p = 0.19 for females and males, respectively), O-JHF (p = 0.89, p = 0.35 for females and males, respectively), T-JHF (p = 0.77, p = 0.4 for females and males, respectively), FTF (p = 0.19, p = 0.84 for females and males, respectively) and LTF (p = 0.58, p = 0.35 for females and males, respectively) tests results. CONCLUSIONS: Clinical examination of the pelvic-hip complex muscles and trunk flexibility by use of SLR, O-JHF, T-JHF, FTF and LTF revealed to be insufficient in diagnosing GJH in children aged 10-13 years. Thus, the Beighton scale should be considered a standard element of physiotherapeutic examination of the musculoskeletal system in children and youth.

Reliability of measurements of the extension-flexion ratio with surface EMG.

BACKGROUND: The surface electromyography (sEMG), by evaluating the paraspinal muscle activity, may be used for diagnosis and evaluation of rehabilitation effectiveness patients with low back pain. OBJECTIVE: The purpose of the study was to determine the intra- and inter-session reliability of the measurement of the activity of the lumbar erector spinae (LES) activity (extension-flexion ratio). METHODS: The study included 21 asymptomatic subjects, aged 14 to 27 years, mean 23.7 ± 2.9. The LES muscle activity was assessed with using of the sEMG during forward trunk flexion and extension by two examiners. Based on the quotient of the LES muscle activity obtained during four concentric and eccentric tasks the extension-flexion ratio was calculated. RESULTS: The measurements displayed excellent or fair-to-good reliability (intraclass correlation coefficient ranged from 0.90 to 0.68). The typical error and coefficient of variations, ranged from 0.34 to 0.58, and from 13.7 to 21.9, respectively. CONCLUSIONS: The measurement of the extension-flexion ratio performed with the use of sEMG shows high level of intra- and inter-session reliability, suggesting that this parameter is a reliable tool in evaluation of the lumbar paraspinal muscles activity. However, the level of typical error should be taken into account.

Active self-correction of back posture in children instructed with 'straighten your back' command.

The ability to adopt the properly corrected body posture is one of the factors determining the effectiveness of therapeutic programmes. This study determined the active self-correction expressed by the change of sagittal spinal curvatures (in standing and sitting positions) in 249 children (136 females, 113 males, aged 10-14 years) instructed with 'straighten your back' command (SYB). Spinal curvatures (sacral slope-SS, lumbar lordosis-LL, global, lower and upper thoracic kyphosis-TK, LK, UK, respectively) were assessed using Saunders inclinometer. The assessment was done in spontaneous standing and sitting positions and in the positions adopted after the SYB. In a standing position SYB led to the significant (P < 0.001) increase in SS, and the significant (P < 0.01) decrease in LL, TK, LK, UK. In a sitting position SYB led to significant changes (P < 0.001) from kyphotic to lordotic position of SS and LL and to the significant (P < 0.001) reduction of TK (36.5° ± 10.8 vs. 23.5° ± 11) and the flattening of LK (15.2° ± 8.7 vs. 1.0° ± 8.4). There were gender-based discrepancy regarding active self-correction only for LL in a standing and UK in a sitting position. Females demonstrated a significant decrease in LL (P < 0.001). UK significantly increased only in males (P < 0.001). The 'straighten your back' command leads to moving the spine away from mid-range towards end range of motion. Therefore, the command should not be used to elicit the most optimal back posture. Further studies are needed to determine if the active self-correction is different in females and males.

Abdominal muscle EMG-activity during bridge exercises on stable and unstable surfaces.

OBJECTIVES: To assess abdominal muscles (AM) activity during prone, side, and supine bridge on stable and unstable surfaces (BOSU, Swiss Ball). DESIGN: Prospective comparison study. SETTING: Research laboratory. PARTICIPANTS: Thirty-three healthy volunteers from a university population. MAIN OUTCOME MEASURES: Surface electromyography of the rectus abdominis (RA), the external oblique (EO) and the internal oblique with the transversus abdominis (IO-TA). RESULTS: The AM exhibited the highest activity during prone bridge on a Swiss Ball (RA, EO, IO-TA 44.7 ± 19.2, 54.7 ± 22.9, 36.8 ± 18.6 in % of MVC, respectively). The lowest activity was observed during supine bridge on a stable surface and a BOSU (under 5.0). The lowest ratio analyzed on the basis of the relation of EO and IO-TA activity to RA was obtained during prone bridge on the Swiss Ball (1.4 ± 0.7 for EO, 0.9 ± 0.5 for IO-TA). The highest ratio was obtained during prone bridge on stable surface and supine bridges. CONCLUSIONS: The highest level of activity in the abdominal muscles is achieved during prone bridge on a Swiss Ball. However, this exercise provided the lowest activity of the EO and IO-TA in relation to RA. It is essential to conduct further studies verifying the usefulness of using Swiss Ball during core stability training.

The comparison of the effects of three physiotherapy techniques on hamstring flexibility in children: a prospective, randomized, single-blind study.

The aim of the study was to evaluate changes in hamstring flexibility in 120 asymptomatic children who participated in a 6-week program consisting of one physiotherapy session per week and daily home exercises. The recruitment criteria included age (10-13 years), no pain, injury or musculoskeletal disorder throughout the previous year, physical activity limited to school sport. Subjects were randomly assigned to one of the three groups: (1) post-isometric relaxation - PIR (n = 40), (2) static stretch combined with stabilizing exercises - SS (n = 40) and (3) stabilizing exercises - SE (n = 40). Hamstring flexibility was assessed with straight leg raise (SLR), popliteal angle (PA) and finger-to-floor (FTF) tests. The examinations were conducted by blinded observers twice, prior to the program and a week after the last session with the physiotherapist. Twenty-six children who did not participate in all six exercise sessions with physiotherapists were excluded from the analysis. The results obtained by 94 children were analyzed (PIR, n = 32; SS, n = 31; SE, n = 31). In the PIR and SS groups, a significant (P<0.01) increase in SLR, PA, FTF results was observed. In the SE group, a significant (P<0.001) increase was observed in the SLR but not in the PA and FTF (P>0.05). SLR result in the PIR and SS groups was significantly (P<0.001) higher than in the SE group. As far as PA results are concerned, a significant difference was observed only between the SS and SE groups (P = 0.014). There were no significant (P = 0.15) differences regarding FTF results between the three groups. Post-isometric muscle relaxation and static stretch with stabilizing exercises led to a similar increase in hamstring flexibility and trunk forward bend in healthy 10-13-year-old children. The exercises limited to straightening gluteus maximus improved the SLR result, but did not change the PA and FTF results.

The influence of self-stretching based on postisometrical relaxation, static stretching combined with stabilizing exercises, and stabilizing exercises only on the flexibility of one-joint and two-joint hip flexors.

BACKGROUND AND OBJECTIVE. The limitations of muscle flexibility are a common dysfunction of the musculoskeletal system. Therefore, various therapeutic techniques are used in rehabilitation programs to increase their flexibility. The aim of this prospective, randomized, single-blind study was to evaluate the changes in the flexibility of hip flexors in children who participated in a 6-week therapeutic program consisting of one physiotherapy session per week with a physiotherapist and daily home exercises. MATERIAL AND METHODS. A total of 94 children aged 10-13 years were randomly assigned to 3 experimental groups: postisometrical relaxation group (PIR group), static stretching combined with stabilizing exercise group (SE/SS group), and stabilizing exercise group (SS group). To assess the flexibility of one- and two-joint hip flexors, the modified Thomas test was used. The examination was conducted by blinded observers. RESULTS. A significant improvement in the flexibility of one-joint hip flexors was documented in all 3 groups (P<0.01). The flexibility of two-joint hip flexors increased significantly only in the SS/SE group (P<0.05). After the program, the highest range of motion of the hip extension (test for one-joint hip flexors) was recorded in the SS/SE group (20.6° ± 4.5°), and it was significantly greater than in the SE group (16.6° ± 4.0°, P<0.05). There were no significant differences in the knee flexion (test for two-joint hip flexors) among all 3 groups (P>0.05). CONCLUSIONS. The 6-week therapeutic program regardless of the technique applied (postisometrical muscle relaxation, static stretching with stabilizing exercises, and stabilizing exercises only) resulted in the increased flexibility of one-joint hip flexors. Only static stretching combined with stabilizing exercises led to a significant increase in the flexibility of two-joint hip flexors.

The influence of generalized joint hypermobility on the sagittal profile of the spine in children aged 10-13 years.

BACKGROUND: Children commonly attend exercise programs to correct abnormal sagittal curvatures of the spine. The presence of generalized joint hypermobility (JH) is often disregarded during exercise planning. The aim of the study was to assess the influence of JH on the sagittal curvatures of the spine. MATERIAL AND METHODS: The JH group included 38 girls and 37 boys aged 10-13 years with known JH (Beighton test cut-off ≥ 5 points for girls, and ≥ 4 for boys). A control group included 197 girls and 150 boys. The children were matched for age, height, weight and BMI. The sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), distal thoracic kyphosis (DK), and proximal thoracic kyphosis (PK) were assessed with a Saunders inclinometer. The results in children with and without JH were compared. RESULTS: There were no significant (p>0.05) differences between girls with and without JH with respect to SS (22.5° ± 9.9 vs 23.0° ± 8.0), LL (31.0° ± 14.0 vs 33.0° ± 10.0), TK (39.0° ± 10.4 vs 39.6° ± 10.0), DK (8.7° ± 6.9 vs 7.9° ± 7.8) or PK (31.3° ± 7.1 vs 32.3° ± 7.3). The differences among boys were similarly non-significant (p>0.05) (19.0° ± 7.9 vs 19.7° ± 6.6; 30.6° ± 9.0 vs 31.9° ± 8.4; 42.7° ± 8.0 vs 40.6° ± 8.7; 9.7° ± 7.9 vs 8.2° ± 7.8; 33.7° ± 5,0 vs 32.8° ± 7.0, for SS, LL, TK, DK and PK, respectively). CONCLUSIONS: 1. The sagittal profile of the spine did not differ between children with and without JH, which may lead to suboptimal exercise plans. 2. The routine examination of the musculoskeletal system should be extended to include an assessment of JH.

Evaluation of the stress level of children with idiopathic scoliosis in relation to the method of treatment and parameters of the deformity.

Stress level due to existing body deformity as well as to the treatment with a corrective brace is one of factors influencing the quality of life of children with idiopathic scoliosis undergoing non-surgical management. The purpose of the study was to evaluate the stress level among children suffering from idiopathic scoliosis in relation to the method of treatment and the parameters of the deformity. Seventy-three patients with idiopathic scoliosis participated in the study. Fifty-two children were treated by means of physiotherapy, while 21 patients were treated with both Cheneau corrective brace and physiotherapy. To assess the stress level related to the deformity itself and to the method of treatment with corrective brace, the two Bad Sobernheim Stress Questionnaires (BSSQs) were applied, the BSSQ Deformity and the BSSQ Brace, respectively.

Inter-examiner, intra-session and inter-session reliability of gait measurement.

Three-dimensional gait analysis is commonly used in the objective evaluation of children with idiopathic scoliosis. However, interpretation of results requires carefulness because the gait measurements are error prone. Assessing the reliability of gait analysis in each laboratory may be contribute to assess sources and magnitude of errors in gait analysis as well as determine the direction of the training of examiners.

Intra- and interobserver repeatability of the assessment of anteroposterior curvatures of the spine using Saunders digital inclinometer.

INTRODUCTION: According to the requirements of Evidence Based Medicine, every research tool and method should be subjected to reliability evaluation. A variety of inclinometers are used for the assessment of sagittal plane spinal curvatures in clinical practice. The aim of the study was to evaluate the intra- and interobserver repeatability of measurements of the anterior-posterior spinal curvatures taken with Saunders digital inclinometer. MATERIAL AND METHODS: The study involved 30 healthy subjects (5 males, 25 females) aged 20 to 35 years. The anteroposterior curvatures of the spine were measured in all subjects using a Saunders digital inclinometer. In order to evaluate the intraobserver repeatability of measurements, the results obtained by one investigator were compared. To evaluate interobserver repeatability, the results obtained by three investigators were compared. Additionally, the levels of reliability and measurement error were determined. RESULTS: The measurements conducted by one investigator showed good repeatability for sacral slope, lumbar lordosis, and thoracic kyphosis, including the angle of proximal (Th1-Th6) and distal (Th6-Th12) thoracic kyphosis (p>0.05). For measurements taken by three investigators, interobserver repeatability was achieved for thoracic kyphosis (p>0.05). The reliability of the measurements was good (Cronbach's alpha was 0.9> α ≥0.8), and the measurement error was between 2.8°-3.8°. CONCLUSIONS: The assessment of anteroposterior curvatures of the spine by one investigator provided good repeatability and reliability of measurements. Measurements performed by more than one investigator displayed partial repeatability. The value of the observational error should be taken into account in the interpretation of results of measurements performed with the Saunders inclinometer. The assessment of anteroposterior curvatures of the spine should be preceded by a verification of measurement reliability.

Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner.

BACKGROUND: Generalized joint hypermobility (JHM) refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS) often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated.The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described. MATERIALS AND METHODS: This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2), Cobb angle range 10°-53° (mean 24.3 ± 11.7), 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1) selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double), number of vertebrae within the curvature (long versus short curves), treatment type (physiotherapy versus bracing) and age.Statistical analysis was performed with Statistica 8.1 (StatSoft, USA). The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi2 test, Pearson and Spermann correlation rank were conducted. The value p = 0.05 was adopted as the level of significance. RESULTS: JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%), whilst in the control group it was diagnosed in only 19% of cases (p = 0.00015). A significantly higher JHM prevalence was observed in both girls (p = 0.0054) and boys (p = 0.017) with IS in comparison with the corresponding controls. No significant relation was found between JHM prevalence and scoliosis angular value (p = 0.35), apical vertebra rotation (p = 0.86), the number of vertebrae within curvature (p = 0.8), the type of applied treatment (p = 0.55) and the age of subjects (p = 0.79). JHM prevalence was found to be higher in children with single curve scoliosis than in children with double curve scoliosis (p = 0.03). CONCLUSIONS: JHM occurs more frequently in children with IS than in healthy sex and age matched controls. No relation of JHM with radiological parameters, treatment type and age was found. Systematically searched in IS children, JHM should be taken into account when physiotherapy is planned.