The term syndesmotic injury is used to describe a lesion of the ligaments that connect the distal fibula and the tibial notch surrounded on both sides by the anterior and posterior tibial tubercles, with or without an associated injury of the deltoid ligament. It includes four major ligaments: the anterior inferior tibiofibular ligament (AITFL), which limits the fibular external rotation; the interosseous ligament (IOL), which limits the lateral translation of the fibula; the posterior inferior tibiofibular ligament (PITFL), which prevents the posterior fibular translation; and the inferior transverse ligament, which limits posterior talar displacement. Injuries to the tibioperoneal Syndesmosis are more frequent than previously thought and their treatment is essential for the stability of the ankle mortise. Recognition of these lesions is essential to avoid long-term morbidity. Diagnosis often requires complete history, physical examination, weight-bearing radiographs and MRI. Treatment-oriented classification is mandatory. It is recommended that acute stable injuries are treated conservatively and unstable injuries surgically by syndesmotic screw fixation, suture-button dynamic fixation or direct repair of the anterior inferior tibiofibular ligament. Sub acute injuries may require ligamentoplasty and chronic lesions are best treated by syndesmotic fusion. However, knowledge about syndesmotic injuries is still limited as recommendations for surgical treatment are only based on level IV and V evidence.
Recognized expert in the area of Orthopaedics and Trauma Surgery, Chief of reconstructive knee, foot and ankle unit at University Reina Sofia Hospital, La Vega and Virgen de la Caridad private Hospitals in Murcia, Spain. He received his PhD at University of Murcia where he is currently a lecturer. He has authored numerous articles and book chapters in his field and is the Director of Foot and Ankle Surgery Update Conference held annually in Murcia. Also, Editor of Orthopaedics, Traumatology and Sports Medicine International Journal (OTSMIJ), MOJ Orthopaedics and Rheumatology and EC Orthopaedics Journal.
Throughout the life span, significant skeletal adaptations occur during maturation to maturity, within the mature state, and during senescence with males and females different in this regard. The associated microstructural and mechanical changes can be influenced by intrinsic and extrinsic factors, such as exercise, diet, and joint injury. Although exercise can positively benefit bone, skeletal muscle, and joint health, chronic exposure to an obesity-inducing diet and its inflammatory sequelae can result in loss of functional integrity with dysregulated tissue repair and risk for musculoskeletal tissue damage. Systemic inflammation from diet-induced obesity and metabolic syndrome can adversely affect bone density and subchondral trabecular bone mechanics and structure, which can negatively impact articular cartilage. Joint injuries (e.g., loss of the anterior cruciate ligament—ACL of the knee) can have rapid and detrimental effects on the structure and mechanical integrity of periarticular bone, joint cartilage, and other joint tissues, and thus, a joint should be considered a multicomponent organ system. After an ACL injury, finite element analyses have revealed specific changes in periarticular bone modulus, 3D trabecular connectivity, and microarchitecture, as well as loss of quadriceps muscle complex integrity. With development of early post-traumatic osteoarthritis, architectural adaptations predominate over bone tissue modulus changes. Altered muscle-tendon-bone cross-talk can also be produced from dysfunctional mechanical and biological stimuli resulting from compromised muscle integrity and contribute to bone loss. The potent interconnectivities among musculoskeletal tissues underscore the importance of implementing a complex systems approach to detailed understanding of mechanisms of skeletal adaptation in health and disease.
At the University of Michigan (UM) since 2007, Ron Zernicke is a Professor in the Department of Orthopaedic Surgery, with joint appointments as Professor in the School of Kinesiology and Department of Biomedical Engineering. For seven years (through June 2016), he served as Dean of the UM School of Kinesiology, and he is currently Co-Director of the UM Exercise & Sport Science Initiative. As of July 2017, he will also become Director of the Michigan Performance Research Laboratory, and a Fellow of the International, Canadian, and American Societies of Biomechanics, American College of Sports Medicine, and National Academy of Kinesiology. He has published more than 600 research papers and abstracts and 2 books.
Osteoarthritis (OA) is the most common joint disorder in the world. The symptoms of OA are progressive and extended over time. Perhaps the most feared symptom is pain. Another characteristic symptom of OA is the progressive incapacity of joint function that tends, in the long term, to result in a loss of mobility. The worst affected joints at the present time are the knees and hips. People with OA almost double the risk of suffering other severe diseases such as cardiovascular diseases, arterial hypertension, and even anxiety and depression. Although OA is mainly associated to seniors, it is actually affecting a highly fragmented population such as sportspeople, women over 45 and occasionally young people. There are 242 million people with symptomatic OA in the world. With the increase in life expectancy over recent decades, the concept of what it is to be young, adult and old has started to change. OA impact is preoccupating. In Canada, the productivity cost of work loss associated with OA was $17.5 billion (Canadian dollars) in 2008. In the same year, the Spanish Healthcare system spent €4.7 billion to treat OA patients. The Osteoarthritis Foundation International (OAFI) is undertaking educational programmes that offer different approaches and fulfill different needs to our targets (seniors, sports, women and children) to empower them with non-pharmacological and prevention measures.
Medical Doctor (M.D.), Master of Science (M.Sc.) in Clinicial Pharmacology, Philosophy Doctor in Medicine (PhD). 20 years as Director Pharmascience and Regulatory in the Bioibérica pharmaceutical, Member of the Evaluation Committee of the National Center for Scientific Research (CNRS) of the INSERM and the Scientific Council of the Lorena region to evaluate different projects and research units in the field of Rheumatology / pharmacology, Member of the Scientific Council and Directing Council of the Bioiberica Chair / UAM (Autonomous University of Madrid) on Chronic Inflammation and Citoprotection (CABICYC). Co-author in more than 50 publications in international scientific journals.
Osteoarthritis of the knee joint is a condition in which the natural cushioning between joints, bones and cartilage wears away. This situation results in pain, swelling, stiffness and decreased range of the knee motion and ability to walk. This condition can occur even in young people but the chance of developing osteoarthritis rises after the age of 45 years. According to the Arthritis Foundation, more than 27 million people in the U.S. have osteoarthritis, with the knee being one of the most commonly affected areas. Women and obese patients are more likely to have osteoarthritis than men. In patients with severe deformity and advanced stages of osteoarthritis the surgery may be indicated. The standard for treatment of advanced stages of osteoarthritis is total knee arthroplasty (TKA), which give patients relieve pain and increase range of the joint motion. Knee replacement surgery can be performed as a partial or a total knee replacement, however the total knee replacement is most common performed. To improve the results of TKA many different techniques were employed for this procedure. One of those is the use of navigation system during surgery. In the Clinic of Orthopedics and Pediatric Orthopedics Medical University of Lodz, the total knee arthroplasty is routinely performed since 1986. The aims of this study was to compare the results of total knee arthroplasty performed with the use of navigation system and with conventional knee arthroplasty and to evaluate the effectiveness of navigation system to support total knee arthroplasty.
Dr. Munaf A Hatem: Finished his PhD degree from Lodz medical university/ orthopedic department, he had 12 years’ experience in orthopedic and traumatology, his filed of interest, mainly Knee and knee disorder, he work as orthopedic consultant in sultanate of Poland / Hepavita medical center/ Lodz for last 2 years, in Oman he work as orthopedic consultant for Oil and Gas company.
The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. This drastic change has led to new batch of difficult to treat, musculoskeletal Disorders of the Upper Extremities such as Miofascial pain syndrome of neck and upper back and thoracic outlet syndrome. The thoracic outlet anatomy and how the bundle passes through the passageway is complex for even musculoskeletal experts. So for doctors trained in other specialties there can be an inadequate understanding about nature and cause of thoracic outlet syndrome. A syndrome rather than a disease, the Mayo Clinic, Cleveland Clinic and the National Institute of Neurological Disorders And Stroke, plus top 10 ranked hospitals for neurology and neurosurgery agree persistent compression of nerves, arteries and veins traveling through the thoracic outlet is what leads to thoracic outlet syndrome. I will discuss the three models of human movement, the inverted pendulum model, the spring-mass model and the integrated spring-mass model (ISMM). The (ISMM), which integrates the spring suspension systems of the foot and shoulder region as well as the torsion spring of the spine and the mass, the head. I will discuss my clinical findings show compressive disorders like TOS and herniated discs are merely an over control of tension on the human spring mechanism leading to these syndromes. I will give brief review of the symptoms and their patterns, the common orthopedic tests, and diagnostic tests, the 16 different common conservative therapies and the 10 reasons for when surgery is medically necessary. I will discuss an alternative treatment for this disorder based on the integrated spring mass model.
Dr. James Stoxen is the president of Team Doctors, Chicago, Illinois, one of the most recognized treatment centers in the world. Dr. Stoxen is a much sought-after speaker by medical societies around the world. He has organized and/or given over 1000 live presentations on health awareness topics. He has been asked to give scientific presentations at more than 65 medical conferences addressing an estimate of more than 50,000 medical doctors and scientists in China, Japan, UK, Germany, Monaco, Malaysia, Indonesia, Russia, Australia, Thailand, Mexico, Columbia, South Africa, Scotland, India, Ireland, UAE, Portugal, Brazil, Italy, and the United States. In 2015, he was awarded an honorary fellowship, by a member of the royal family, the Sultan of Pahang, at the opening ceremonies of the World Congress of Sports and Exercise Medicine for his distinguished research and contributions to the advancement of Sports and Exercise Medicine on an International level. Dr. Stoxen has treated more than 500 national and world champions at over 60 national and world championships. He has been inducted in the National Fitness Hall of Fame, the Personal Trainers Hall of Fame, and appointed to serve on the prestigious, Global Advisory Board, of The International Sports Hall of Fame. He was a appointed a member of the Muscle and Fitness editorial advisory board by publisher Joe Weider in 1994.
One of best MIS hip approaches is at least theoretically Röttinger’s muscles sparing Watson-Jones anterolateral approach in decubitus lateralis position but in our hands difficulties were present, especially during learning curve, to mobilize the femur without excessive supero-medial capsule and external rotators e.g. piriformis and/or obturator internus release in many cases. External rotators release increases hip laxity and longer arthroplasty necks are usually needed resulting to leg lengthening. In the presented personal new ALMIS hip approach for hip arthroplasty the opposite leg is stabilized at the posterior leg table support and not at the anterior that is removed. Only gluteus minimus insertion tendon accompanied by some not important anterior fibers of gluteus medius is temporary elevated and reinserted to its place at the end of operation. No any serious vessel’s branch is present at this approach so blood loss is very minimal. The operating leg is not placed in extension but in small flexion, adduction and external rotation during femoral preparation without stress on abductors. Opposite leg on its support in slight abduction and extension accompanied by slight anterior inclination of the table during femoral access facilitates even more femoral preparation in difficult cases. Excessive capsule or external rotators release is avoided almost in all cases. This approach can be used in all primary or secondary osteoarthritis even in dysplasia or congenital dislocation cases as also in obese patients. In these last cases, skin incision may easily be extended without e.g. lateral cutaneous nerve of the thigh or deep femoral artery branches limitations presented in anterior MIS approaches. Course in 725 patients operated with this new technique in 282 of them using a short curved antirotation uncemented stem in combination with a new generation biologically fixed threaded cup is spectacular compared to classic Hardinge approach cases using classic implants and more successful than our previously published less invasive and bloodless lateral MIS approach for hip arthroplasty. Mobilization and gait is immediate.
Nikolaos Christodoulou is Chairman of Orthopaedic Surgical Department in Iatriko Psychikou Clinic - Athens Medical Group (Greece). He has studied medicine in the University of Athens having succeeded the Greek National Scholarship IKY. He had courses in internal medicine by ‘Exchange Program of Students’ in Frankfurt University in Germany, the experience of a biostatistics annual program of the University of Athens and a stage in the post of Assisted Researcher in Research Cancer Center ‘G. Papanikolaou’ in Athens. He was specialised in orthopaedic surgery in Asclepeion Orthopaedic Hospital of Hellenic Red Cross. He achieved the Scholarship of ‘College de Medicine des Hôpitaux de Paris (CMHP) in 1981 and worked at the post of ‘Resident des Hôpitaux des Paris’ in the University Hospital A-PARE’ in Paris, France (1981-1982). He has been Consultant Orthopedic Surgeon in Asklepeion Orthopedic Hospital at Athens in1983-1985 and received his PhD from the University of Athens in 1985 concerning the influence of intrinsic factors in the anatomical patern and location of fractures of the proximal femur. He has been also Consultant Orthopedic Surgeon-Orthopedic Department of Korinthos Hospital, Greece (1985-1989), Chief Clinical Director, Orthopedic Department of Karpenissi Hospital, Greece (1989-2009), Chief Clinical Director, Orthopedic Department of ‘White Cross’ Hospital, Athens, Greece (2009-2011) and from 2011 Chairman Clinical Director of Orthopedic Department of Iatriko Psychikou Clinic - Athens Medical Group, Athens. Clinical innovations include achievements of two patents for in field ‘External Fixators’ (CH-N external fixators for sub-trochanteric fractures and tibial osteotomies) entitled CH-N from the initial letters of his name. He has published many clinical and research works accompanied by extensive citation concerning mainly Hip Fractures, Hip arthroplasties, High Hip Center technique in Congenital Hip Dislocation cases, Anterolateral Knee instability, Knee osteotomies, Hip, Knee and Foot External fixation, New MIS hip approaches and the ALMIS personal technique using a different surgical table and legs position during femoral exposure. These works and scientific articles were published in many serious international orthopedic magazines, mainly as first name, in Clinical Orthopaedic and Related Research, JBJS, Acta Orthopedica Scandinavica, Orthopedics, Revue de Chirurgie Orthopédique, C.I.O.D. (Italiano Dell Osteosinthesi Dinamica), Aggiorn Club Ital Osteosint, Journal of Surgical Orthopaedic Advances, European Journal of Orthopaedic Surgery
Introduction: Historically high risk cardiac patients who suffer hip fracture requiring surgery have been treated aggressively with blood transfusions post-operatively to treat their acute blood loss anemia. This practice was thought to lessen complications and enhance recovery. This talk outlines the purpose, results, conclusions and sequelae of the randomized clinical trial called “FOCUS: The Transfusion Trigger Trial (Jeff Carson, PI) performed in the US and Canada between 2005 and 2011 and eventually published in the New England Journal of Medicine. Methods: Over 2000 high risk cardiac patients with hip fracture requiring surgical correction were randomized into one of two groups: 1) A liberal group which was transfused at HGB levels of less than 10 gm/dL (or upon becoming “symptomatic” of anemia) OR 2) a restrictive group which was transfused at HGB levels of less than 8 gm/dL. The primary outcome was the ability of the patient to walk 10 ft “across a room” 3 months after the performance of the surgery. Results: The restrictive group recovered ambulatory capacity faster and had fewer complications across the board. Conclusions: A restrictive approach to blood transfusion in frail high risk patients requiring hip fracture repair surgery (including various types of hip arthroplasty and open reduction and internal fixation) was superior to the more traditional “liberal approach” to transfusion. The standard of care has changed as a result of this RCT and others. The results are generalizable to many similar frail populations.
Dr. William B. Macaulay is a Professor of Clinical Orthopedic Surgery and Associate Chief, Division of Adult Reconstruction, Education & Research NYU Langone Orthopedic Hospital. Twenty-six years ago I decided to specialize in orthopedic surgery and have never second-guessed that decision. As an orthopedic surgeon at NYU Langone, I specialize in primary and revision total hip and knee replacement, as well as partial knee replacement, hip resurfacing surgery, hip fracture repair, and knee arthroscopy. I am excited to bring my expertise to one of the top ranked orthopedic teams in the country, providing compassionate, minimally invasive care and advancing the field with the use of innovative technology. I am a member of The Hip Society, The Knee Society, and the American Association of Hip and Knee Surgeons, at whose 2007 meeting I was awarded the Lawrence D. Dorr Surgical Techniques and Technologies Award. For the last 20 years my research has focused on important advances in hip and knee reconstructive surgery: surgical recovery enhancement and outcomes of hip and knee replacement surgery, including partial knee replacement and hip resurfacing. I am proud to have served as site investigator, principal investigator, and steering committee member of several prominent randomized clinical trials. The most notable of these was the FOCUS trial—the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair—the results of which were published in the New England Journal of Medicine.
With the advent of C-arm, more research works on fracture treatment were emphasized on closed reduction and percutaneous fixation with less invasive mechanical implant without further damage to the injured soft tissues and bone. Here comes the importance of closed reduction and percutaneous pinning. The design of the frame work of the implant is different for different fractures depending on 1. The anatomical shape of the particular region 2. Early mobilization of the adjacent joint. 3. The scaffolding frame work should accommodate the fractured comminuted fragments in the reduced position without any displacement. 4. The impact of the deforming force against the frame work after fixation. 5. There should be at least 2 k-wires in each inter-fragmentsary fixation. 6. There should be maximum crossing of the different K-wires. Fracture distal end radius is one of the most common fractures and it accounts 20% of the total. Aim of My Clinical Research Work on Closed Percutaneous Pinning of Fracture Distal End Radius was to Achieve 1. An anatomical reduction of the fracture fragments by a new method of closed reduction, even in comminuted and intra-articular fractures. 2. To create a stable mode of percutaneous pinning with K-wires a) which itself is strong enough to hold the fracture fragments against the deforming forces, b) Which allow some amount of painless radio-carpel joint (RCJ) movement from the immediate post op period to engage the patient to some amount of personal work including writing? c) This helps to regain the full range of movement (ROM) within a maximum of 3 months. d) Which helps to regain full grip strength within 6 months and return to the original work as early as possible? e) It should be a patient friendly surgical treatment without protruding any implant outside the skin and early implant removal within 2 months. I had successfully implemented an innovative technique of closed reduction and per-cutaneous fixation by creating 2 triangles in 2 planes in the triangular shaped distal end Radius by using 6 k-wires with the help of a self developed K-wie jig. The new mode of closed reduction and percutaneous pinning is a superior, cost effective, patient friendly surgical treatment for all types of fractures of distal end of Radius.
Had his medical graduation and post graduation from Govt. Medical College, Trivandrum- a prestigious institution of India. Started his orthopedic carrier as Orthopedic Surgeon at Semalk Hospital, Ottapalam in the year 1989. Mean while for 7 years from 1993 to 1999 he served for government sector and returned back to Semalk Hospital. He had done more than 5000 orthopedic surgeries of various types concentrating mainly on trauma. He began his clinical research work in 1999 on closed reduction and internal fixation. He had started to implement closed reduction and percutaneous nailing for diaphysial fractures and closed percutaneous pinning for metaphysical fractures of long bones. He designed a jig for percutaneous pinning of distal radius by which the creation of 2 triangles in 2 planes is very easy for the new surgeons. He has membership in various international and national organizations like. Indian Orthopedic Association, Asia Pacific Orthopedic Association, International Society of Orthopedic Surgery and Traumatology, Kerala Orthopaedic Association, Orthopaedic Association of South Indian States. He had presented more than 15 papers in national and international conferences in different parts of the world including SICOT Orthopedic World Congress at Cape Town, Asia Pacific Orthopedic Association Congress at Turkey, Annual Scientific meeting of Singapore Orthopaedic Association, 9th Orthopedics Expo & Surgeons Meeting at Chicago, USA. In the Joint Scientific Meeting of ASSH ( American Society for the Surgery of Hand) & SSHS( Singapore Society for Hand Surgery) 2018 at Singapore his paper was selected as one of the best papers and received their award. His upcoming presentations are International Colloquium on Medical & Clinical Trials” Conference in UAE, European conference on Orthopaedics at Netherlands and 100th British Orthopaedic Association Annual congress at Birmingham.
It is well known that approximately 25% of patients with RA have multiple joint replacement surgeries despite controlling the disease activity by biologic DMARD and new-generation, more aggressive therapeutic strategies.(1) We have to acknowledge that little is known about the predictors of the prevalence of joint arthroplasty over the course of the disease. So far some studies have verified the potential group of risk category and paid attention to female RA patient, younger age, seropositive for RF who would undergo and benefit from the multiple joint replacements in RA. The purpose of the study is to analyze the contributing factors of joint replacement surgery in a cohort of rheumatoid arthritis (RA) patients and evaluate them regarding to the age when RA was diagnosed and the age when complaints started, as well as seropositivity (Anti CCP, RF), erosive joint disease, synovitis in small joints, BMI, comorbidities (primary arterial hypertension, diabetes mellitus, stroke), and smoking history. Material and Methods. A case-control prospective study was conducted with one hundred fifteen RA patients, female 80.9%, aged from 21 to 84 years. Thirteen of them had joint replacement surgery after RA was diagnosed and were considered as a case group. The case and control groups were matched in age, gender and disease duration. Disease activity was measured by the Das28 score and the CDAI score. Disease severity was assessed using X-ray proved erosions in the small hand and feet joints; musculoskeletal sonography was performed for the synovial joints. The additional information obtained was seropositivity (AntiCCp/RF), smoking history (years), BMI (body mass index), diabetes mellitus, stroke, primary arterial hypertension, and joint replacement surgery. A P value of less than 0.05 was used as the threshold for statistical significance. Statistical analysis was performed by using IBM SPSS 21.0. Results. The patients with joint replacement surgery were mostly females (84.6%), with an average age of 59.23 (±13.0) years. The patients had a median (interquartile range) of the age when RA was diagnosed of 54 (48.0-69.5) years, but the median of the disease duration was 4 (1.5-10.0) years. The case and control group did not statistically differ by age (p=0.842), gender (p=0.715), disease duration (p=0.387), age when RA was diagnosed (p=0.589) and onset of the complaints (p=0.902). BMI was 28.06 (24.89-31.23) as calculated for the patients of the case group (p=0.247). Amongst all joint replacement (total joint arthroplasty (TJA))surgeries on the hip joints 38.5 % were the unilateral hip joint replacements, 30.8 % were bilateral hip joint replacements; amongst knee joint replacement surgeries (total knee arthroplasty) 15.4 % were unilateral and 23.1% bilateral knee joint replacements, only 7,7% were unilateral surgeries of the small hand joint. Disease activity evaluated by the Das 28 (CRP) score for the case group was 4.10 (3.6-5.4) but assessed by the CDAI -23(15.2-36.2). Disease activity in the case group did not differ from the control group, respectively the Das 28 score (p=0.367), the CDAI score (p=0.121). Seropositivity (RF and Anti CCP) was found in 76.9% patients with joint replacement therapy, however, it did not differ between the case and the control group, respectively for RF (p=0.198), for Anti CCP (p=0.848). Joint erosive disease was found in 100% of the case group patients statistically differing from the Pearson Chi-Square of the control group (p<0.001). Synovitis was found equally in both groups (p=1.00) affecting 100% of the case group patients. Amongst all case group patients 69.2% were suffering from primary arterial hypertension (p=0.764), 15.4% had experienced stroke (p=0.611), but 7.7% had such comorbidity as diabetes mellitus (p=0.457). Smoking was detected in 30.8% of cases (p=0.394), long-term smoking history was observed for 27.5(19.75-45.0) years. Conclusion. In our case-control study, joint replacement therapy was associated with joint erosive disease evaluated by X-ray in the small joints of hands and feet. Neither the age when RA was diagnosed nor age when the complaints started, as well as seropositivity(Anti CCP, RF), synovitis in the small joints, comorbidities (primary arterial hypertension, stroke, diabetes mellitus), smoking history, BMI had some association with the joint replacement surgery.
There are many patients to visit rheumatology clinic with the complaint of digital pain due to osteoarthritis of hands including Heber den’s and/or Bouchard's nodes. But it's true that rheumatoid picture can be superimposed on them. Objective: To evaluate Iguratimod’s action on digital pain relief in the patients with hand osteoarthritis (hand OA). Method: To examine visual analogue scale of the pain (pain VAS) (mm) in the fifteen patients with simple hand OA as a final diagnosis, but who were treated under a diagnosis of possible rheumatoid arthritis. Result: In thirteen out of fifteen patients (86%), pain VAS was decreased after administration of Iguratimod. After 4 weeks<=, <8 weeks, amelioration of pain VAS was seen significantly (-25.5; p<0.01), which is almost as same as that of loxoprofen Na on osteoarthritis shown in the phase Ⅲ trial of celecoxib. Thereafter, amelioration of pain VAS was -25.7(p<0.02) at 8 weeks<=, <12 weeks, -19.55(p<0.1)at 12 weeks<=,<24 weeks, -34.4(p<0.01)at 24 weeks<=,<52 weeks and -31.8(p<0.05)at 52 weeks<= after administration of Iguratimod respectively. Conclusion: Iguratimod is thought to have a remarkable action of pain relief in the patients with hand OA.
The middle school years are called the second growth period. Protein anabolism is promoted in this period in boys in particular, body fat increases are inhibited, and changes in body composition appear. If this mechanism is impaired, qualitative changes in morphology may occur from accelerated increase in body fat or excessive burning of body fat. Tanaka, Fujii et al. (2008) created a regression evaluation chart to determine level of accumulation in body fat percentage with respect to BMI for Japanese middle school boys, and determined differences in morphological quality. Tanaka, Fujii et al. (2009) also investigated physical strength in Korean middle school students with differences in morphological quality, and showed that even in groups with the same BMI physical strength decreased as fat accumulation increased. However, there are no reported investigations of physical strength characteristics depending on differences in level of fat accumulation by body fatness type among individuals. In the present study, therefore, in addition to categorizing body types based on determination of body fatness by BMI, we also determined level of fat accumulation, and investigated physical strength in 9 different body type classifications based on differences in morphological quality.The subjects were 201 first-year junior high school boys, in whom physique,body composition and physical strength were measured. Morphological quality was judged from two directions, a BMI evaluation of obesity or leanness and an evaluation of level of fat accumulation derived from regression polynomials of body fat percentage against BMI. Then, differences in physical fitness in the 9 groups classified according to BMI and level of fat accumulation were examined.
Nozomi Tanaka has completed her PhD from Graduate School of Business Administration and Computer Science, Aichi Institute of Technology, (Japan) in 2015. She is the lecture of Department of Sport and Health Science at Tokai Gakuen University. She has published more than 15 papers in reputed journals
In this study the theory proposed by Scammon was first re-examined to investigate the standardization of the human growth system, and a new growth curve model was constructed for the standard human growth pattern. That growth model pattern is proposed as the Fuijimmon growth model for sport medicine. As data showing the four attributes classified from the growth curves of Scammon, the data used were cross-sectional growth data from age 1 year to 20 years for brain weight (as the neural type), thymus gland and tonsils (as the neural type), testicles (as the genital type), and liver and heart (as the general type) shown by Takaishi et al.(1987). The Wavelet Interpolation Model (WIM) is a method to examine growth distance values. A growth curve is produced by data-data interpolation with a wavelet function and deriving the growth velocity curve obtained by differentiating the described distance curve to approximately describe the true growth curve from given growth data. The effectiveness of the WIM lies in its extremely high approximate accuracy in sensitively reading local events. They have already been set forth in prior studies by Fujii (1999). As the results, that the velocity curves in general type visceral growth and genital type testicular growth can be shown to be very similar is something that seems to have been demonstrated for the first time by Fujii (2015). This proposal for the Fujimmon growth curves as a standardization of the human growth model may make it possible to verify the changes in human proportions formed from three patterns, a neural type, lymphoid type, and general type, from the relative changes in the growth of the head, which is representative of the neural type, and the growth in height, which is representative of the general type. And Fujimmon growth model is newly proposed for sport medicine and science field.
Katsunori Fujii has completed his PhD at the age of 52 years from Kanazawa University and graduated at age of 22 years from Tokyo University of Education. He is professor of Aichi Institute of Technology. He has published about more than 100 papers in reputed journals and has been serving as an editorial board member of repute.
The distal radius fracture is one of the most common injuries for both the hand surgeon and the general orthopedic surgeon. Traditionally, closed reduction and cast immobilization treatment is used for stable and undisplaced fractures, specially for the low demand patient. When dealing with unstable or irreducible fractures, as well as with the ones that lose their reduction during its follow-up, one must consider the surgical treatment. There are numerous surgical procedures that can be used for this treatment and the volar locking plates can provide a more rigid mechanical construct, allowing an earlier mobilization and an improved outcome. The functional outcome of distal radius fractures can be affected by many factors, such as extra-articular alignment, anatomic reduction, cartilage and ligamentous and other soft-tissues injuries. Wrist arthroscopy is recognized as an important adjunctive procedure, providing a more accurate anatomic articular reduction and assessment of the commonly associated soft tissues injuries.
Dr. Marcelo P. T. Alves is a Board Certified Orthopaedic and Hand Surgeon and has completed his MSc from Universidade Federal Fluminense, Brazil, and is a member of the Portuguese Hand Surgery Society, European Wrist Arthroscopy Society and the International Society for Sport Traumatology of the Hand. He is a Consultant Orthopaedic Hand Surgeon of Affidea Évora. He has published many papers in both brazilian and portuguese reputed orthopaedic surgery journals.
To demonstrate that genistein (GEN) inhibits vascular endothelial growth factor (VEGF) expression and angiogenesis induced by the inflammatory environment of rheumatoid arthritis via IL-6/JAK2/STAT3/VEGF signaling pathway in MH7A and EAhy926 cell. MH7A cells were treated with tumor necrosis factor-α (TNF-α) and GEN at different concentrations. Interleukin-6 (IL-6) and VEGF protein level in the conditioned medium was measured by enzyme-linked immunosorbent assay and the expression of IL-6 and VEGF mRNA was evaluated by reverse transcription polymerase chain reaction (RT-PCR). Then, MH7A and Eahy926 cells were treated with IL-6 (50ng/ml) and GEN at different concentrations to verify whether GEN can inhibits VEGF expression via JAK2/STAT3 signaling pathway. Nuclear translocation of signal transducer and activator of transcription 3 (Stat3) was determined by immunofluorescence technique. IL-6 induced endothelial cell migration was measured with wound healing assay and transwell. In vitro angiogenesis was determined with endothelial cell tube formation assay in matrigel. Results shown that, after stimulated with TNF-α or IL-6, the expression and secretion of VEGF was apparently up-regulated. GEN treatment suppressed VEGF mRNA expression and protein secretion in a dose-dependent manner. What’s more, GEN dose-dependently inhibited the nucleus translocation of Stat3 induced by IL-6, it also inhibit IL-6 induced vascular endothelial cell migration and tube formation in vitro. To sum up, genistein inhibits IL-6-induced VEGF expression and angiogenesis via suppressing the nucleus translocation of Stat3 in rheumatoid arthritis, which has provided a novel insight into the anti-angiogenic activity of genistein in rheumatoid arthritis.
Dr. Zhang Peng has completed his PhD from Shanghai Jiao Tong University School of Medicine, China and postdoctoral research from Zhejiang University, China. He is the Scientific director & Professor of Shenzhen Institutes of Advanced Technology Chinese Academy of Science. He has published more than 28 papers in reputed journals and has been serving as an editorial board member of repute.
In an athlete group (male: 45, female: 50) and a control group (male: 85, female: 85), the Wavelet Interpolation Method (WIM) was applied to the longitudinal records of individuals’ heights and weights from 6 to 17 years of age (1983 to 1994). The criterion of maturity was derived from age at Maximum Peak Velocity (MPV) of height in the control group. Ages at MPV of height and weight were compared between the athletes and control subjects. The WIM was also applied to mean heights from 6.5 to 17.5 years of all the subjects classified by maturation rate in order to derive a model of growth velocity types. Among the athletes, the males were early-maturing, and the females tended to be late-maturing. The difference between the ages at MPV of height and weight in males and females was less in the athletes than in the control group. For the growth velocity model, in the athlete group, three types could be confirmed among the males, and five among the females. By making use of the type models, it was possible to clarify the spans of adolescence as classified by maturation rates, and it was concluded that the period following the age at MPV seems appropriate for the introduction of regular athletic training for each level of maturity.
Yusaku Ogura has completed his Master of Education from Gifu University at age of 24. He is at graduate school of business administration and computer science, Aichi Institute of technology.
Objectives: The aim of the present investigation was to evaluate if home-based training or guided exercises with or without joint-mobilizations were superior to a control who did not receive any treatment in patients with Subacromial pain, SAPS. Methods: Two double-blinded randomized controlled trials in Swedish primary care setting built on the same methodology to make comparisons of the results possible. A total of one-hundred and seventy patients aged between 20-59 years were recruited from 7 health centers in Stockholm during 2010 to 2016. In each of the studies the patients were randomized into three groups. All patients who fulfilled the inclusion criteria and gave informed consent underwent ultrasonic sound and x-rays on the symptomatic shoulder. Primary outcome was a modified Constant-Murley score. Secondary outcomes were pain and range of motion. Results: In study 1 significant differences in changes of the Constant-Murley score in favour to the two intervention groups were found after six, 12 weeks and 6 months. No significant differences between the two intervention groups according to the Constant-Murley score were found but the add-on mobilization group reached significant decreased pain in flexion after 6 weeks, p= 0.042 and a tendency to decreased pain in abduction after 6 weeks, p = 0.069 and 3 months, p = 0.062 compared to the guided exercise group. No significant differences in range of motion between groups were found. In study 2 on homebased training with or without mobilizations a significance in change of the score was found after 3 months in favour to the two intervention groups. Conclusions: 12-weeks of guided exercises, targeting the rotator cuff and scapular control can be effective in decreasing pain and increasing function in patients with Subacromial pain. The change in the Constant-Murley score are of clinical importance according to former studies. Add-on treatment with joint-mobilizations may be helpful to reduce pain. Our results in study 2 strengthen the proofs that home training is better than no treatment for this condition.
Biography: Anna Eliason is a Physiotherapist, Specialist in Orthopaedic Manual Medicine with an interest to work clinically. She is a PhD student at Stockholm Sports Trauma Research centre, Department of Molecular Medicine and Surgery, Karolinska Institute.
The sacroiliac joint (SIJ) is structured by articular surfaces between the sacral and the iliac bones. The SIJ embraces different functions, because it connects the spine with pelvis, which permits the soaking up of vertical forces form spine and thus, transferring vertical forces to the pelvis and lower extremities. The first goal of the SIJ is to preserve stability that is partly done by the muscles surrounding the SIJ, and realized by various procedures, encompassing a large complex of ligaments connected to the SIJ. The range of motion of the SIJ is evaluated to be around 2 to 4 degrees. The 35 muscles connected to the sacrum bone or innominate, work together in synergy with the fascia and ligaments to produce movement and ensure stability of the trunk and lower extremities. The SIJ is an important source of pelvic and low back pain (LBP), which should be taken into consideration in the differential diagnosis of pelvic and LBP. The prevalence of SIJ pain tends to be underappreciated because no research has been done concerning the SIJ posterior ligaments. In the United States and the rest of the world, there is an increased prevalence of LBP and its associated costs. In Europe, the augmentation of LBP cases in an adult population is due to sedentary activities such as working with a computer. Marcucci, Alexander and Matthew found in a pilot study including 20 patients, after applying two different osteopathic release techniques on the posterior SIJ ligaments a reduction of the pain in 18 patients, from which 12 patients had no pain anymore, and 6 patients had only a reduction of the intensity of pain. Only in two cases, the applied techniques did not produce any effect. There is a need to investigate the potential function of SIJ posterior ligaments in LBP.
Sergio Marcucci has completed his DHSc from A. T. Still University, College of Graduate Health Studies, Mesa, USA. He received his MSc from A. T. Still University of Kirksville USA, and his D.O. from Sutherland College of Osteopathic Medicine, Belgium. He had 9 oral presentations and one poster presentation. He has published 2 papers in reputed journals and has been serving as a reviewer board member of three repute journals.
It is seen in the annual changes in physical growth that children worldwide are growing larger and reaching puberty earlier. With conventional analysis methods, however, growth distance curves are analyzed in nearly all cases, and velocity curves are analyzed based on the difference in the amount of annual growth. This method may show that young people are becoming larger, but there is no guarantee that it objectively demonstrates early maturation. The present study applied the wavelet interpolation method and specified the age of maximum peak velocity (MPV) in growth during puberty from the described height growth velocity curve. Then, from an investigation of age at MPV of height, generational shifts in early maturation were verified. Moreover, the relationship between annual trends in gross domestic product (GDP) and age at MPV of height is analyzed from cross correlation function, and the relational composition between Japan’s high economic growth and the early maturation phenomenon in physical growth is examined. From the results of this study, a strong negative correlation was seen when a cross-correlation function was applied to the secular trends in GDP and the MPV age of the height in males and females. Therefore, the relationship between high economic growth and the physical maturation was indicated to be very strong. This means that when GDP increases, age at MPV of height tended toward early maturation.
Yuki Kani has completed his Master of Education from Aichi Institute of Technology at the age of 35 years. He is in a doctoral course of Aichi Institute of Technology . He is assistant professor of Tokai Gakuin College. He is publishing papers on physical development of an infant and children.
Mindfullness meditation is a structured group program that appears to be promising adjunct to medical treatments in patients with RA. Mindfullness meditation teaches participants to notice and relate differently to thoughts and emotions, with a sense of compassion for self and others underlying the endeavor. Rheumatoid arthritis (RA) is accompanied by increased risk of various forms of psychological distress. Increasingly, patients with RA are turning to complementary and alternative therapies, among which meditation may hold promise in addressing the emotional strain of RA. The aim of this abstract is to provide insight into the effects of minfullness meditation on pain severity, depressive symptoms, disease activity, psychological distress, well‐being, and mindfulness in patients with RA. Up to date, there have been two randomized clinical trials examining the effects of mindfullness meditation in patients with RA. In the first study, participants were attended an 8‐week course and 4‐month maintenance program. Self‐report questionnaires were used to evaluate depressive symptoms, psychological distress, well‐being, and mindfulness. At 6 months, there was significant improvement in psychological distress, well‐being, depressive symptoms, mindfulness and a 35% reduction in psychological distress. As for second study, participants were randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E). Participants receiving P showed the greatest pre to post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians’ ratings of joint tenderness. Overall, participation in an mindfullness meditation program is likely to result in copping better with symptoms, improved well-being, and enhanced health outcomes. As an adjunct to standard care, mindfullness meditation has a potential for much wider application in clinical settings for patients with RA.
Zehra Gok Metin has completed her PhD from Hacettepe University Faculty of Nursing, Turkey and postdoctoral studies from University of Alabama, USA. She is currently working an assistant professor in Medical Nursing Department at Faculty of Nursing of Hacettepe University. She has conducted several high quality clinical trials, has published more than 20 papers in reputed journals, and has been serving as an editorial board member of reputed journals.
Osteoarthritis (OA) is a common form of arthritis affecting hands, knees, hips and spine or any joint in the body. Patients with OA state a range of physical impairments including joint stiffness, muscle weakness, reduced balance, pain, gait abnormalities, and difficulty in performing activities of daily living. Additionally, OA is a long-term condition with physical and psychological impacts on patients’ movement and function. Maintaining a healthy weight, using analgesics and oral nonsteroidal anti-inflammatory agents, and staying active may slow progression of the disease and help improve the pain and joint function. However, patients with OA still suffer from OA-related symptoms. As a novel holistic approach, awareness through movement (ATM) is a form of physical therapy that focuses on awareness of internal body sensations. The aim of this abstract is to review the effect of ATM on pain management in patients with OA. ATM techniques can be used by patients with OA mainly include meditation, yoga, tai chi, qi-gong, and etc. These ATM techniques were reported to be effective mild-moderately on pain, joint stiffness, physical functioning, quality of life and activities of daily living without adverse effects. ATM consists of simple exercises such as lying, standing or walking, with an emphasis on each moment of a small movement during several repetitions. Relevant studies stated that patients showed an increase in perceived well-being and a positive relationship with welfare. Additionally, patient adherence to exercise is better than current exercise programs. Key mechanisms of action of ATM for OA related pain include decreased catastrophizing, increased self-efficacy for managing pain and increase pain acceptance. Moreover, potentially shedding light on underlying mechanisms, the intervention reduced inflammatory signaling. As a conclusion; in this incurable disease condition, more attention should be paid to complementary approaches, especially ATM techniques which improves quality of life and palliate OA related symptoms.
Canan Karadas has completed the master degree at Hacettepe University Faculty of Nursing, Turkey and started to PhD. She is currently working as a research assistant in Medical Nursing Department at Faculty of Nursing of Hacettepe University. Her fields of interest are mobility, geriatrics and complementary and alternative therapies.
Aim of the work To assess the health related quality of life in a group of children with rheumatic diseases and to detect its relation to disease activity and functional disability. Materials and methods: 51 patients were divided into three groups according the nature their disease with the age of onset before 16 years old. Group 1 includes 27 patients diagnosed as juvenile idiopathic arthritis. Group 2 includes 15 patients diagnosed as juvenile onset systemic lupus erythematosus. Group 3 includes 9 patients; 3 diagnosed as Juvenile Dermatomyositis, 3 diagnosed as Familial Meditirian Fever and 3 female’s patients diagnosed as Juvenile Scleroderma. Childhood Health Assessment Questionnaire, Pediatric Quality of Life generic core scale version 4.0, Visual analogue scale for pain and Visual analogue scale for global assessment were recorded. The activity index was assessed in each patient according to the nature of the disease Results: In JIA patients, the mean PedsQL score was 73.6, mean CHAQ score was 0.7, mean DAS28 was 3.5, with a significant negative correlation between PedsQL and CHAQ (p=0.48), VAS pain (p=0.001), and DAS28 activity index (p=0.017). In SLE patients, the mean PedsQL was 66, mean CHAQ score was 0.7 and, mean SLEDAI-2K was 24.2 with no significant correlation between functional disability and SLEDAI-2K (p=0.539). PedsQL showed significant negative correlation with SLEDAI-2k (p=0.001) and positive correlation between CHAQ (p=0.022). Conclusion: Health related quality of life in patients with juvenile rheumatic diseases is correlated with disease activity and functional disability and should be assessed in regular basis.
It has been suggested that menarche occurs late in female athletes as delayed menarche. Warnings about delayed menarche in female athletes have been expressed by Malina(1983) and Malina et al(1978). Moreover, it is thought that body fat percentage decreases from the effects of regular sports training around the time of menarche in female athletes, and that delayed menarche and amenorrhea occur when girls to not reach a body fat percentage of about 17–20%. Female athletes tend to be late maturing, something that has also been stated by Malina, but to date delayed menarche has not been clearly demonstrated(1994).Of course, delayed menarche does not occur in all female athletes, but it is closely associated with amenorrhea, menstrual irregularity, and dysmenorrhea, and strongly affects later menstrual status. In this study we constructed a system to evaluate delayed menarche in female athletes and investigated delayed menarche in female athletes. It was developed as a regression method to estimate age at menarche from age at pubertal peak velocity (MPV) in height, specified using a wavelet interpolation method. Female university students in the Tokai region of Japan, all of whom had participated in national sport competitions at the high school level (athletes group), were chosen as subjects. Longitudinal height and weight records of the subjects for the period from the first grade of elementary school to the final year of senior high school were used. First-year female university students and third-year female high school students in the Tokai region who had undergone almost no athletic training before and after the age of menarche were chosen for the control group of non-athletes. Longitudinal height and weight records were obtained for the years from the first grade of elementary to the third year of senior high school , following a procedure similar to that for the ball game players. The age at menarche also was confirmed according to a procedure similar to that for the ball game players. From the delayed menarche evaluation chart, Compared with general girls, many female athletes were determined to have delayed menarche.
Kohsuke Kasuya The Graduate of Business Administration Section of Department of Business Administration at Aichi Institute of Technology. On the register of Aichi Institute of Technology graduate school management information department of scientific research.
Background: It is commonly believed that many patients with Bell’s palsy have acceptable motor recovery spontaneously. Despite of this belief, many research studies reported that around one third of patients show residual persistent symptoms. Many studies evaluated effects of adding electrical stimulation to the prescribed medications on facial motor recovery. However, there is a lack of agreement among clinicians on beneficial effects of electrical stimulation on facial motor recovery. Therefore, the aim of the current review is to evaluate the effect of electrical stimulation on facial motor recovery documented in the literature. Methods: We searched clinical trials on Bell’s palsy in the PubMed, Google Scholar and Cochrane search engines. The keywords include; Bell’s palsy and electrical stimulation. A total number of 26 articles were selected at the first step. In the next stage, 13 articles were excluded due to one or more of the following reasons: not written in English, surgical treatments were included, reporting a case. In the final stage, 13 articles were evaluated. Results: Many articles did not meet the quality needed for a clinical trial. Therefore, despite the fact that most of them showed significant improvement in the motor recovery the conclusion should be made by cautious. Conclusion: Electrical stimulation has beneficial effects on facial motor recovery when used in the first 3 weeks of the onset. However its superiority on other treatments is not well evaluated. Future qualified clinical trials are needed to confirm whether there is any superiority for electrical stimulation compared to other treatments.
Manizheh Saberi has received her Bachelor degree in Physiotherapy from Shiraz University of Medical Sciences, Shiraz, Iran. She is now studying Doctor of Physiotherapy in National University of Medical Sciences, Madrid, Spain. She is the director of Marvdasht Physiotherapy clinic. She has several years of experiences on rehabilitating patients.
Background: Low back pain (LBP) is a major health problem commonly seen by the clinicians. 60 to 90% of lifetime prevalence has been reported in general population. LBP is the major cause of disability in people younger than 45 year of the age. There is no information about physiotherapy practice toward the low back pain. Whether the Physiotherapist practicing in India is using the recommend guidelines for interventions for LBP is yet to explore. Objective: To explore the contesnts of Physiotherapy interventions for management of low back pain among physiotherapists in India. To compare the contents with the intervention supported by current available highly quality evidence. Methods: In this cross sectional study, 200 physiotherapists practicing in different sectors of Gujarat were screened for eligibility criteria. 187 physiotherapists were recruited as they fulfilled selection criteria. A Physiotherapy Intervention Recording form (PIRF) which content patient details, physiotherapist details and recommended interventions for low back pain was developed and pilot tested. Using PIRF, the physiotherapists were observed while treating different low back pain patients for single sessions. The demographic details of participants and physiotherapist were recorded and the duration of used interventions were also recorded in physiotherapy intervention recording form (PHRF). Descriptive analysis was done to analyses the data. Results: The content of the physiotherapy treatment for low back pain were not uniform. Only 19.8 % physiotherapist used recommended guidelines for the treatment of low back pain. Conclusion: The current survey found that the contents of physiotherapists’ treatment for low back pain where lack of consensus and not according to the recommended guidelines. A very few physiotherapists in India used recommended guideline for the low back pain management.