The proprioceptive neuromuscular facilitation-concept; the state of the evidence,a narrative review

Introduction: The proprioceptive neuromuscular facilitation-concept (PNF-concept) is a widely used rehabilitation concept, and is in many countries part of the undergraduate curriculum of physiotherapy education. It is also offered in postgraduate training worldwide. The modern physiotherapist is confronted with the application of evidence-based practice; therefore, the aim of this review is to summarize the available evidence for this rehabilitation concept.

Method: A search was completed using Pubmed, ScienceDirect, PEDro, Cochrane library and the International PNF Association website. An evidence-based practice approach has been promoted in the field of physiotherapy since the early 1990s, hence we limited the search from 1990 until 2014.

Major findings: Seventy-four sources that were found were categorized in: (A) PNF philosophy, (B) PNF basic principles and procedures, (C) PNF techniques in rehabilitation. In the reviewed publications, a variety of indications and subject populations were identified including: neurological, musculoskeletal, pulmonary, geriatric and mixed disorders. The publications varied in type and quality, ranging from case studies, clinical trials, randomized controlled trials and reviews. This variety of publications, treatment indications and outcome measures in the publications warranted a narrative review

Discussion and conclusion: The scope and diversity of articles in the review make it difficult to study the PNF-concept in a methodical way, since different components of a comprehensive rehabilitation approach may act as confounders when measuring the effects of one specific part of the approach. There is a substantial body of research which supports the use of PNF as a comprehensive rehabilitation concept. The literature also describes that the PNF-concept is applied in clinical practice in a variety of populations and indications; however, efficacy for specific indications and populations requires further investigation.     

ST-elevation myocardial infarction caused by very late stent thrombosis

The case of a 46 year-old man suffering from diabetes mellitus and dyslipidaemia hospitalised with acute coronary syndrome with ST-segment elevation caused by very late in-stent thrombosis is presented.     

Catecholaminergic ventricular tachycardia initially diagnosed as right ventricular outflow tract arrhythmia. Differential diagnosis of CPVT, LQTS and RVOT arrhythmia

We described a case of 33 year-old woman with catecholaminergic polymorphic ventricular tachycardia (VT) with first presentation as syncope in age of 14. In subsequent ECGs premature ventricular contractions (PVC) with morphology of left bundle branch block-like pattern with positive R wave in leads: II, III and aVF what suggested PVC arising from right ventricular outflow tract were observed. Nonsustained VT was observed. No ventricular arrhythmias were induced during EPS. The 2 unsuccessful sessions of ablation were performed in the right ventricular outflow area. The exercise test provoked bidirectional VT. The adrenaline infusion provoked bidirectional nonsustained VT and the U wave amplitude augmentation. Betablocker was initiated (bisoprolol). The patient is free of symptoms, only single PVC is observed.     

Dual-acting diether derivatives of piperidine and homopiperidine with histamine H(3) receptor antagonistic and anticholinesterase activity

The study presents novel biological properties of diether derivatives of homo‐ or substituted piperidine ligands of the histamine H₃ receptor. The compounds were evaluated for their inhibitory potency against acetylcholinesterase (AChE) from the electric eel and butyrylcholinesterase (BuChE) from horse serum. The most interesting multifunctional compound 13 displayed high affinity for the cloned hH₃R (K_i = 3.48 nM) and moderate inhibitory potency against both enzymes (IC₅₀ AChE = 7.91 µM and BuChE = 4.97 µM). Molecular modeling studies revealed interactions with key amino acid residues in the homology model of histamine H₃ receptor ligands, as well as the binding model for AChE and BuChE in the catalytic and peripheral active sites.     

Comparison between clinical significance of serum proinflammatory proteins (IL-6 and CRP) and classic tumor markers (CEA and CA 19-9) in gastric cancer

Gastric cancer (GC) is a second most common cause of cancer-related death and represents an inflammation-driven malignancy. It has been suggested that interleukin 6 (IL-6) and C-reactive protein (CRP) play a potential role in the growth and progression of GC. The aim of the present study was to compare clinical significance of IL-6 and CRP with classic tumor markers—carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) in GC patients. The study included 92 patients with GC and 70 healthy subjects. The serum concentrations of IL-6, CEA and CA 19-9 were determined using immunoenzyme assays, whereas CRP using immunoturbidimetric method. We defined the diagnostic criteria and prognostic value for proteins tested. In GC patients, the serum concentrations of all the proteins tested were significantly higher than in healthy subjects. The IL-6, CEA and CA 19-9 levels correlated with nodal metastases, while CRP with tumor stage, gastric wall invasion, presence of nodal and distant metastases. Diagnostic sensitivity of IL-6 was higher (85%) than those of other markers (CRP 66%, CA 19-9 34%, CEA 22%) and increased in combined use with CRP or CEA (88%). The area under ROC curve for IL-6 was larger than those of CRP and classic tumor markers (CEA and CA 19-9). None of the proteins tested was independent prognostic factor for the survival of GC patients. Our findings indicate better usefulness of serum proinflammatory proteins—IL-6 and CRP than classic tumor markers—CEA and CA 19-9 in the diagnosis of GC.     

Lipid and carbohydrate parameters in children with chronic hepatitis C

PurposeHCV chronic infection still presents a very serious epidemiological and clinical problem. Apart from its cytopathic effect on liver parenchyma, its detrimental effect on lipid and carbohydrate metabolism has recently been emphasized. The aim of the study was to assess lipid and carbohydrate parameters in children with chronic HCV-related hepatitis.Material/MethodsThe study comprised 41 children with chronic hepatitis C (CHC) aged between 7 and 18 years, and 30 healthy controls. The anthropometric measurements of the subjects were taken, and, after overnight fasting, serum glucose, insulin, total bilirubin, AST, ALT, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels were investigated. The HOMA IR insulin resistance index was also calculated.ResultsThe values for mean body mass index (BMI), glucose, insulin, bilirubin, LDL-cholesterol, HDL-cholesterol, triglycerides, HDL/C index and HOMA IR levels did not differ significantly between the two groups. AST and ALT were significantly higher in the control group. The serum levels of cholesterol and LDL-cholesterol showed a tendency toward lower values in the control group. We found positive correlation between serum levels of insulin and HOMA IR with staging (respectively r=0.336, P < 0.04 and r=0.386, P < 0.02).ConclusionsIn children with CHC and a relatively short duration of the disease, lipid and glucose disorders are not observed. Correlations between insulin and HOMA IR with staging suggest the ability of HCV to contribute to fibrosis through interference with glucose metabolism.