Efficacy of myofascial therapy and kinesitherapy in improving function in shoulder pathology with prolonged immobilization: A randomized,single-blind,controlled trial

BackgroundThe best physiotherapeutic approach in shoulder pathology that generates prolonged immobilization is still uncertain. Kinesitherapy remains the most widely used option. Myofascial therapy is a therapeutic approach in which the aim is to release fascial tension and regain mobility although its efficacy in shoulder pathology has not been sufficiently studied. This Prospective, single-blind randomized controlled trial in a university hospital setting aimed to compare the efficacy of myofascial therapy and kinesitherapy in improving function in shoulder pathology with prolonged immobilization.MethodsPatients were randomly assigned to a control group or to the intervention group.Both groups completed a therapeutic exercise program. Main Outcome Measures: The QuickDash questionnaire was the primary outcome, Pain Visual Analog Scale and the Range Of Motion of the shoulder were the secondary outcomes. The outcomes were evaluated at baseline (T0), at 4 (T2), 8 (T2), and 12 weeks (T3)Results44 participants were included. In the analysis of evolution over time, a significant improvement in functionality and range of motion measurements was observed in both groups (p < 0.05), although at 12 weeks only Myofasical Group achieved a clinically and statistically significant reduction in pain. Comparative analysis at 12 weeks revealed no statistically significant differences between the two therapies in the variables explored.ConclusionsBoth, myofascial therapy and kinesitherapy can improve function, mobility, and pain in patients with painful shoulder associated with prolonged immobilization, with no significant differences between therapies, although in the medium term only myofascial therapy achieves a clinically and statistically significant improvement in pain.Trial registrationTrial registration: ClinicalTrials.gov NCT04944446.     

COVID-19 vaccine and pregnancy: A safety weapon against pandemic

The ongoing COVID-19 pandemic is raising great concern all over the world. The recent introduction of vaccines has offered reason for optimism, however, new issues have arisen, such as vaccine reluctance. The safety of vaccines for pregnant women is one of the most serious of these concerns. The purpose of this review article is to provide updated international vaccine recommendations, results of ongoing studies and clinical trials, and the role of gynecologists in counseling the women to understand the risks versus benefits as well as form an informed decision towards vaccine acceptance for COVID-19.Although COVID-19 infection increases the risk of severe morbidity and mortality in pregnant women, pregnant women were not included in the initial vaccine trials. As a result, safety information is scarce. Nations have differing recommendations, though many have recently approved the COVID-19 immunization in pregnancy following a risk-benefit analysis. The Joint Committee on Vaccination and Immunization (JCVI) of the United Kingdom recently approved an mRNA vaccination for pregnant women. Vaccination is recommended by the CDC, ACOG, ARFM, and WHO. India recently took a stand, with the ICMR and the Ministry of Health and Family Welfare recommending vaccination during pregnancy and lactation.     

云南拉祜族六个基因座的遗传多态性研究

目的：了解云南拉祜族６ 个短串联重复序列基因座遗传多态性分布。方法：应用复合扩增技术对ＣＳＦ１ＰＯ、ＴＰＯＸ、ＴＨ０１ 、Ｆ１３Ａ０１、ＦＥＳＦＰＳ和ｖＷＡ等６ 个ＳＴＲ基因座进行分析,采用高分辨率的聚丙烯酰胺凝胶电泳分离、银染法显影技术,对云南拉祜族上述６ 个ＳＴＲ基因座进行遗传多态性调查。结果：ＣＳＦ１ＰＯ基因座,观察到８ 个等位基因,２０ 个基因型;ＴＰＯＸ 基因座,观察到５ 个等位基因,１４ 个基因型;ＴＨ０１ 基因座,观察到６ 个等位基因,１７ 个基因型;Ｆ１３Ａ０１ 基因座,观察到６ 个等位基因,１３ 个基因型;ＦＥＳＦＰＳ基因座,观察到７ 个等位基因,１５ 个基因型;ｖＷＡ基因座,观察到７ 个等位基因,１７ 个基因型。结论：上述６ 个短串联重复序列基因座基因频率分布与Ｈａｒｄｙ Ｗｅｉｎｂｅｒｇ 平衡吻合良好。     

Rape attitudes amongst British medical students

OBJECTIVES: To examine the rape attitudes of a sample of 252 British medical students. DESIGN: A 20-item questionnaire was used. SETTING: A London medical school. SUBJECTS: Fourth-year medical students. RESULTS: In general, students were well informed on legal and factual issues regarding rape and sexual assault. However, significant differences were found in the attitudes to rape between males and females. Female students were significantly more positive in their responses to victims. CONCLUSIONS: These results support findings from previous studies of rape attitudes in other professional groups. Better knowledge and enlightened attitudes amongst health care staff can have a significant impact on the management of sexual assault and influence the likelihood of victims presenting for treatment. In conclusion, this study emphasizes the importance of teaching about sexual violence in British medical schools.     

Evaluating problem-based learning in a multilingual student population

OBJECTIVES: The University of Natal Medical School in South Africa provides training for a student body composed of two groups: one with English as a first language and the other with an African language as a first language and English as the second. A new methodology was developed to evaluate an innovative course using modified problem-based learning techniques in this heterogeneous environment. DESIGN: The learning model proposed required achieving a balance of three components: content, enquiry/learning process and social interaction/group process. A multidimensional system, felt to be consistent with this educational philosophy, was developed using seven different quantitative and qualitative techniques. SETTING: The University of Natal Medical School. SUBJECTS: First-year multilingual medical students. RESULTS: The results revealed that social interaction was highly successful in reducing barriers between the student groups and between students and facilitators. However, the emphasis on group participation may have overshadowed the enquiry process, leading to superficial discussions of problems and feelings of repetitiveness. During the course students and facilitators expressed concern that the innovative assessments used did not assess the course content adequately. While the group presentations and projects were useful exercises for consolidation and group interaction, they did not enable facilitators to identify struggling students. CONCLUSIONS: The outcome of the evaluation stressed the need of achieving an appropriate balance both in the curriculum and assessments of the three components of the learning model, particularly in a setting where student backgrounds and language ability differ. Multidimensional methodology is needed for effective evaluation that promotes critical reflection.     

Prevalence and clinical relevance of Blastocystis hominis in diverse patient cohorts

The pathogenicity of Blastocystis hominis is extensively debated in the medical literature. Therefore, we did a prevalence study to investigate the association between the presence of several intestinal parasites and gastrointestinal symptoms in diverse patient cohorts. The study population consisted of 1216 adults, including immunocompromised patients, institutionalized psychiatric or elder subjects, immigrants from developing countries, travellers to developing tropical countries and controls. Several variables for each risk group were considered. Stools specimens, collected in triplicate, were processed by the same technicians. Clinical data about each subject were provided by standardized questionnaires. The presence of gastrointestinal symptoms were related to the presence of any parasite. In addition, on the basis of microbiological results, five subgroups of subjects were evaluated. The results showed a high prevalence of parasites in all the risk groups. Immunocompromised status, recent arrival from developing countries and the presence of behavioural aberrations were significantly related to presence of parasites. B. hominis was the parasite most frequently detected in each studied group. B. hominis showed a significant correlation with gastrointestinal symptoms only when detected in the group including subjects with a severe immunodepression. Immunodepression seems to be a factor of primary importance of the pathogenic role of B. hominis.     

Serosurvey of wild rodents for Rickettsioses (spotted fever, murine typhus and Q fever) in Java Island, Indonesia

The prevalence of antibodies against spotted fever group rickettsia (SFGR), murine typhus and Q fever were investigated in wild rats captured in Indonesia. Sera of 327 rats were collected from Jakarta and Boyolali on Java Island. The prevalences of antibodies against SFGR and murine typhus were 128 (39.1%) and 48 (14.7%), respectively. Antibodies against Q fever were not detected in these serum samples. Antibodies against SFGR were found in all species of rats (20.8–51.9%). The antibody positive rate against murine typhus in Rattus norvegicus (38.0%) was significantly higher than that in other rat species (0–4.8%, p < 0.01). The antibody positive rates against SFGR and murine typhus in rats captured in Jakarta were significantly higher than those in rats captured in Boyolali (p < 0.01). In this survey, all species of rats had antibodies against SFGR, indicating that the 4 species of tested rats (R. norvegicus, R. rattus, R. exulans, R. tiomanicus) were infected with SFGR and that SFGR may infest the whole of Java Island. Most of the rats that were antibody-positive against murine typhus were captured in Jakarta. Therefore, R. norvegicus and R. rattus are likely to be important hosts of murine typhus in Jakarta. The antibody-positive rates against SFGR and murine typhus in rats captured in the dry season were significantly higher than those in rats captured in the rainy season. This may coincide with the active periods of ticks and fleas in Indonesia.     

Blutgruppenantigenexpression in papillären karzinomen der schilddrüse Eine immunhistochemische und klinische studie über das Vorkommen von Lewis-, AB0- und verwandten antigenen

Zusammenfassung In einer immunhistochemischen Arbeit wurden 104 papilläre Schilddrüsenkarzinome auf das Vorkommen von Blutgruppenantigenen des AB0- und Lewis-Systems sowie verwandter, tumorassoziierter Antigene mit Typ-1- und Typ-2-Grundstruktur untersucht. Folgende Strukturen wurden im Gewebe nachgewiesen: CA-50 (sialinierter Typ-1-Vorläufer), CA-19-9 (Sialyl-Le^a), Le^a, Le^b, A, B, H, Le^x, Sialyl-Le^x und Le^y. Während gesundes, adultes Schilddrüsengewebe keine Blutgruppenantigene exprimierte, waren die papillären Karzinome durch die progressive Expression dieser Strukturen gekennzeichnet. Die meisten Tumoren reagierten mit dem C-50-Antikörper (84%), während deutlich weniger Gewebe das CA-19-9-Antigen aufwiesen (38%). Die Typ-2-Strukturen Le^x (47%) und Le^y (13%) wurden deutlich seltener gefunden als die korrespondierenden Typ-1-Antigene Le^a (71%) und Le^b (62%). Die Vorbehandlung mit Neuraminidase verstärkte die Le^a- und Le^x-Färbeergebnisse in 27 bzw. 44 Fällen. Von den A-, B-, und H-Antigenen wurden die A-Determinanten am häufigsten nachgewiesen (24%). In vergleichenden Untersuchungen von Serienschnitten der gleichen Tumoren wurde eine Koexpression mehrerer Typ-1-Antigene im denselben Tumorarealen festgestellt. Karzinome mit Expression von Typ-1- und Typ-2-Strukturen wiesen häufig eine komplementäre Antigenexpression in verschiedenen Bereichen der Gewebe auf. Einige Tumoren exprimierten Typ-1- und Typ-2-Strukturen auch in den gleichen Zellen, jedoch in verschiedenen Bereichen der jeweiligen Zellen.In 68 Fällen wurde eine Follow-up-Untersuchung durchgeführt. Die Beobachtungszeiträume lagen zwischen 12 und 217 Monaten. In 13 Fällen rezidivierte der Tumor, 7 dieser Patienten verstarben an dem Tumorleiden. Die meisten Rezidive traten bei Patienten auf, deren Tumoren die Grenzen des Organs überschritten hatten (pT4, n=19), während keines der pT1-Karzinome (n=20) zu einem Rezidiv geführt hatte. Während Lymphknotenmetastasen in 39 Fällen auftraten, wiesen 6 Patienten Fernmetastasen auf. Die klinischen Ergebnisse wurden mit den Färbeergebnissen korreliert. Es bestand kein Zusammenhang zwischen Antigenexpression und Tumordifferenzierung. Die pT4-Tumoren zeigten eine signifikant stärkere Expression der CA-50-, CA-19-9-, Le^a und Sialyl-Le^x-Strukturen. Karzinome mit Le^y-Expression wiesen signifikant häufiger Metastasen auf. Le^y, H-Typ-1 und H-Typ-2 traten häufiger in rezidivierenden Tumoren auf. Im Gegensatz dazu waren alle Patienten, deren Karzinom das A-Antigen exprimierte, fernmetastasen- und rezidivfrei (n=14). In der multiplen Regressionsanalyse wies der Faktor Fernmetastasierung die größte prognostische Relevanz auf, während im Vergleich dazu die Färbeergebnisse statistisch von untergeordneter Bedeutung waren.

---

Blood group antigen expression in papillary carcinoma of the thyroid — An immunohistochemical and clinical study on the occurrence of Lewis-, AB0, and derived antigens

Nine monoclonal antibodies, lectin from Ulex europaeus and neuraminidase enzyme were employed to demonstrate the occurrence of type 1 and type 2 blood group antigens in 104 cases of papillary carcinoma of the thyroid. The reagents applied, recognize the following blood group related antigens: CA-50 (sialylated type 1 precursor), CA-19-9 (sialylated Le^a), Le^a, Le^b, A, B, H, Le^x, sialylated Le^x, and Le^y.Immunohistochemical studies revealed that papillary carcinoma of the thyroid, in contrast to histologically normal thyroid tissue, is characterised by a progressive expression of blood group antigens. Most tumours (84%) reacted with C-50 antibody, whereas only a minority of the tissues demonstrated the CA-19-9 antigen (38%). Type 2 structures Le^x (47%) and Le^y (13%) were found less often than their corresponding type 1 isomers Le^a (71%) and Le^b (62%). Desialylation with neuraminidase increased the Le^a and Le^x staining intensity in 27 and 44 cases, respectively. of the A, B, H antigens the A determinants encountered most frequently (24%).Comparative examinations of sequential sections of the same tumour revealed coexpression of type 1 antigens in the same areas. In carcinomas showing type 1 and type 2 antigen reactivity, a complementary distribution of the structures in different tumour areas was often demonstrated. Some tumours presented combined type 1 and type 2 antigen expression in the same cells, however, in distinct areas within the cell.A follow-up examination was carried out in 68 of the 104 cases. The observation time ranged from 12 to 217 months. Thirteen patients suffered from recurrence, of which 7 died. While lymphatic metastases occurred in 39 tumours, distant metastases were detected in 6 patients. Most of the recurrences were found in patients with tumour classification pT4 (n=19), whereas none of the pT1 carcinomas (n=20) showed recurrence.The clinical results were compared to the blood group antigen expression results. There was no correlation between antigen expression and differentiation degree of the tumour. The pT4 tumours showed a significant higher expression of the CA-50, CA-19-9, Le^a and Sialyl Le^x structures. Carcinomas expressing the Le^y antigen were associated with a significant higher level of metastasizing capacity. The Le^y, H type 1 and H type 2 antigens occurred more frequently in recurrent tumours (n=14). In contrast, none of the patients whose carcinomas expressed the Aantigens (n=14) suffered from a recurrence or hematogenous metastasis.Multiple stepwise regression analysis was carried out to check the importance of each staining and clinical factor. In this analysis, distant metastasis was the most important parameter, whereas the staining results were of minor statistical importance.

     

The therapist's use of self and cultures in children's psychotherapy groups

This paper presents a model for understanding decisions that a therapist makes concerning the use of the self as a therapeutic tool in children's psychotherapy groups. The parameters within which a therapist uses self is directly related to the development of the group's culture. It is proposed that two complementary cultures develop within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. Having taken the time to learn a group's indigenous peer culture the therapist can use its metaphors to speak to the children in their own language; eventually it will be possible to engage them in collaboratively building a meaning system which is uniquely designed to address their psychotherapeutic needs. Initially, when indigenous peer culture is predominant, the therapist uses self more receptively in order to connect with the children through empathic immersion, holding intolerable affects and developmental time travel; as treatment progresses and a therapeutic group culture is slowly constructed, the therapist may use him/her self for more change directed interventions through role modeling, confrontation and self disclosure.Chief Psychologist and Coordinator, Children's Clinical Services, Brookline Community Mental Health Center and Instructor, Psychiatry (Psychology), Harvard Medical School and private practice in Brookline and Newton Massachusetts.