超声引导液压松解盂肱关节囊联合康复训练治疗冻结肩的临床效果

目的评价可视化超声引导下液压松解盂肱关节囊治疗冻结肩的有效性及安全性。资料与方法纳入55例冻结肩患者,其中Ⅰ期患者17例,Ⅱ期23例,Ⅲ期15例,在可视超声实时引导下,穿刺针经肩关节后斜上方路径液压松解盂肱关节囊,松解治疗后联合同步肩关节康复训练。初次治疗及末次治疗后4周应用肩关节功能评分(Constant-Murley)评定其治疗效果的有效性及安全性。结果55例冻结肩患者Constant-Murley评分均有效,其中评分为优37例,良18例。37例评优的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为15例(88.2%)、13例(56.5%)、9例(60.0%)。18例评良的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为2例(11.7%)、10例(43.4%)、6例(40.0%)。各期冻结肩患者治疗前后Constant-Murley评分比较,差异有统计学意义(P<0.05)。其中Ⅰ期冻结肩患者疗效显著,治疗后1周疼痛及关节活动度基本缓解,4周内症状基本消失。所有患者均在超声引导下一次性穿刺成功,治疗过程中所有患者均能耐受,未发生明显不适及并发症。结论超声引导下液压松解盂肱关节囊治疗冻结肩安全、有效,本穿刺路径治疗联合系统的肩关节康复训练有效提高冻结肩的治疗效果。     

Supporting mandibular resection with intraoperative navigation utilizing augmented reality technology – A proof of concept study

ObjectiveThe aim of this study was to compare the accuracy of simulated mandibular osteotomies performed with cutting guides and two different intraoperative navigation systems based on simple (sAR) and navigated (nAR) augmented reality technology.Material and methodsA total of 126 osteotomies were performed on 21 identical mandible models according to a prespecified virtual surgery plan. The data from postoperative computed tomography (CT) images were fused with preoperative CT scans to objectively compare the outcomes, i.e. angular deviations from the osteotomy trajectory (°) and displacement of two control points (mm).ResultsOsteotomies performed with cutting guides turned out to be the most accurate, with mean angular deviation of 4.94 ± 4.62° and mean control point displacement of 1.65 ± 0.88 mm. Mandibular osteotomies assisted with sAR and nAR were less accurate in terms of mean angular deviations (5.34 ± 3.67° and 7.14 ± 5.19°, respectively) and control point displacements (1.79 ± 0.94 mm and 2.41 ± 1.34 mm, respectively).ConclusionOur findings imply that in future, AR-based intraoperative navigation systems may find application in everyday clinical practice. Although AR technology still requires some improvements, it can already be used for presentation of digital navigation data, enhancing surgeon's awareness and hand-eye coordination during mandibular resection and reconstruction procedures.     

Independent and combined effect of home-based progressive resistance training and nutritional supplementation on muscle strength,muscle mass and physical function in dynapenic older adults with low protein intake: A randomized controlled trial

BackgroundWith the aging phenomenon, there is growing interest in developing effective strategies to counteract dynapenia, the age-related loss of muscle strength. The positive effect of progressive resistance training on muscle strength is well known, however, the effect of nutritional supplementation or its synergistic effect along with exercise on muscle strength is not a consensus in the literature, especially in populations with low protein intake.MethodsWe analyzed the muscle strength (handgrip strength and sit-to-stand test), muscle mass, body mass index, insulin resistance, and physical function (gait speed, timed up & go test, and single-leg-stance test) of 69 dynapenic older adults with low protein intake, before and after the intervention period of three months. The participants were randomly allocated into four groups: resistance training, supplementation, resistance training plus supplementation, and control.ResultsThere was a significant group x time interaction on the following outcome measures: handgrip strength (p < 0.001), gait speed (p = 0.023), and sit-to-stand test (p < 0.001). Considering the outcomes that showed a significant difference between and within groups, only the resistance training group and the resistance training plus supplementation group showed a large effect size in handgrip strength, gait speed, and sit-to-stand test, whereas the supplementation group showed a moderate effect size in gait speed. After the intervention period, there was no difference between the resistance training and the resistance training plus supplementation groups.ConclusionThis study reinforces the value of resistance training in improving muscle strength. The nutritional supplementation added no further benefits in this specific population.Registration number at the Brazilian registry of clinical trials: RBR-4HRQJF.     

Addiction Research Centres and the Nurturing of Creativity

This paper describes the history and current structure of the Institut für Therapieforschung (IFT) [Institute for Therapy Research] in Munich, as well as major research topics and factors which might contribute to a creative structure and atmosphere for innovative research in the addiction field. The institute was founded in 1973 as a non‐profit non‐governmental organization (NGO) with a focus on applied research. Starting with behaviour therapy‐based development and evaluation of programmes for alcohol, illicit drugs and smoking and the evaluation of treatment services, the institute gradually expanded its topics, covering prevention (1985) and epidemiology and policy evaluation (1990), and participated throughout this period in the development of guidelines and screening, diagnostic and clinical instruments. Later, the IFT tried to bridge the gap between basic sciences, applied research, health‐care services and health policy, with a network of national and international contacts, including its own university engagements and collaborations with foreign research groups and national and European Union (EU) agencies. Possible creativity‐promoting factors on the institutional and individual levels are discussed, e.g. the collaboration of experienced senior researchers with carefully selected innovative doctoral students, considerable in‐house and external training of young researchers and the early participation and presentation of their work at international conferences, independence from stakeholders in the field and the refusal of project funds which require external clearance of publications.     

Recreational football is medicine against non-communicable diseases: A systematic review

The purpose of this research was to conduct a systematic review of published articles related to the effect of recreational football on non-communicable diseases. A systematic review of Web of Science, SPORTDiscus, MEDLINE, and PubMed databases was performed according to PRISMA guidelines. Only empirical studies were included. There were no restrictions on the types of study design eligible for inclusion. The primary outcome measures result from the potential effects of recreational football on non-communicable diseases (eg, blood pressure, bone density, LDL cholesterol, and fat mass). A total of 44 articles met the inclusion criteria and were included. Recreational football is shown to: (a) decrease blood pressure and resting heart rate, improve cardiac structure and functioning, as well as increase maximal oxygen uptake in both sexes; (b) reduce cholesterol and triglycerides levels, increase insulin sensitivity, and have a positive impact on glycemic control; (c) improve bone mineralization, increase both bone mineral density and content, as well as acting as a stimulus for osteogenesis; and (d) be clearly beneficial for bone health, while slightly beneficial for body composition, muscle strength, and maximal oxygen uptake in adults with prostate cancer. The present systematic review demonstrated the benefits of recreational football practice on non-communicable diseases related to cardiovascular and bone health, body composition, type 2 diabetes, and prostate cancer. The effectiveness of recreational football on the aforementioned diseases may be related to age and gender; however, further research is required.     

Autophagy is required for performance adaptive response to resistance training and exercise-induced adult neurogenesis

Endurance training promotes exercise-induced adaptations in brain, like hippocampal adult neurogenesis and autophagy induction. However, resistance training effect on the autophagy response in the brain has not been much explored. Questions such as whether partial systemic autophagy or the length of training intervention affect this response deserve further attention. Therefore, 8-week-old male wild-type (Wt; n = 36) and systemic autophagy-deficient (atg4b^−/−, KO; n = 36) mice were randomly distributed in three training groups, resistance (R), endurance (E), and control (non-trained), and in two training periods, 2 or 14 weeks. R and E maximal tests were evaluated before and after the training period. Forty-eight hours after the end of training program, cerebral cortex, striatum, hippocampus, and cerebellum were extracted for the analysis of autophagy proteins (LC3B-I, LC3B-II, and p62). Additionally, hippocampal adult neurogenesis was determined by doublecortin-positive cells count (DCX+) in brain sections. Our results show that, in contrast to Wt, KO were unable to improve R after both trainings. Autophagy levels in brain areas may be modified by E training only in cerebral cortex of Wt trained for 14 weeks, and in KO trained for 2 weeks. DCX + in Wt increased in R and E after both periods of training, with R for 14 weeks more effective than E. Interestingly, no changes in DCX + were observed in KO after 2 weeks, being even undetectable after 14 weeks of intervention. Thus, autophagy is crucial for R performance and for exercise-induced adult neurogenesis.     

Avoiding high-risk rotator cuff loading: Muscle force during three pull-up techniques

Heavily loaded overhead training tasks, such as pull-ups are an effective strength training and rehabilitation exercise requiring high muscle forces maintained over a large range of motion. This study used experiments and computational modeling to examine loading patterns during three different pull-up variants and highlighted risks to vulnerable musculoskeletal structures. Optical motion tracking and a force platform captured kinematics and kinetics of 11 male subjects with no history of shoulder pathology, during performance of three pull-up variants—pronated front grip, pronated wide grip, and supinated reverse grip. UK National Shoulder model (UKNSM) simulated biomechanics of the shoulder girdle. Muscle forces and activation patterns were analyzed by repeated measures ANOVA with post-hoc comparisons. Motor group recruitment was similar across all pull-up techniques, with upper limb depression occurring secondary to torso elevation. Stress-time profiles show significant differences in individual muscle patterns among the three pull-up variants, with the most marked differences between wide grip and reverse grip. Comparing across techniques, latissimus dorsi was relatively more active in wide pull-ups (P < .01); front pull-ups favored activation of biceps brachii and brachialis (P < .02); reverse pull-ups displayed higher proportional rotator cuff activation (P < .01). Pull-ups promote stability of the shoulder girdle and activation of scapula stabilizers and performing pull-ups over their full range of motion is important as different techniques and phases emphasize different muscles. Shoulder rehabilitation and strength & conditioning programs should encourage incorporation of all three pull-up variants with systematic progression to provide greater global strengthening of the torso and upper limb musculature.