Muscle Contracture Research Articles

A Case Study On The Use Of Theratogs® With Conventional Physiotherapy On A Child With Cerebral Palsy, GMFCS Level V

Children with Cerebral Palsy (CP) exhibit postural malalignment due to muscle imbalance and spasticity. Studies have shown that orthotic garments can help improve posture in such children by reducing fluctuations in tone and contracture of muscles. Orthotic garments have also been shown to improve spinal geometry in children with CP. The aim of this study aims to determine the effect of orthotic garments (TheraTogs® WUNZI) on a child with CP and GMFCS levels V along with conventional physiotherapy. In this study, the child received physiotherapy five times a week and wore the TheraTogs® for 6 hours daily. The outcome measure used in the study were GMFM, posture evaluation with images and patient satisfaction. The results of the study showed that the TheraTogs® has a positive influence on posture, and it also helped in improving gross motor function. Further randomised controlled trials are needed on children with GMFCS level 5 to validate our findings.     &nbsp

ACUTE SURGICAL ABDOMEN: UNEXPECTED MEDICAL CAUSE

Acute surgical abdomen is a diagnostic and therapeutic emergency, manifested by a generalized contracture of the abdominal muscles following a peritoneal irritation. In the majority of cases, acute peritonitis is the most common etiology requiring urgent surgical intervention. Nevertheless, some medical pathologies, notably acute adrenal deficiency and inflammatory colitis, can mimic this surgical situation, leading to an aberrant surgical intervention. Through a clinical case, we report the diagnostic and therapeutic modalities of a multifocal tuberculosis initially admitted for an acute surgical abdomen.

Modified Nishida Procedure Combined with Lateral Rectus Disabling for Duane Retraction Syndrome

ABSTRACT Duane retraction syndrome (DRS) is a complex congenital cranial dysinnervation disorder. The choice of surgical procedure in esotropic-DRS depends upon several factors that include: the amount of esotropia in the primary position, the presence and severity of palpebral fissure narrowing, globe retraction, presence of medial rectus muscle (MR) contracture, the likelihood of improving abduction, age of the patient, and the presence of binocularity and stereopsis. In the presence of MR contracture, MR recession is performed either alone (unilaterally or bilaterally) or in conjunction with Y splitting plus recession of the lateral rectus muscle (LR) for reducing globe retraction. MR recession, with or without adjustable sutures, may be simultaneously combined with partial thickness vertical rectus muscle transposition (VRT) or with superior rectus muscle transposition (SRT). We describe a novel combination of surgical procedures in the management of esotropic-DRS in two patients. In our first patient, following an initial MR recession combined with LR disinsertion and periosteal fixation (LRDAPF), a modified Nishida procedure was performed. In our second patient following a prior simultaneous MR recession and LR Y splitting with recession, we combined periosteal fixation of the LR with a modified Nishida procedure of the vertical rectus muscles.

Surgical treatment of congenital muscular torticollis

Surgical treatment of congenital muscular torticollis with tripolar release of the sternocleidomastoid muscle, followed by modified postoperative treatment with aspecial orthosis. Muscular torticollis due to contracture of the sternocleidomastoid muscle; failure of conservative therapy. Torticollis due to bony anomaly or other muscular contractures. Tenotomy of the sternocleidomastoid muscle occipitally and resection of at least 1 cm of the tendon at the sternal and clavicular origin. Orthosis must be worn for 6weeks 24 h/day, then for another 6weeks 12 h/day. A total of 13patients were treated with tripolar release of the sternocleidomastoid muscle and modified postoperative management. Average follow-up time was 25.7months. One patient presented with recurrence after 3years. No intra- or postoperative complications were observed.

The outcomes of congenital torticollis delayed surgery in older children: A case series

Introduction and importanceCongenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis. Case presentationWe report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion. Clinical discussionChildren treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement. ConclusionDelayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.

Biomechanical impact of elbow motion in elbow stiffness.

A mechanical block in the elbow due to osteophytes in the olecranon fossa is a common clinical symptom for elbow stiffness. This study aims to understand the biomechanical characteristics or changes in the stiff elbow in the resting (or neutral) and swing position of the arm using a cadaveric model. The hypotheses included the following: (1) a difference exists in the articular contact pressure of the elbow by comparing the non-stiff and stiff models in in vivo studies; (2) the degree of stiffness would affect the increase of the joint loading of the elbow. Controlled laboratory study, cadaveric study. Eight fresh-frozen specimens from individuals of both sexes were included in the biomechanical study. The specimen was mounted on a custom-designed jig system with gravity-assisted muscle contracture to mimic the elbow in a standing position. The elbow was tested in two conditions (the resting and passive swing). Contact pressure was recorded for three seconds in the resting position, which was the neutral position of the humerus. By dropping the forearm from 90° of the elbow flexion, the passive swing was performed. The specimens were tested sequentially in three stages of stiffness (stage 0, no stiffness; stage 1, 30° of extension limitation; and stage 2, 60° of extension limitation). After data collection was completed in stage 0, a stiff model was sequentially created for each stage. The stiff model of the elbow was created by blocking the olecranon by inserting a 2.0K-wire into the olecranon fossa horizontally with the intercondylar axis. The mean contact pressures were 279 ± 23, 302 ± 6, and 349 ± 23kPa in stages 0, 1, and 2, respectively. The increases in the mean contact pressure in stages 2 versus 0 were significant (P < 0.0001). The mean contact pressures were 297 ± 19, 310 ± 14, and 326 ± 13kPa in stages 0, 1, and 2, respectively. The peak contact pressures were 420 ± 54, 448 ± 84, and 500 ± 67kPa in stages 0, 1, and 2, respectively. The increases in mean contact pressure in stage 2 versus 0 were significant (P = 0.039). The increases in peak contact pressure in stages 0 versus 2 were significant (P = 0.007). The elbow bears the load created by gravity and muscle contracture in the resting and swing motion. Moreover, extension limitation of stiff elbow increases the load bearing in the resting position and swing motion. Careful surgical management should be considered for meticulous clearance of bony spur around olecranon fossa to resolve the extension limitation of the elbow.

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

A Very Rare Case of Juvenile Dermatomyositis with Typical Cutaneous Clinical Signs

Protocolo diagnóstico de las mialgias

Myalgia, or muscle pain, is a common complaint among the adult population. Diffuse myalgias are more frequent than localized myalgias. Excessive physical effort, trauma, medications, and viral infections are among the most common causes. Myalgias are most often benign, but in a certain percentage of cases, they are the symptom of muscle disease (myopathy) or muscle inflammation (myositis). Myaglias caused by a primary muscle disorder are generally triggered with exercise and are accompanied by other signs/symptoms. In patients with carbohydrate metabolism disorders, muscle symptoms are triggered by brief isometric exercise or less intense, sustained dynamic exercise and can cause cramps and recurrent myoglobinuria. In lipid metabolism disorders, the symptoms tend to be induced by infections, fever, prolonged or intense exercise, and prolonged fasting. These patients do not develop true muscle cramps or contractures and do not experience the phenomenon known as “second wind.”

EVALUATION OF PHYSIOTHERAPY EFFECTS USING SPECIFIC TESTS IN DUCHENNE MUSCULAR DYSTROPHY – A CASE STUDY

Currently, patients with Duchenne muscular dystrophy manage to reach the fourth or fifth decade of life due to advances in the management of different specialties that are involved through evaluations and anticipatory therapies based on a type of suitable approach for identifying specific medical complications as early as possible. The progressive decrease in muscular strength that affects the cardiovascular, respiratory and musculoskeletal systems needs to be constantly managed. The purpose of this case study is to observe to what extent physiotherapy contributes to the modification of North Star Ambulatory Assessment (NSSA), NM-Score and Vignos Scale in a 27-year-old patient with Duchenne muscular dystrophy. NSAA is used to monitor disease progression and treatment effects but also to measure various motor skills. The NM-Score classifies functional abilities into three main motor domains. The Vignos Scale measures lower limb function. The scores obtained in the initial assessment were 11/34, 2/4, 1/4, 1/4 and 3/10, and the functional recovery treatment was carried out over a period of 6 months. Specific, non-specific and complex physiotherapy methods were used with the main objectives of improving joint range of motion, gait and balance, reducing muscle contractures, increasing endurance and promoting independence in carrying out daily activities. The final assessment showed improvements in all scores, so the objectives were accomplished. Along with the other medical specialties that help dystrophic patients improve their quality of life, physiotherapy plays an important role because movement is the key to a healthy and long life.

The use of physical exercises in restoring the health of young children with congenital pathology of the hip joints in rehabilitation centers

The analysis of scientific literature shows that the leading place in the development of methods of restoring the health of young children with congenital pathology of the hip joints in rehabilitation centers is occupied by the use of physical exercises and massage, and the most progressive methods of rehabilitation today are the use of osteopathic techniques and kinesiotaping.&#x0D; The tasks of using physical exercises to restore the health of young children with congenital hip joint pathology in rehabilitation centers include: prevention and elimination of thigh muscle contracture; formation of hip joints, restoration of their shape, fixation of joints in the position of maximum correction; strengthening of the muscles that produce movement in the hip joints (flexion, extension, abduction, inward rotation); full development of active movements in hip joints; correction of the valgus position of the knee and ankle joints, which occurs during treatment with the use of tires.&#x0D; The most important task of using physical exercises is to relieve tension and strengthen the muscles of the hip joint, restore the range of motion as much as possible and organize the motor activity of the child for its full and harmonious physical development. Physical exercises, which are divided into general developmental and special, begin to be used from the beginning of a child's life as reflex exercises taking into account his psychomotor development. Special exercises contribute to the improvement of trophic processes in the hip joints, thigh muscles and buttocks. Taking into account the age of the child, passive (up to a year) and active exercises (from 1 to 3 years) are used. Kinesiotherapy in the rehabilitation of children with congenital dislocation of the hip is the main means of forming a healthy joint and the only means of supporting motor development. The use of physical exercises in water is characterized by a positive combination of physical therapy, aqua massage and relaxation. Hydrokinesitherapy for children is the most effective and affordable means of physical development and rehabilitation.

Algorithm for Controlling the Movement of the Actuator of the Device for Active-Passive Mechanotherapy of the Ankle Join

Purpose of research. The article is devoted to the development of an algorithm for controlling the movement of a controlled mobile platform of a passive mechanotherapy ankle joint apparatus. One of the most common injuries sustained by humans is damage to the ankle joint in sports, domestic, industrial exercises, and as a result of car accidents. Falls from heights with a landing on the feet, including parachute jumps, also often result in ankle injuries. In order to increase the effectiveness of rehabilitation, mechanotherapy is usually used. The relevance of the topic is related to the high efficiency of robotic rehabilitation devices, which, thanks to back-linking and electrically controlled actuators, can perform lower limb movements in an optimal way.Methods. The structural diagram of the device control system has been developed. The proposed algorithm uses the strategy of paralleling control actions with the use of corrective and reference controls to calculate control voltages. Presence of force-moment feeling system enables to estimate change of reaction value in time and timely fix the moment of spastic effects appearance, muscle contracture and automatically make changes in foot movement laws in order to exclude patient's traumatisation and pain syndrome elimination.Results. A methodology for constructing the desired dependence of foot rotation angles on time in the sagittal and frontal planes is proposed. We have developed an operating algorithm for the laws of motion and decision-making block, an algorithm for generating control voltages from the reference model, an operating algorithm for the voltage correction block, and an operating algorithm for the reference model correction block. As a result of virtual tests on the mathematical model of the device, we obtained the basic patterns of motion of the actuator in the form of dependences of the rotation angle of the platform from the time.Conclusion. The results of testing the device show that controlling the movement of the actuator for active-passive mechanotherapy of the ankle joint using the algorithms described in the article is reasonable.

PROCESSING OF THE STRATEGIC SEQUENCE OF DIAGNOSTIC PATIENTS WITH TEMPOMANDIBULAR DISORDERS AND OCCLUSIVE INTERFERENCES

Temporomandibular joint pathology in combination with the development of pathological processes in the muscles and cranial dysfunction manifests as a complicated clinical picture, which leads to difficulties in diagnostic. In the diagnostics of disorders of the neuromuscular apparatus and the temporomandibular joint, modern clinical, instrumental, functional and radiological examination methods are widely used with biomechanical digital analysis, which require systematization.&#x0D; The aim of the study was development of a strategic structured sequence of diagnostic of patients with temporomandibular disorders and occlusal interferences.&#x0D; The highest percentage of diagnosed joint and combined (joint + muscle) disorders, both among men and among women, namely: joint in 114 patients (38,65 %) and combined in 97 patients (32,89 %), which together made up 71,54 %, and this is exactly the kind of pathology that, in combination with occlusal interferences, is the most difficult in the treatment process. Among confirmed temporomandibular disorders accounted only muscle disorders in 12,88 % (4,07 % in men and 8,81 % in women). The number of women who applied for help is in 2,3 times higher than the number of men, and 81,75% of patients who applied for help were aged from 21 to 50 years, that is, the most productive period of a person's life.&#x0D; Among the pathologies that imitated temporomandibular disorders (more than 10 %) prevailed: osteochondrosis of the cervical spine (17,39 %), contracture of masticatory muscles (post-injection, traumatic) (13,04%) and neuropathology (10,87%).&#x0D; The diagnosis of temporomandibular disorders was rejected in 15,59 % of observations, which indicates the need for a thorough examination of such patients and the involvement of specialists for additional consultation, such as in the field of dentistry (for example, an orthodontist or maxillofacial surgeon), or in the field of general medicine ( psychologist, neurologist, rheumatologist, otolaryngologist, etc.).

Twenty-minute harvesting of flow-through type vastus lateralis muscle flap significantly reduces the need for a temporary intravascular shunt in the treatment of severe upper extremity trauma in civilian patients.

For the reconstruction of severe upper extremity trauma involving arterial injury in civilian patients, it is generally recommended that the revascularization time be shortened using a temporary intravascular shunt (TIVS). However, if a flow-through type vastus lateralis muscle (VLm) flap can be harvested in 20 minutes and bypassed at the obstructed ischemic zone within 30 minutes, blood flow can be restored as quickly or more quickly than when using a TIVS, eliminating the need for a TIVS. This procedure was applied in the reconstruction of 3 cases of severe extremity trauma with vascular injury. The mean age was 69.7 years. Surgery was started an average of 2.93 hours from the onset. The average flap harvest time was 0.33 hours. The average time to revascularization from flap harvest was 1.33 hours, the average total operation time was 6.43 hours, and all upper extremities were salvaged. No cases showed ischemia-reperfusion injury or severe muscle contracture. The flow-through-type VLm flap can be applicable as a bypass graft for a 20 cm defect at any region distal to the elbow. In addition, harvesting the flap attached to blood-rich muscle not only controls the infection of contaminated wounds through the filling of dead space, but also has the potential to replace damaged muscle or tendon tissue. Even though TIVS placement is currently used extensively in this field of treatment, its role could be significantly reduced if a flow-through-type VLm flap can be harvested within 20 minutes.

ASSESSMENT OF EFFECTIVENESS IN APPLYING MULTIDISCIPLINARY EXPERIMENTALLY-BASED APPROACH IN CHOOSING THERAPY FOR PATIENTS WITH FUNCTIONAL MAXILLOFACIAL DISORDERS IN COMBINATION WITH PRIMARY DEEP BITE

Introduction. In recent years, the percentage of adults seeking orthodontic care has been increasing. The management of such a group of patients poses a number of challenges the orthodontists have to solve. One of the common problems that arise during the bite correction with fixed orthodontic appliances is debonding. The highest percentage, 43%, of adhesion disruption is observed in patients with a deep overlap. There is also an increase in the number of dental patients presenting with manifestations of the development of functional occlusion disorders caused by reconstructive prosthetic restorations under the existing bite pathology.&#x0D; Materials and methods. A comparison of electromyography indicators in patients before and after the treatment was carried out. The study included 51 patients aged 18-45 years (average age was 29.6±6.1 years). The selection was made on the basis of inclusion / exclusion criteria. The first group involved 24 patients (9 men, 15 women) with a deep bite, occlusal disorders with unexpressed architecture of the occlusal surface of reconstructive restorations mainly made of composite and polymer materials; the participants presented no pronounced pain symptoms, but presented complaints about the masticatory muscles (discomfort, trismus, contracture of the lateral pterygoid muscle, bruxism, etc.). Patients of this group were characterized by multiple direct restorations and short-length orthopaedic structures. The second group included 27 patients (10 men, 17 women) with a deep bite, occlusal disorders, pronounced architecture of the occlusal surface of reconstructive prosthetic restorations and existing pain manifestations from the masticatory muscles, which appeared after their functional overload. In order to compare the effectiveness of treatment, each of the clinical groups was divided into 2 subgroups, test and control.&#x0D; Results. The findings obtained demonstrated the normalization of bioelectric activity indicators after the treatment, both in the control group and in the test group (p&lt;0.05). For patients of clinical group 1, the level of the bioelectrical activity after the treatment in the test group was statistically significantly (p=0.0049) lower than in the control group. The same was observed for the patients from 2 clinical groups (p&lt;0.001)&#x0D; Conclusions. The scheme of the proposed algorithm for the fixation of orthodontic appliances and measures aimed at normalizing the work of masticatory muscles significantly improves the indicators of functional research methods, in particular, the indicators of bioelectric activity during electromyography in patients of all study groups.

Ear disease in pet rabbits

Background: Ear disease is a common presenting condition in pet rabbits in veterinary practice and can involve any or all parts of the ear – the external ear canal, the middle ear and the inner ear. Our knowledge of ear disease in this species has advanced significantly over the past 10 years, with recent and relevant publications reported in the literature. A higher incidence occurs in lop‐eared rabbits, thought to be due to their pinna anatomy (Johnson and Burn 2019).Aim of the article: This article reviews rabbit ear disease, focusing on clinical signs, diagnostics and treatment in pet rabbits. Clinical signs may vary depending on the severity, chronicity and anatomical location and range, from ear scratching and head shaking with otitis externa, to facial muscle contracture and neurological deficits with otitis media. The diagnosis of ear disease is also covered in this article, which is based on clinical signs and clinical examination findings, along with diagnostic imaging, ear cytology and culture. Treatment options for rabbits with ear disease are outlined as well; these vary depending on the clinical signs, disease location and severity. Prompt diagnosis and treatment of ear disease in pet rabbits is essential to avoid progression of disease and clinical signs. This article is a useful overview for all veterinary staff treating pet rabbits in veterinary practice.

Development and prevention of ischemic contracture ("stone heart") in the pig heart.

Stone heart (ischemic contracture) is a rare and serious condition observed in the heart after periods of warm ischemia. The underlying mechanisms are largely unknown and treatment options are lacking. In view of the possibilities for cardiac donation after circulatory death (DCD), introducing risks for ischemic damage, we have investigated stone heart in pigs. Following cessation of ventilation, circulatory death (systolic pressure <8 mmHg) occurred within 13.1 ± 1.2 min; and a stone heart, manifested with asystole, increased left ventricular wall thickness and stiffness, established after a further 17 ± 6 min. Adenosine triphosphate and phosphocreatine levels decreased by about 50% in the stone heart. Electron microscopy showed deteriorated structure with contraction bands, Z-line streaming and swollen mitochondria. Synchrotron based small angle X-ray scattering of trabecular samples from stone hearts revealed attachment of myosin to actin, without volume changes in the sarcomeres. Ca2+ sensitivity, determined in permeabilized muscle, was increased in stone heart samples. An in vitro model for stone heart, using isolated trabecular muscle exposed to hypoxia/zero glucose, exhibited the main characteristics of stone heart in whole animals, with a fall in high-energy phosphates and development of muscle contracture. The stone heart condition in vitro was significantly attenuated by the myosin inhibitor MYK-461 (Mavacamten). In conclusion, the stone heart is a hypercontracted state associated with myosin binding to actin and increased Ca2+ sensitivity. The hypercontractile state, once developed, is poorly reversible. The myosin inhibitor MYK-461, which is clinically approved for other indications, could be a promising venue for prevention.

Advances in the clinical application of orthotic devices for stroke and spinal cord injury since 2013.

Stroke and spinal cord injury are common neurological disorders that can cause various dysfunctions. Motor dysfunction is a common dysfunction that easily leads to complications such as joint stiffness and muscle contracture and markedly impairs the daily living activities and long-term prognosis of patients. Orthotic devices can prevent or compensate for motor dysfunctions. Using orthotic devices early can help prevent and correct deformities and treat muscle and joint problems. An orthotic device is also an effective rehabilitation tool for improving motor function and compensatory abilities. In this study, we reviewed the epidemiological characteristics of stroke and spinal cord injury, provided the therapeutic effect and recent advances in the application of conventional and new types of orthotic devices used in stroke and spinal cord injury in different joints of the upper and lower limbs, identified the shortcomings with these orthotics, and suggested directions for future research.

CT-based morphological study of the pelvis in patients with gluteal muscle contracture

BackgroundIn the clinic, gluteal muscle contracture (GMC) causes pelvic structural changes, including acetabular retroversion. However, its causes and forms are not well understood. This study aimed to investigate and analyse the clinical significance of pelvic structural differences between GMC patients and healthy individuals.MethodsAs the GMC group, we identified 100 GMC patients who received treatment and met the inclusion criteria between January 2019 and January 2020. Control subjects were drawn from the hospital’s emergency trauma patients who had no history of pelvic or hip joint disease. All subjects underwent CT scans to measure their pelvic rotation, including the superior iliac angle (SIA), inferior iliac angle (IIA), and ischiopubic angle (IPA), and acetabular coverage, which includes anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), horizontal acetabular sector angle (HASA), and superior acetabular sector angle (SASA).ResultsThe SIA, IIA, IPA, and PASA of the GMC group were considerably smaller than those of the control group, while the AASA of the GMC group was higher, indicating a statistically significant difference (P < 0.05). The HASA and SASA of the GMC group, on the other hand, were not considerably different from those of the control group. The angles in the GMC group were relativized as follows: The HASA had a positive correlation with the AASA and PASA (r = 0.750, P < 0.01; r = 0.749, P < 0.01); the SASA had a positive correlation with the AASA, PASA, and HASA (r = 0.555, P < 0.01; r = 0.273, P < 0.01; r = 0.552, P < 0.01); the AASA had a negative correlation with the SIA, IIA and IPA (r = − 0.355, P < 0.01; r = − 0.551, P < 0.01; r = − 0.30, P < 0.01); the PASA had a positive correlation with the IIA (r = 0.315, P < 0.01) and had no correlation with the SIA and IPA (P > 0.05); and the IIA had a positive correlation with both the SIA and IPA (r = 0.664, P < 0.01; r = 0.465, P < 0.01).ConclusionIndividuals with GMC have an abnormal pelvic morphology, with acetabular retroversion caused by ilial rotation rather than dysplasia of the acetabular wall.

Resident muscle stem cell myogenic characteristics in postnatal muscle growth impairments in children with cerebral palsy.

Children with cerebral palsy (CP), a perinatal brain alteration, have impaired postnatal muscle growth, with some muscles developing contractures. Functionally, children are either able to walk or primarily use wheelchairs. Satellite cells are muscle stem cells (MuSCs) required for postnatal development and source of myonuclei. Only MuSC abundance has been previously reported in contractured muscles, with myogenic characteristics assessed only in vitro. We investigated whether MuSC myogenic, myonuclear, and myofiber characteristics in situ differ between contractured and noncontractured muscles, across functional levels, and compared with typically developing (TD) children with musculoskeletal injury. Open muscle biopsies were obtained from 36 children (30 CP, 6 TD) during surgery; contracture correction for adductors or gastrocnemius, or from vastus lateralis [bony surgery in CP, anterior cruciate ligament (ACL) repair in TD]. Muscle cross sections were immunohistochemically labeled for MuSC abundance, activation, proliferation, nuclei, myofiber borders, type-1 fibers, and collagen content in serial sections. Although MuSC abundance was greater in contractured muscles, primarily in type-1 fibers, their myogenic characteristics (activation, proliferation) were lower compared with noncontractured muscles. Overall, MuSC abundance, activation, and proliferation appear to be associated with collagen content. Myonuclear number was similar between all muscles, but only in contractured muscles were there associations between myonuclear number, MuSC abundance, and fiber cross-sectional area. Puzzlingly, MuSC characteristics were similar between ambulatory and nonambulatory children. Noncontractured muscles in children with CP had a lower MuSC abundance compared with TD-ACL injured children, but similar myogenic characteristics. Contractured muscles may have an intrinsic deficiency in developmental progression for postnatal MuSC pool establishment, needed for lifelong efficient growth and repair.

Port Workers' Use of Medical Services in a Maritime Container Terminal in Costa Rica.

Supervised by three or four medical doctors and one nurse in rotating shifts, the medical clinic in Costa Rica's Moín Container Terminal is open 24/7 for visits from port workers. In our study, we aimed to identify the sociodemographic and clinical characteristics of a consecutive series of patients who attended the medical clinic for outpatient services during an 8-month period. Our descriptive study involved collecting patient records from the medical clinic during the first 8 months of 2021 (i.e., 1 January-31 August 2021), during which 3050 visits from 1301 port workers were registered. Terminal tractor drivers, crane operators, and stevedores were the most frequent job categories among the patients. Doping (i.e., ICD-10 Z03.6) was observed in 64% of the visits. The top ICD-10 codes among all other patients not observed to have engaged in doping (n = 469) were diseases of the musculoskeletal system (7.2%) and abnormal clinical and laboratory symptoms (6.2%). Problems with the musculoskeletal system were primarily back pain (36.0%), muscle contracture (30.1%), and secondary headache (25.2%). Two-thirds of the visits were due to screening for alcohol and drugs or doping; however, inconsistency in the coding system complicates the analysis of data, and a dropdown menu in the registration is therefore needed to prevent errors. Relative risk calculations are impossible due to a lack of data about the at-risk population but should be pursued under different circumstances in future studies. In the support chain of goods, the medical clinic in the port plays a key role in saving time in shipping, which means that the injured or sick employees in most cases can continue working. For the shipping industry, quick un- and offloading is very important to stay competitive in the market for transport.