Subacute Stage Research Articles

Comparisons of postural control, proprioception, muscle strength, pain and disability between individuals with acute, subacute and chronic low back pain

Purpose/Aim Postural control, proprioception and lower extremity muscle strength are affected in individuals with low back pain (LBP). However, it is yet unknown whether these variables differentiate between acute, subacute and chronic stages of LBP. The aim was to investigate if there were any differences in postural control, proprioception, lower extremity muscle strength, pain intensity and disability between individuals in the different stages of LBP. Materials and Methods In this cross-sectional study, 124 individuals with LBP were grouped as acute LBP (ALBP) (n = 38), subacute LBP (SLBP) (n = 30) and chronic LBP (CLBP) (n = 56) groups. Postural control was assessed via computerised technology. Lumbar proprioception, lower extremity muscle strength, pain intensity and disability were assessed using Joint Repositioning Error Test, hand-held dynamometer, Numeric Rating Scale and Oswestry Disability Index (ODI), respectively. Kruskal–Wallis Tests, ANCOVA and post hoc Mann–Whitney U-Test with Bonferroni correction were performed. Results While there were no significant differences in terms of postural control, proprioception and pain intensity (p > 0.05), significant differences were found in terms of lower extremity muscle strength and ODI scores between groups when adjusted for age (p < 0.05). Individuals with CLBP demonstrated poorer lower extremity muscle strength than those with ALBP and SLBP, and higher disability than those with ALBP (p < 0.017). Conclusions Although postural control, proprioception and pain intensity were similar between individuals with acute, subacute and chronic LBP, muscle strength and disability seem to worsen stepwise as the pain becomes chronic. Muscle strength and disability should be taken into account while evaluating and/or managing individuals with acute and subacute stages of LBP.

Involvement of chemokine receptor CXCR3 in the defense mechanism against Neospora caninum infection in C57BL/6 mice.

C-X-C motif chemokine receptor 3 (CXCR3) is an important receptor controlling the migration of leukocytes, although there is no report regarding its role in Neospora caninum infection. Herein, we investigated the relevance of CXCR3 in the resistance mechanism to N. caninum infection in mice. Wild-type (WT) C57BL/6 mice and CXCR3-knockout (CXCR3KO) mice were used in all experiments. WT mice displayed a high survival rate (100%), while 80% of CXCR3KO mice succumbed to N. caninum infection within 50 days. Compared with WT mice, CXCR3KO mice exhibited significantly lower body weights and higher clinical scores at the subacute stage of infection. Flow cytometric analysis revealed CXCR3KO mice as having significantly increased proportions and numbers of CD11c-positive cells compared with WT mice at 5 days post infection (dpi). However, levels of interleukin-6 and interferon-γ in serum and ascites were similar in all groups at 5 dpi. Furthermore, no differences in parasite load were detected in brain, spleen, lungs or liver tissue of CXCR3KO and WT mice at 5 and 21 dpi. mRNA analysis of brain tissue collected from infected mice at 30 dpi revealed no changes in expression levels of inflammatory response genes. Nevertheless, the brain tissue of infected CXCR3KO mice displayed significant necrosis and microglial activation compared with that of WT mice at 21 dpi. Interestingly, the brain tissue of CXCR3KO mice displayed significantly lower numbers of FoxP3+ cells compared with the brain tissue of WT mice at 30 dpi. Accordingly, our study suggests that the lack of active regulatory T cells in brain tissue of infected CXCR3KO mice is the main cause of these mice having severe necrosis and lower survival compared with WT mice. Thus, CXCR3+ regulatory T cells may play a crucial role in control of neosporosis.

Inhibition of Notch 1 signaling in the subacute stage after stroke promotes striatal astrocyte-derived neurogenesis.

Inhibition of Notch1 signaling has been shown to promote astrocyte-derived neurogenesis after stroke. To investigate the regulatory role of Notch1 signaling in this process, in this study, we used a rat model of stroke based on middle cerebral artery occlusion and assessed the behavior of reactive astrocytes post-stroke. We used the γ-secretase inhibitor N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester (DAPT) to block Notch1 signaling at 1, 4, and 7 days after injury. Our results showed that only administration of DAPT at 4 days after stroke promoted astrocyte-derived neurogenesis, as manifested by recovery of white matter fiber bundle integrity on magnetic resonance imaging, which is consistent with recovery of neurologic function. These findings suggest that inhibition of Notch1 signaling at the subacute stage post-stroke mediates neural repair by promoting astrocyte-derived neurogenesis.

Trening hoda uz pomoć robotizovanih trenažera hoda kod osoba nakon moždanog udara

A gait disorder, which arose as a result of a stroke, leads to a significant disability. The main goal of neurorehabilitation is to restore the function of independent movement through conventional physiotherapy, but also the application of Robot-assisted Gait Training. The aim of this paper is to analyze the current use of robotic gait trainers in the rehabilitation of gait in people after a stroke. In clinical practice, there are different types of devices that are adapted for people, both in the subacute and chronic stages after suffering a stroke. Changes in gait function resulting from the use of robotic gait trainers, such as increases in gait speed, stride length, and spatial symmetry, are evident in clinical practice. However, there is a lack of follow-up evaluations and long-term effects, as well as risk assessment of the use of these devices in gait rehabilitation in people after a stroke.

Патологія пародонту при системному червоному вовчаку

Introduction. Periodontal disease (PD), including gingivitis and periodontitis, is a very common disease worldwide. The prevalence of gingivitis ranges from 38% to 85%. There is increasing evidence that oral dysbiosis as well as periodontitis-related pathogens may be involved in the pathophysiology of autoimmune inflammatory diseases, including systemic lupus erythematosus (SLE). Methods. Based on the analysis of scientific sources, establish the main pathological aspects of periodontal damage in SLE. Results. The clinical picture of the condition of peri-dental tissues in SLE was represented by a polymorphic combination characterized by hypertrophic and catarrhal lesions of the periodontium in acute and subacute stages of periodontitis, which is mostly untreatable without correcting the therapy of the underlying disease. The X-ray picture was characterized by thinning of the top of the interdental septa (especially the compact bone plate) and diffuse osteoporosis of the bone tissue. Gross destructive bone resorption is uncharacteristic for SLE. At the same time, radiological changes in the bone tissue of the jaws, as a rule, were uniform throughout the alveolar edge, which indicated the simultaneous involvement in the process in the entire area and the systemic (caused by the main rheumatic disease) genesis of periodontal changes. The results of studies of periodontal tissues showed that patients with SLE do not have a big difference in the values of hygiene indices and gum condition, but have low periodontal indices due to the smaller depth of periodontal pockets compared to the group of somatically healthy patients. Researchers explain this fact mainly by the effects of long-term use of hormonal drugs and, possibly, the lower pathogenicity of the microflora of the oral cavity. Conclusions. SLE affects the periodontium. In most cases, periodontitis with SLE has a hypertrophic and catarrhal character with more pronounced bleeding and granulations from periodontal pockets.

Abnormal Morphology of Blood Vessels in Erythematous Skin from Atopic Dermatitis Patients

Background: Atopic dermatitis is a lesion of skin that affects the blood vessels originated from the vascular plexus. It is a pruritic inflammatory lesion with continuous relapses in between. It has an unknown etiology with no evidence of interaction between environmental and genetic factors. AD has many manifestations including; allergic skin reactions, rhinitis and asthma. This study will illustrate the morphological changes associated with the person suffering from erythematous skin in AD patients. Methods: It is a case control study which has included 40 participants aged between 20-65 years including 20 AD and 20 healthy patients. Study was conducted between the time period of Dec 2021 to Nov, 2022. Cases included all those patients who were diagnosed with AD from a period of at least 3 months whereas controls were taken by matching the age and race with the cases population. Specimens of skin were collected from all the patients and then observed under a photon microscope. Results: Results of the study states that the patients suffering from AD demonstrate thick, complex vessels of blood causing increased flow of blood within the erythematous as well as non-erythematous skin. It suggests that these morphological changes are not observed in all acute and subacute stages but only in chronic stages. In addition, bifurcation was absent in both the lesions either lichenification or erythematous. Practical implication: This study will help the clinicians to understand the morphological changes that occur in atopic dermatitis patients in order to differentiate them from the normal population. Further, it will help the community to differentiate themselves on the basis of the signs and symptoms associated with Atopic dermatitis patients. Conclusion: Study concluded that these results will be helpful in the development of clinical strategies for the treatment of eczema in AD patients. Keywords: Atopic dermatitis, lichenification, flexuous blood vessels, pruritus, eczema, vascular endothelial growth factor.

Rights of Others and Public Health Strategies: Medical Support at the Subacute Stage in Arrival Phase of the Afghan Special Contributors’ Resettlement

Major health problems of the refugee and asylum seeker can be managed effectively to reduce vulnerability and risk of society, and contribute to population health. In this context, this article outlines the experience of the health and medical support for Afghan special contributors in 2021-2022, Yeosu, Republic of Korea. It is intended to find a meaningful implication in that it provided an opportunity to consider about the specificity of the migrant health and public health problems that our society faces in the process of providing a care of early stages of the migrant cycle. In other words, the management of health problems of ‘others’ who came from another places without awareness can be emphasized an important policy targets and means to reach the both goals, ‘human rights’ and ‘social safety.’

FNIRS-based brain functional response to robot-assisted training for upper-limb in stroke patients with hemiplegia.

Robot-assisted therapy (RAT) has received considerable attention in stroke motor rehabilitation. Characteristics of brain functional response associated with RAT would provide a theoretical basis for choosing the appropriate protocol for a patient. However, the cortical response induced by RAT remains to be fully elucidated due to the lack of dynamic brain functional assessment tools. To guide the implementation of clinical therapy, this study focused on the brain functional responses induced by RAT in patients with different degrees of motor impairment. A total of 32 stroke patients were classified into a low score group (severe impairment, n = 16) and a high score group (moderate impairment, n = 16) according to the motor function of the upper limb and then underwent RAT training in assistive mode with simultaneous cerebral haemodynamic measurement by functional near-infrared spectroscopy (fNIRS). Functional connectivity (FC) and the hemisphere autonomy index (HAI) were calculated based on the wavelet phase coherence among fNIRS signals covering bilateral prefrontal, motor and occipital areas. Specific cortical network response related to RAT was observed in patients with unilateral moderate-to-severe motor deficits in the subacute stage. Compared with patients with moderate dysfunction, patients with severe impairment showed a wide range of significant FC responses in the bilateral hemispheres induced by RAT with the assistive mode, especially task-related involvement of ipsilesional supplementary motor areas. Under assisted mode, RAT-related extensive cortical response in patients with severe dysfunction might contribute to brain functional organization during motor performance, which is considered the basic neural substrate of motor-related processes. In contrast, the limited cortical response related to RAT in patients with moderate dysfunction may indicate that the training intensity needs to be adjusted in time according to the brain functional state. fNIRS-based assessment of brain functional response assumes great importance for the customization of an appropriate protocol training in the clinical practice.

Screening the immune-related circRNAs and genes in mice of spinal cord injury by RNA sequencing.

Spinal cord injury (SCI) is a pathological condition that leading to serious nerve damage, disability and even death. Increasing evidence have revealed that circular RNAs (circRNAs) and mRNA are widely involved in the regulation of the pathological process of neurological diseases by sponging microRNAs (miRNAs). Nevertheless, the potential biological functions and regulatory mechanisms of circRNAs in the subacute stage of SCI remain unclear. We analyzed the expression and regulatory patterns of circRNAs and mRNAs in SCI mice models using RNA-sequencing and bioinformatics analysis. A total of 24 circRNAs and 372 mRNAs were identified to be differentially expressed. Then we identifying the immune-related genes (IRGs) from them. The protein-protein interaction network were constructed based on the STRING database and Cytoscape software. Furthermore, Go and KEGG enrichment analysis were conducted to predict the functions of the IRGs and host genes of DECs. These findings will contribute to elucidate the pathophysiology of SCI and provide effective therapeutic targets for SCI patients.

Physiotherapy for complete motor recovery in 4-year-old child with Guillain Barre syndrome- A case study

This study was conducted in 4-year-old male child in sub-acute stage of Guillain Barre Syndrome (GBS) for 12 weeks in a local clinical setup after discharge from the hospital completing IVIG dose. Physiotherapy was given for 12 weeks, 5 days in a week of 1 and half hour session per day with rest periods between the session. Physiotherapy intervention includes passive – active exercise, resisted exercise, weight bearing exercise, mat activities, breathing exercises, task-oriented exercise, balance and coordination exercise, abdominal strengthening, gait training, and play activities. Outcomes used before and after the intervention were Manual Muscle Test (MMT), Five Times Sit to Stand Test (FTSST), Functional independent Measure (FIM), Time Up and Go test (TUG) and Hand dynamometer to analyse the effects of physiotherapy intervention. This study concluded that there was a significant improvement in patient’s motor functions and independence in daily activities after an effective physiotherapy treatment. There was a complete motor recovery after 12 weeks of physiotherapy.

Single cell profiling of CD45+ spinal cord cells reveals microglial and B cell heterogeneity and crosstalk following spinal cord injury

BackgroundImmune cells play crucial roles after spinal cord injury (SCI). However, incomplete knowledge of immune contributions to injury and repair hinders development of SCI therapies. We leveraged single-cell observations to describe key populations of immune cells present in the spinal cord and changes in their transcriptional profiles from uninjured to subacute and chronic stages of SCI.MethodsDeep-read single-cell sequencing was performed on CD45+ cells from spinal cords of uninjured and injured Swiss-webster mice. After T9 thoracic contusion, cells were collected 3-, 7-, and 60-day post-injury (dpi). Subpopulations of CD45+ immune cells were identified informatically, and their transcriptional responses characterized with time. We compared gene expression in spinal cord microglia and B cell subpopulations with those in published models of disease and injury. Microglia were compared with Disease Associated Microglia (DAM) and Injury Responsive Microglia (IRM). B cells were compared to developmental lineage states and to an Amyotrophic Lateral Sclerosis (ALS) model.ResultsIn uninjured and 7 dpi spinal cord, most CD45+ cells isolated were microglia while chronically B cells predominated. B cells accumulating in the spinal cord following injury included immature B to mature stages and were predominantly found in the injury zone. We defined diverse subtypes of microglia and B cells with altered gene expression with time after SCI. Spinal cord microglia gene expression indicates differences from brain microglia at rest and in inflammatory states. Expression analysis of signaling ligand–receptor partners identified microglia–B cell interactions at acute and chronic stages that may be involved in B cell recruitment, retention, and formation of ectopic lymphoid follicles.ConclusionsImmune cell responses to SCI have region-specific aspects and evolve with time. Developmentally diverse populations of B cells accumulate in the spinal cord following injury. Microglia at subacute stages express B cell recruitment factors, while chronically, they express factors predicted to reduce B cell inflammatory state. In the injured spinal cord, B cells create ectopic lymphoid structures, and express secreted factors potentially acting on microglia. Our study predicts previously unidentified crosstalk between microglia and B cells post-injury at acute and chronic stages, revealing new potential targets of inflammatory responses for SCI repair warranting future functional analyses.

Development of a Short-Form Stroke Impact Scale Using a Machine Learning Algorithm for Patients at the Subacute Stage.

Several short forms of the Stroke Impact Scale Version 3.0 (SIS 3.0) have been proposed in order to decrease its administration time of about 20 min. However, none of the short-form scores are comparable to those of the original measure. To develop a short-form SIS 3.0 using a machine learning algorithm (ML-SIS). We developed the ML-SIS in three stages. First, we calculated the frequencies of items having the highest contribution to predicting the original domain scores across 50 deep neural networks. Second, we iteratively selected the items showing the highest frequency until the coefficient of determination (R2) of each domain was ≥.90. Third, we examined the comparability and concurrent and convergent validity of the ML-SIS. Hospitals. We extracted complete data for 1,010 patients from an existing data set. Twenty-eight items were selected for the ML-SIS. High average R2s (.90-.96) and small average residuals (mean absolute errors and root-mean-square errors = 0.49-2.84) indicate good comparability. High correlations (rs = .95-.98) between the eight domain scores of the ML-SIS and the SIS 3.0 indicate sufficient concurrent validity. Similar interdomain correlations between the two measures indicate satisfactory convergent validity. The ML-SIS uses about half of the items in the SIS 3.0, has an estimated administration time of 10 min, and provides valid scores comparable to those of the original measure. Thus, the ML-SIS may be an efficient alternative to the SIS 3.0. What This Article Adds: The ML-SIS, a short form of the SIS 3.0 developed using a machine learning algorithm, shows good potential to be an efficient and informative measure for clinical settings, providing scores that are valid and comparable to those of the original measure.

Clinical application of multicolor imaging in Leber hereditary optic neuropathy.

To characterize features of retinal never fiber in Leber Hereditary Optic Neuropathy (LHON) using multicolor (MC) imaging and color fundus photography (CFP). Ninety-two eyes of patients with LHON underwent MC imaging, optic disc spectral domain optical coherence tomography (SD-OCT), and CFP. Two independent observers graded RNFL visibility scores and two other experts determined never fiber bundle defects from four-quadrant readings. CFP, standard MC, infrared reflectance (IR), green reflectance (GR), blue reflectance (BR), and green-blue-enhanced (BG) imaging were compared. Agreement on never fiber bundle defects was substantial for CFP, standard MC, GR, BR, and BG images relative to IR. It was shown that BR (2.71 ± 0.55) had the best mean RNFL visibility score, BG (2.69 ± 0.52), GR (2.69 ± 0.56), standard MC (2.04 ± 0.79), CFP (1.80 ± 0.82), and IR (0.45 ± 0.59) followed. Agreement on temporal area defects was relatively improved. Youden's indices for CFP (78.21%), standard MC (84.48%), GR (90.92%), BR (89.64%), and BG (90.99%) indicated good detection of defects in the papillomacular bundle (PMB)/ high suspicion of patients with LHON, particularly for BG and GR. According to the proportion of never fiber bundle defects, standard MC, GR, BR, and BG can roughly determine the LHON clinical stage, especially in subacute and chronic stages, and standard MC is superior for patients with LHON of all stages. The stage judged by MC was consistent with the course inferred by pRNFL thickness. As an adjunct to SD-OCT, the MC image, particularly the GR and BG can delineate RNFL more effectively than CFP. The MC image may be a useful adjunct to OCT for detecting or monitoring never fiber bundle defects, providing inexpensive and rapid methods that can quickly identify patients with high suspicion of LHON.

Caster Walker GAIT Trainer (CGT): A robotic assistive device

Stroke has become one of the leading causes of lower limb paresis. Costing the patients, a fortune for its diagnosis and prognosis. Clinical experimentations have proven that one can regain ambulation if the rehabilitation is started in the acute or sub-acute stage. Traditional mode of rehabilitation include manual therapies which are labor-intensive and time consuming. Therefore, robotic training are preferred over manual therapies. Nevertheless, there are some limitations such as devices are bulky and complex, some are not portable, others need body weight support system, and costly. To address such issues, this paper proposes development of a new Caster Walker Gait Trainer (CGT) for gait rehabilitation. CGT is an end-effector based passive device in which Stephenson III six-bar linkage has been implemented to mimic the kinematics of a healthy gait. The trainer device uses a belt-pulley system for providing motion to the linkage. The lower limb of the patient gets the drive as he/she pushes the cater walker forward or backward. The paper also proposed the optimal design of defect-free Stephenson III six-bar linkage using loop-by-loop approach. To design the linkage, an optimal problem is formulated, and tear drop ankle trajectory is desired. The optimization problem is solved using a nature-inspired algorithm and it is found that the trajectory generated by the synthesized mechanism is able to mimic the desired trajectory. Then using the notion of inverse kinematics, hip and knee trajectories are obtained from the generated ankle trajectory for validation.

Technetium-99m labelled somatostatin analogue myocardial uptake in subacute and “old” myocardial infarction: initial experience

Background. It has been shown that prognosis following acute myocardial infarction (MI) strongly correlates with intensity of inflammatory reactions in response to myocardial injury. Thereby diagnostic methods for myocardial post-infarction inflammation (PII) monitoring are needed. Scintigraphy with somatostatin receptor targeted radiotracers has prospects for PII imaging, but its clinical value is poorly studied.Methods. Six patients with ST-segment elevation anterior myocardial infarction (STEMI) were examined by chest SPECT/СT with 99mTc-Tektrotyd and rest myocardial perfusion scintigraphy (MPS) at subacute and remote (8 th month) period of the disease. Parameters of both scintigraphic methods were estimated.Results. In subacute stage of MI myocardial perfusion defects were revealed in all 6 patients (mean SRS 11.83 ± 8.89), 99mTc-Tektrotyd uptake in myocardium was revealed in 3 of 6 patients. At remote period intense uptake of 99mTc-Tektrotyd was found only in 1 patient. This uptake was more spread and clears, comparing with accumulation in subacute stage of AMI.Conclusion. Myocardium scintigraphy with 99mTc-Tektrotyd allows identifying overexpression of somatostatin receptors in areas of recent and old myocardium infarction. In some patients the radiopharmaceutical uptake may expands to a remote period of the disease. Further larger studies and histological validation of scintigraphic results are needed.

Risk factors for constipation in patients with acute and subacute ischemic stroke: A retrospective cohort study

BackgroundThe objective of this study was to examine the incidence of constipation and the risk factors for patients with ischemic stroke in acute and subacute stage. MethodsIn this retrospective cohort study, patients with acute and subacute ischemic stroke in the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine between 2019 and 2021 were analyzed. Univariate and multivariate analysis were conducted using demographic characteristics, clinical evaluations, and stroke related complications, to explore the risk factors of constipation after stroke. ResultsOf the 222 patients with acute and subacute ischemic stroke, 128 (57.7 %) developed constipation. Univariate analysis revealed that pulmonary infection, NIHSS, ADL, KWST scores and nutritional status were significantly associated with post-stroke constipation (p < 0.05). Binomial logistic regression showed that NIHSS score is the independent risk factors of the poststroke constipation, and patients with NIHSS score >8.5 had higher risk for constipation. ConclusionsCurrent findings suggested a significant interaction between constipation and NIHSS score in stroke patients, providing new insights into therapeutic target for neural functional recovery among patients with acute and sub-acute ischemic stroke.

Constrained spherical deconvolution -based tractography of major language tracts reveals post-stroke bilateral white matter changes correlated to aphasia

PurposeUsing constrained spherical deconvolution (CSD)-based tractography, we aimed to obtain conjoint analysis of diffusion measures of major language white matter (WM) tracts in post-stroke aphasic patients bilaterally, and to correlate the measures of each tract to the different language deficits. Material and methods17 aphasic patients with left hemispheric stroke, at the subacute stage, and ten age- matched controls underwent diffusion MRI examination. CSD-based tractography was performed. Diffusion measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD)] were extracted after dissection of major language tracts bilaterally. Aphasia was assessed using language subset of hemispheric stroke scale. Comparisons of diffusion measures, for all tracts, between the two groups were performed. Partial correlations between the diffusion measures and different language components were obtained. ResultsIn the left hemisphere, significant lower FA and or higher MD with higher RD of patients' WM tracts compared to the control group. Significant differences of diffusion measures were also evident in the right hemisphere yet, less prominent. All changes reflected damage of the tracts' integrity. Significant correlations were found between comprehension and FA of the left arcuate fasciculus (AF) and left inferior longitudinal fasciculus. Additionally, a significant correlation was found between MD of the right AF and repetition. ConclusionConjoint analysis of diffusion measures, based on CSD tractography, can provide important markers for the underlying WM changes bilaterally. Moreover, our findings emphasize that language processing can be mediated by both ventral and dorsal streams and further highlight the contribution of the right AF in repetition.

Computed Tomography Criteria for Differential Evaluation of True and False Lumens in Aortic Dissection

The aim of study Based on computed tomography data, to determine the most characteristic criteria for true lumen (TL) and false lumen (FL) in aortic dissection. To identify the relationship of the studied features with the stage of aortic dissection. Materials of the study Computed tomography (CT) data of 115 patients diagnosed with aortic dissection (AD) who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The average age of the patients was 54.5 years (median — 56 years), men predominated in the studied group. AD types according to the De Bakey classification were distributed as follows: Type I — in 47% of patients, Type II — in 16.5%, Type III — in 36.5%. Dissection in the acute stage occurred in 62% of the patient, in the subacute — in 16%, in the chronic — 22%. Results In the studied group, FL in all cases prevailed over the TL by size, regardless of the stage and type of AD. Analysis of lumen ratio showed that in 63.55% of patients, FL occupied 75% or more of the aortic cross-sectional area. Location of FL: at the level of the ascending aorta, along the right and anterior walls of the aorta — 94.5%; in the descending thoracic aorta, along the posterior and left walls — 84%; in the abdominal aorta, along the posterior and left walls — 70%. Calcifications of the non- dissected part of the aortic wall, as a sign of a true lumen, were found in 59.1%. There was no correlation between calcification and the AD stage. Partial thrombosis of one of the lumens was detected in 59% (in FL — 85%, in TL — 13%, thrombosis of both lumens — 2%). The beak signs occurred in 85% of patients with AD, however, it was significantly more often detected in patients with acute and subacute AD stages than in the chronic stage (p&lt;0.001). The cobweb sign was found in one third of patients with AD, however, it was statistically significantly more often determined in patients in acute and subacute stages (p&lt;0.05). Conclusion CT is reasonably considered a highly informative method of diagnosing AD. The signs of true and false lumen presented in the work, as well as their combination, make it possible to perform a quick and error-free marking of the aortic lumen with a high degree of probability. A number of the described CT signs correlate with the stage of AD.

Ability of MRI Diagnostic Value to Detect the Evidence of Physiotherapy Outcome Measurements in Dealing with Calf Muscles Tearing

Background: Calf muscle tearing is one of the most sudden pain that affects the calf, foot, or thigh area. It can be diagnosed through Magnetic Resonance Imaging (MRI) and treated through physiotherapy interventions. The aim of the current study is to evaluate and assess the efficiency of physiotherapy interventions using Myofascial release and Stretching exercises in calf muscle treatment, and verification this effectiveness by traditional physiotherapy measurement tools and MRI. Methods: The study included 30 patients with at least one degree tearing of the calf muscles. All patients were undergoing leg MRI imaging using a 1.5 Tesla MRI. The Visual analogue scales (VAS) and Functional disability scale for ankle (FADI) were assessed before the patients were offered therapies. Then the patients were randomly distributed into two groups: the first group was 15 patients who were given Myofascial release treatment, while the second group was 15 patients who were given treatment using Stretching exercises. After treatment, the efficacy of treatment was checked for patients by different tools: VAS, FADI, and MR imaging. Patients' outcomes before and after treatment were compared. Results: The results showed that both Myofascial release and Stretching exercises had the same effect on patients. Comparison between pre- and post-score within groups for VAS, FADI, and MRI findings. Whereas, all P value values were less than 0.05 for all samples. When comparing the techniques presented for treatment between the two groups, the results showed that there were no differences between the two techniques in each of the VAS, FADI, and MRI findings, where the P-values post-treatment were 0.644, 0.112, and 0.831, respectively. Conclusion: Myofascial release and Stretching exercises can be used to treat calf muscle tears in the sub-acute stages.

Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study

Purpose Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. Materials and methods Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Results Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. Conclusions Experts agree effectiveness of interventions differs through the evolution of LR. IMPLICATIONS FOR REHABILITATION To date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition. Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication. Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered. Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.