Fresh Water Aquatic Training in Patients with Upright Posture Maintaining Disorders

The use of the fresh water aquatic training course, as a more gentle training method, may allow patients to ensure effective restoration of muscle functions responsible for maintaining an upright body position. A more accurate control of the course results can be performed using a virtual analysis carried out using the «Habilect» system that allows to determine the body parts attitude. Aim. To study the effect of training in fresh water using the Habilect system based on the Microsoft Kinect infrared sensor (video stabilometry) on motor functions that contribute to maintaining an upright body posture in patients with mild gait disturbances. Material and methods. An open descriptive study was conducted including 12 patients (7 men, 5 women), aged 40 to 62 years, with upright posture maintaining disorders, which correspond to the functional diagnosis encoded by the ICF «Gait Stereotype Functions» B770.1 – mild violations (5–24%). A group of subjects (n = 12), in addition to basic therapy and training with an exercise therapy instructor, underwent aquatic training in fresh water for two weeks (30 minutes, 6 days a week). Assessment methods: the research was carried out using the Habilect gait video analysis system before and after the rehabilitation course. The χ2 test was used to assess the significance of differences between groups of qualitative variables. When analyzing quantitative variables, the Shapiro-Wilk’s (W) test was performed. For abnormal distribution, the data is in Me format [Q25-Q75]. The Wilcoxon T-test was used to assess the significance of differences in quantitative variables of the two studied groups. The processing of the obtained research results was carried out using the Statistica for Windows, v. 8.0 (StatSoft Inc., USA) and Microsoft Excel (Microsoft, USA). The significance of the differences was considered established at p <0.05. Result and discussion. When examining the amplitude of body deflection along the X-axis before training, they were 3.25 cm [-98 cm; 93.9 cm], after – -9.96 cm [-100.92 cm; -81.96 cm], on the Y-axis before training – -29.01 cm [-29.01 cm; 13.76 cm], after –-30.59 cm [-30.59 cm; 31.09 cm], on the Z-axis before training – 388.1 cm [369.22 cm; 393.39 cm], after training – 380.96 cm [377.98cm, 400.05 cm], deviation of the body movement vector before training 16.45 cm [7.46 cm; 338.67 cm], after training – 324.7 cm [324.7 cm; 342.56 cm]. When examining the amplitude of head deflection along the X-axis before training, they were -0.92 cm [-1.24 cm; -0.92 cm], after – 1.5 cm [-10.19 cm; 2.38 cm], Y-axis before training – 125.33 cm [61.13 cm; 128.94 cm], after – 107.42 cm [52.49 cm; 107.42 cm], along the Z-axis before training – -8.59 cm [-8.97 cm; -5.33 cm], after training – -14.89 cm [-14.89 cm, -3.45cm]. When calculating the increase in deviation (deviations of the main body axes from the initial value) using the Wilcoxon T-test revealed statistically significant deviations in the X-axis (an increase of 306.5%, p = 0.0504), the Z-axis (an increase of 112.68%, p =0.0225) and the Body Angle parameter (an increase of 1973.86% p = 0.0323). When calculating the increase in the deviation of the head axes from the initial value using the Wilcoxon T-test, statistically significant deviations were revealed along the X axis (increase of 163.04%, p = 0.0280), the Y axis (increase of 85.71%, p = 0.0199) and the parameter Z (an increase of 173.34% p = 0.0292). The study revealed a decrease in the body axes deviations amplitude in all 3 planes, which indicates an improvement in the work of all brain parts that are responsible for the coordination of motor functions and their vegetative support, an improvement in functional interaction within individual muscle chains. The reduction in the head and neck muscles in compensatory balancing participation during walking and maintaining a vertical body posture mainly due to the muscles of the lower extremities and pelvis contributes to the prevention of arterial and venous circulation disorders in the head and neck and makes training not only more effective, but also safer. Conclusion. Due to the decrease in the amplitude of deviations along all three axes (Z, Y, X), the course of aquatic training contributes to the correction of upright posture maintaining disorders, a statistically significant decrease in the amplitude of head and neck movements.

The Macromicroscopic Anatomy and Microtopography of the Lower Jaw in Fetuses of 14–18 Weeks

In the article the features of anatomical structure and microtopography of the lower jaw of fetus at the age of 14–18 weeks were discussed. The relevance of the research is due to the prevalence of congenital pathology of the maxillofacial region, the possibilities of its early prenatal diagnosis and correction in connection with the development of fetal surgery.The aim of the research is to get new data of the macromicroscopic anatomy and microtopography of the lower jaw in fetuses of 14–18 weeks.Material and methods. The object of the research was the lower jaw of 40 male and female fetuses at the age of 14–18 weeks. The research was carried out using morphological methods and the method of ultrasound scanning. The qualitative and quantitative characteristics of the lower jaw were studied.Results. The lower jaw of the fetus at the age of 14–18 weeks is already formed and has basic anatomical structures. The body, angle, ramus, condylar and coronoid processes, teeth anlages, which can be described on morphological preparations and studied using the method of ultrasound scanning, are defined in the lower jaw. In front of the lower jaw, soft tissues are located, their thickness varies from 2.1 to 3.9 mm. Behind the lower jaw, there is a slit space with a width of 0.3 to 1.5 mm, behind it the tongue and the oral part of the pharynx are situated. The latter has an irregular shape. In a fetus of 14-18 weeks, major salivary glands (parotid, sublingual and submandibular) are already formed and determined on different cuts. The length of the alveolar arch is 29.1±6.2 mm, the width of the lower jaw is 19.5±4.2 mm. At this time, the lower jaw can be presented by two anlages and a symphysis located along the median line. The symphysis on horizontal cut has a fusiform shape, it narrows to the outer and inner surfaces of the lower jaw. In the narrow part, its size varies from 0.1 to 0.4 mm, the extension in the central part is from 0.5 to 0.9 mm. In the lower jaw, the anlages of decidual teeth of an irregular shape are determined. The size of anlages varies from 1.3 to 2.3 mm, depending on the type of tooth. On some cuts under the anlage of primary tooth, it is possible to determine the anlage of permanent one. The significant bilateral and sex differences of human fetuses at the age of 14–18 weeks of intrauterine development were not revealed.Conclusion. The lower jaw of fetuses at the age of 14–18 weeks has all elements of the anatomical structure, with certain fetal features (incomplete accretion of the mandibular processes, anlages of decidual and permanent teeth, microtopographic relationships with adjacent anatomical structures). At this stage of development, there are no significant bilateral and sex differences. The use of various methodological approaches to the research of the qualitative and quantitative anatomy of the lower jaw makes it possible to detail and supplement the substantiation of approaches for fetal surgery.

What are risk factors for subsequent fracture after vertebral augmentation in patients with thoracolumbar osteoporotic vertebral fractures

Background Due to its unique mechanical characteristics, the incidence of subsequent fracture after vertebral augmentation is higher in thoracolumbar segment, but the causes have not been fully elucidated. This study aimed to comprehensively explore the potential risk factors for subsequent fracture in this region. Methods Patients with osteoporotic vertebral fracture in thoracolumbar segment who received vertebral augmentation from January 2019 to December 2020 were retrospectively reviewed. Patients were divided into refracture group and non-refracture group according to the occurrence of refracture. The clinical information, imaging findings (cement distribution, spine sagittal parameters, degree of paraspinal muscle degeneration) and surgery related indicators of the included patients were collected and compared. Results A total of 109 patients were included, 13 patients in refracture group and 96 patients in non-refracture group. Univariate analysis revealed a significantly higher incidence of previous fracture, intravertebral cleft (IVC) and cement leakage, greater fatty infiltration of psoas (FIPS), fatty infiltration of erector spinae plus multifidus (FIES + MF), correction of body angle (BA), BA restoration rate and vertebral height restoration rate in refracture group. Further binary logistic regression analysis demonstrated previous fracture, IVC, FIPS and BA restoration rate were independent risk factors for subsequent fracture. According to ROC curve analysis, the prediction accuracy of BA restoration rate was the highest (area under the curve was 0.794), and the threshold value was 0.350. Conclusions Subsequent fracture might cause by the interplay of multiple risk factors. The previous fracture, IVC, FIPS and BA restoration rate were identified as independent risk factors. When the BA restoration rate exceeded 0.350, refractures were more likely to occur.

Mandibular reconstruction with microvascularized graft after ameloblastoma resection: case series

Ameloblastoma is a locally aggressive and highly infiltrative tumor with a high recurrence rate. Its multicystic form the recommended treatment is resection with a safety margin, which results in significant facial defects with esthetic and functionals repercussions. Microvascular surgery revolutionized the reconstruction of significant defects because these grafting techniques allow a more satisfactory aesthetic and functional restoration. This study aimed to report a series of cases of reconstructions of mandibular defects using microvascularized fibular graft after ameloblastoma resection. Six patients were included in this study, and we collected data related to the surgical procedure, diagnosis, complications and follow-up. The patients were characterized as four women and two men, with a mean age of 23.8 years, with a diagnosis of mandibular ameloblastoma located mainly in the body, angle and mandibular ramus. These patients underwent lesion resection, resulting in defects larger than 5 cm, which justified using a microvascularized fibular graft for its reconstruction. The patients evolved well, with good results and without recurrences or complications in a postoperative follow-up of 2 to 5 years. Ameloblastoma is a lesion that reaches large dimensions and causes excellent cosmetic and functional damage. The microvascularized graft is an alternative in reconstructing significant defects and allows satisfactory morphofunctional reestablishment with minimal complications.

A biomechanical examination of the inclusion of active flexibility in artistic gymnastic movements requiring mobility

Background and Study Aim. The purpose of the study is a biomechanical examination of the inclusion of active flexibility in artistic gymnastic movements requiring mobility (muscles' ability to stretch), flexibility and other motor abilities such as force, power, etc. Material and Methods. The study included 17 girl gymnasts aged 7-9 years old, with a body height of 140.7±10.2, weight of 34.1±6.4, and a body mass index of 17.6±3.0. Data collection in the study was made by using performance tests developed by FIG such as a Forward-Backward Split, Side Spit, Arm-Trunk Angle Backward, Trunk Bent Forward, Leg Raise forward, Leg Raise Sideward, Bridge, Standing long Jump, Lift Trunk Forward-60secs, Angle Degree of the Leg Split Position in Cartwheel, and Arm-Upper Body Angle Backward in Bridge Technique. The Kinovea 0.8.15 program was used in the data analysis of the variables in the study. The SPSS 24 software program was used for the data analysis. Percentages of the angle degree calculated by the formula “%= (angle0 of the mobility in functional movement / angle0 of the active flexibility) *100” were found. Results. Results indicate that active flexibility was 90% functional in the leg raise sideward, 90% in the leg split during execution of the cartwheel, 17.5% in the bridge technique, and completely functional for the flexibility ratio expressed in the leg raise forward technique. In the analysis of the various elements of the similar biomechanics, the anatomic structure and similar body planes, it was concluded that active flexibility expressed in the movements required a mobility of around 65-75%. Conclusions.. it was determined that the functionality rate of the techniques requiring active flexibility and requiring mobility of the same biomechanical and anatomical structure was around 65-75%. Therefore, to execute 100% of the flexibility in action (during active elements) as it is in a passively or actively, it may significantly increase force, motor control, dynamic balance, coordination etc., in the large range of motion.

Restoration of Some Anatomical Dimensions By Spiron Short Stem Hip Replacement Applied To Vietnamese People

Background: The process of using proximal bone in hip arthroplasty will allow the remaining bone to be preserved in future surgeries. To take advantage of these advantages, many types of short stem prosthetics have been developed in recent years. The obtained survey parameters combined with the obtained anatomical parameters shown that the Spiron joint is suitable when applied to adult Vietnamese.Research subjects and methods: The anatomical dimensions of the hip joint related to Spiron joint replacement were analyzed by the authors.Results: The anatomical results with Spiron showed that the acetabular average diameter and tilt angle were 49.77 mm and 41.55°. The femoral neck-to-body angle, the femoral upper-neck diameter, the distance from the crest to the hard shell along the femoral neck axis was on average 131.52°, 34, 32mm, and 51.39mm, respectively. The offset distance from the center of the crest to the axis of the femur is 38.33mm. These parameters show the working ability as well as stability when replaced by the Spiron joint.Conclusion: When applied to adult Vietnamese, the femoral neck diameter is consistent with the Spiron diameter. Preoperative planning is needed to check the femoral neck angle and femoral neck length prior to surgery to see if the Spiron joint replacement is eligible. The findings of this study support the assumption that it is feasible to use Spiron prostheses in joint replacement in Vietnamese adults.

Idiosyncratic Characteristics of Postural Sway in Normal and Perturbed Standing

ObjectiveAre people with a characteristically large physiological sway rendered particularly unstable when standing on a moving surface? Is postural sway in standing individuals idiosyncratic? In this study, we examine postural sway in individuals standing normally, and when subtle continuous sinusoidal disturbances are applied to their support platform. We calculate consistency between conditions to verify if sway can be considered characteristic of each individual. We also correlate two different aspects of participants’ responses to disturbance; their sway velocity and their regulation of body orientation.MethodsNineteen healthy adults (age 29.2 ± 3.2 years) stood freely on footplates coaxially aligned with their ankles and attached to a motorized platform. They had their eyes closed, and hips and knees locked with a light wooden board attached to their body. Participants either stood quietly on a fixed platform or on a slowly tilting platform (0.1 Hz sinusoid; 0.2 and 0.4 deg). Postural sway size was separated into two entities: (1) the spontaneous sway velocity component (natural random relatively rapid postural adjustments, RMS body angular velocity) and (2) the evoked tilt gain component (much slower 0.1 Hz synchronous tilt induced by the movement of the platform, measured as peak-to-peak (p-p) gain, ratio of body angle to applied footplate rotation).ResultsThere was no correlation between the velocity of an individual’s sway and their evoked tilt gain (r = 0.34, p = 0.15 and r = 0.30, p = 0.22). However, when considered separately, each of the two measurements showed fair to good absolute agreement within conditions. Spontaneous sway velocity consistently increased as participants were subjected to increasing disturbance. Participants who swayed more (or less) did so across all conditions [ICC(3,k) = 0.95]. Evoked tilt gain also showed consistency between conditions [ICC(3,k) = 0.79], but decreased from least to most disturbed conditions.ConclusionThe two measurements remain consistent between conditions. Consistency between conditions of two very distinct unrelated measurements reflects the idiosyncratic nature of postural sway. However, sway velocity and tilt gain are not related, which supports the idea that the short-term regulation of stability and the longer-term regulation of orientation are controlled by different processes.

A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: a retrospective study

Objectives The purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures. Methods We retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, and radiological findings were assessed and compared among the 3 groups. Results All of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05). Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperation and the POPSF group had the best improvements in the last follow-up (P < 0.05). Conclusion Both PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment, and the radiation times.

A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: A retrospective study

Objectives The purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures. Methods We retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, radiological findings were assessed and compared among the 3 groups. Results All of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05).Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperatio and the POPSF group had the best improvements in the last follow up (P < 0.05). Conclusion Both PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment and the radiation times.