SPECT/CT in the Evaluation of Suspected Skeletal Pathology

Dedicated multi-slice single-photon emission computed tomography/computed tomography (SPECT/CT) cameras have become widely available and are becoming a mainstay of clinical practice. The integration of SPECT and CT allow for precise anatomic location of scintigraphic findings. Fusion imaging with SPECT/CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. This review article addresses the technique, basic science principles, and applications of integrated SPECT/CT in the evaluation of musculoskeletal pathology.

Tryptophan-Kynurenine Pathway in COVID-19-Dependent Musculoskeletal Pathology: A Minireview

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), affecting multiple organ systems, including the respiratory tract and lungs. Several studies have reported that the tryptophan-kynurenine pathway is altered in COVID-19 patients. The tryptophan-kynurenine pathway plays a vital role in regulating inflammation, metabolism, immune responses, and musculoskeletal system biology. In this minireview, we surmise the effects of the kynurenine pathway in COVID-19 patients and how this pathway might impact muscle and bone biology.

Longitudinal study of occupational pathology risks in open-pit apatite miners of the Kola Peninsula

Mining in the Arctic is associated with an increased risk of developing occupational diseases. The aim of the study was to assess risks of developing occupational pathology over 10-year period of mining apatite ore in the Kola Arctic open-pit mines. We studied data on working conditions (certification of workplaces), health status (periodic medical examinations) and primary occupational pathology (monitoring "Working conditions and occupational morbidity of the population of the Murmansk region" in 2009-2018) of open-pit apatite miners. It was found that, according to an overall assessment, the working conditions of all 436 surveyed open-pit apatite miners corresponded to 3.2-3.3 hazard classes. During 10 years of employment (2009-2018), 88 (20.2%) miners were first diagnosed with 134 occupational diseases, which are 3.07 cases per 100 people per year. The main cause for their occurrence was the severity of work above the permissible level (39.6%), whole-body vibration (37.3%) and noise (17.9%), and their structure is dominated by vibration disease (35.8%) and musculoskeletal pathology (30.0%). The main factor in the occurrence of occupational diseases was recognized as imperfection of technological processes (58.2%). The risk of occupational pathology formation in the excavator drivers (RR=1.95; CI 1.33-2.86; p<0.001) and in the drilling rig drivers (RR=1.60; CI 1.04-2.47; p=0.031) was higher than that of bulldozer drivers. In 2009-2018, unlike the bulldozer and drilling rig drivers, the excavator drivers showed an increased risk of developing occupational diseases (RR=3.50; CI 1.90-6.43; p<0.001). In 2009-2018, the open-pit apatite miners of the Kola Peninsula retained a high level of occupational morbidity, and it tended to increase among excavator drivers.

Criteria for evaluation of educational achievements of primary school students with positional disorders in physical education lessons

The article substantiates the need to assess the success of junior high school students in physical education classes. The system of pedagogical control of coordination abilities of junior schoolchildren with postural disorders is presented, which objectively reflects the health effectiveness of physical education lessons in grades 1-4 and determines the quality of the process of motor training of students with musculoskeletal pathology. Given that coordination abilities and posture are interrelated, because since the mechanism of their development involves the same morphofunctional and psychophysiological indicators of the body, and informative strength and flexibility in forming a stereotype of posture, criteria for assessing the development of coordination skills, and as well as control tests and standards for assessing the strength of the muscular corset and flexibility of the spine of primary school children with posture defects. The choice of motor tests is related to the focus of exercise on the development of coordination skills, and also takes into account the informativeness of the strength of the muscular corset and the mobility of the spine. Objective criteria for assessing the academic achievements of students with postural disorders in physical education classes: in the motivational, cognitive and activity spheres are determined. There are three levels of academic achievement of student youth: low, medium, high. In an effort to achieve complete certainty in the establishment of a particular level, qualitative characteristics have been developed that allow to objectively assess the health effects of physical education lessons for students with posture defects.

Differences in the mechanisms of therapeutic action of platelet-rich plasma in the treatment of various joints

The paper presents the results of the application of the plasmolifting technique in the treatment of various types of musculoskeletal pathology and analyzes the possible mechanisms of the positive therapeutic effect of this technique. It is suggested that its success is in direct proportion to the composition of the tissues that make up a particular articular formation. It is supposed that the conditions for the positive therapeutic effect of the platelet auto-suspension technique include, first of all, the presence of a branched network of capillaries, which provides sufficient blood supply and, as a result, access to the sanitized tissue of granulocytic cells. The second condition is the presence of connective tissue formations containing basophils and mast cells, which, together with the endothelium of the above capillaries, secrete a sufficient amount of cytokines that trigger the therapeutic effect of this manipulation. A number of recommendations were made to increase the sanitizing effect of the plasmolifting technique on a specific joint formation.

Longitudinal study of medical downgrades in the Royal Air Force

IntroductionAs the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement.MethodDatabase of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region.Results2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among ‘high risk’ personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged.ConclusionMusculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.

Mineralizing potential of mixed saliva and the course of dental caries in children and adolescents with endocrine and musculoskeletal disorders

The features of microcrystallization and the mineralizing potential of mixed saliva, the intensity of caries in children and adolescents with endocrine pathology and pathology of the musculoskeletal system at the age of 9–10, 12–13 and 16–17 years have been studied, the relationship between the intensity of dental caries and the mineralizing potential of saliva has been revealed. The study of saliva in patients with endocrine pathology showed a low saliva mineralizing potential, crystals of type II and III were found, with a predominance of type III. The lowest mineralizing potential of saliva is observed at the age of 12–13 years. The carious process progresses with age and the subcompensated degree of activity prevails. The study of mixed saliva in patients with pathology of the musculoskeletal system showed a low mineralizing potential, crystals of types II and III were encountered, with a predominance of type III. The lowest mineralizing potential of saliva is observed at the age of 12–13 years. The carious process stabilizes over time and compensated degrees of activity prevail. The examinees with endocrine and musculoskeletal pathologies have reduced salivary mineralizing potential, high rates of intensity and degree of caries activity. In patients with endocrine pathology, indicators are worse than in patients with musculoskeletal pathology. The age of 12–13 is critical.

Musculoskeletal Pathology in Cerebral Palsy: A Classification System and Reliability Study

This article presents a classification of lower limb musculoskeletal pathology (MSP) for ambulant children with cerebral palsy (CP) to identify key features from infancy to adulthood. The classification aims to improve communication, and to guide referral for interventions, which if timed appropriately, may optimise long-term musculoskeletal health and function. Consensus was achieved by discussion between staff in a Motion Analysis Laboratory (MAL). A four-stage classification system was developed: Stage 1: Hypertonia: Abnormal postures are dynamic. Stage 2: Contracture: Fixed shortening of one or more muscle-tendon units. Stage 3: Bone and joint deformity: Torsional deformities and/or joint instability (e.g., hip displacement or pes valgus), usually accompanied by contractures. Stage 4: Decompensation: Severe pathology where restoration of optimal joint and muscle-tendon function is not possible. Reliability of the classification was tested using the presentation of 16 clinical cases to a group of experienced observers, on two occasions, two weeks apart. Reliability was found to be very good to excellent, with mean Fleiss’ kappa ranging from 0.72 to 0.84. Four-stages are proposed to classify lower limb MSP in children with CP. The classification was reliable in a group of clinicians who work together. We emphasise the features of decompensated MSP in the lower limb, which may not always benefit from reconstructive surgery and which can be avoided by timely intervention.