Effect of age on outcomes after allogeneic disc tissue supplementation in patients with chronic discogenic low back pain in the VAST trial

Aim: To explore the effects of viable allogeneic disc tissue supplementation in younger patients with discogenic chronic low back pain (CLBP). Patients & methods: VAST was a randomized placebo-controlled trial of disc allograft supplementation in 218 patients with discogenic CLBP. We conducted a post hoc analysis of change from baseline to 12 months in Oswestry Disability Index (ODI) and visual analog scale for pain intensity scores stratified by patient age. Results: Patients aged <42 years receiving allograft experienced greater improvement in ODI (p = 0.042) and a higher ODI response rate (≥10-, ≥15- and ≥20-point reductions in ODI) than those receiving saline (p = 0.001, p = 0.002 and p = 0.021, respectively). Conclusion: Young patients with discogenic CLBP may have significant functional improvement following nonsurgical disc allograft supplementation.

Very Early Initiation Reduces Benefits of Poststroke Rehabilitation Despite Increased Corticospinal Projections

Background. Although the effect of rehabilitation is influenced by aspects of the training protocol, such as initiation time and intensity of training, it is unclear whether training protocol modifications affect the corticospinal projections. Objective. The present study was designed to investigate how modification of initiation time (time-dependency) and affected forelimb use (use-dependency) influence the effects of rehabilitation on functional recovery and corticospinal projections. Methods. The time-dependency of rehabilitation was investigated in rats forced to use their impaired forelimb immediately, at 1 day, and 4 days after photothrombotic stroke. The use-dependency of rehabilitation was investigated by comparing rats with affected forelimb immobilization (forced nonuse), unaffected forelimb immobilization (forced use), and a combination of forced use and skilled forelimb training beginning at 4 days after stroke. Results. Although forced use beginning 1 day or 4 days after stroke caused significant functional improvement, immediate forced limb use caused no functional improvement. On the other hand, a combination of forced use and skilled forelimb training boosted functional recovery in multiple tasks compared to simple forced use treatment. Histological examination showed that no treatment caused brain damage. However, a retrograde tracer study revealed that immediate forced use and combination training, including forced use and skilled forelimb training, increased corticospinal projections from the contralesional and ipsilesional motor cortex, respectively. Conclusions. These results indicate that although both very early initiation time and enhanced skilled forelimb use increased corticospinal projections, premature initiation time hampers the functional improvement induced by poststroke rehabilitation.

Psoas abscess due to mycobacterium tuberculosis: a case report

Iliopsoas abscess (IPA), a collection of pus in the iliopsoas compartment that has traditionally been classified into primary and secondary according to its origin, is an infrequent condition worldwide. Mostly active TB is confined to the lung, but approximately 15% are extrapulmonary. The most common types of extrapulmonary TB are, in descending order of frequency, pleural, lymphatic, bone and joint, genitourinary, miliary disease, meningitis, and peritonitis. Tuberculosis (TB) remains as one of the leading opportunistic infection in patients in developing countries. Here we report a rare case of psoas abscess of tubercular origin in patient who presented with back pain and limping. Diagnosis is done based on history, physical examination, plain radiology, microbiological investigation and CT scan of abdomen which revealed a large psoas abscess caused by M. tuberculosis. Patient was diagnosed as psoas abscess due to Mycobacterium tuberculosis and treated empirically with DOTS category I and significant functional improvement was noted on follow up.

Delayed functional improvement after near-fatal bleeding complication following endobronchial valve therapy for emphysema

<p>Endoscopic treatment of emphysema is supported by different methods, including valves, coils and sealants. The mechanism is mainly related to volume reduction of targeted area. Endobronchial valves (EBV) appear the most studied method. In a multicentre randomised study, placement of unidirectional endobronchial valves resulted in a statistically significant functional improvement in the treated cohort compared to the control. Adverse events, occurring post procedure, included COPD exacerbations, haemoptysis, pneumothorax and pneumonia. In our centre we treated 30 patients, between January 2009 and February 2012, with variable improvement of lung function and only mild postoperative complications. The case we report here appears very interesting for the unusual near-fatal complication (massive alveolar haemorrage) followed by delayed strong functional improvement (FEV1 +23%; RV -18%; 6MWD:+33%) six months after the valve placement. This improvement could be attributable to the EBV procedure, but an alternative explanation is that the lung volume reduction may have been enhanced by the complication itself, as an effect of alveolar collapse.</p>

The lingering effects of a busted myth — false time limits in stroke rehabilitation

It was once falsely believed that neurological and functional recovery after stroke occurred only in the first 6 months after lesion. The perception of this “6-month myth” continues to negatively impact the attitudes of patients towards their rehabilitation and on the clinicians and therapists making optimal training plans. Here we briefly outline some evidence that debunked the 6-month myth, where the concept of this temporal limit may have originated, and the lingering misunderstanding that individuals with stroke reach a plateau of recovery after 6 months even with rehabilitation training. We present evidence that significant functional improvement can occur years after stroke when rehabilitation training is applied. We frame the concepts of active and passive neurological recovery and that active neurological recovery continues far beyond any temporal limit. Because the effects of this busted 6-month myth persist, we aim to remind active physicians, therapists, exercise professionals, and those with stroke to continuously seek opportunities for active rehabilitation training. Meanwhile, trained and certified exercise professionals can play critical roles in facilitating rehabilitative training for community-dwelling stroke survivors.

Utilisation du Plasma Riche en Plaquettes pour le traitement des tendinopathies rotuliennes et achilléennes

The purpose of this study was to retrospectively evaluate the effectiveness of Platelet-Rich Plasma Injection (PRP) for Achilles and patellar tendinopathy refractory to conventional conservative treatments. For this, we compared the data from 34 patients treated with one or two injections of PRP. Pain, functional ability, athletic recovery and satisfaction of patients were evaluated. The results show a significant reduction in pain after the PRP injection treatment, as a significant functional improvement and better sports recovery, without any significant difference according to the affected tendon or the sports. Patients are, on average, satisfied. The PRP is not the miracle treatment but can be however considered in cases of refractory tendinopathy as a possible chance of improvement. Despite the potentially positive effect of PRP injection therapy on patellar and Achilles tendinopathy, there is still not enough scientific literature of high methodological quality about it.