CHANGES OF RESPIRATORY EXCHANGE RATIO IN CHILDREN AND ADOLESCENTS: A LONGITUDINAL STUDY

We conducted a longitudinal study to examine changes in the respiratory exchange ratio (RER) during progressively increasing body exertion in children and adolescents of female sex. In this analysis we only included 23 examinees for whom we had all yearly measurements from examinee\u27s age 9 years until 18 years of age. The data were analyzed according to the chronological and biological age. According to both criteria, the highest RER values were recorded at moments of maximum exertion and they did not increase with age. We found the highest RER values were in the year of the menarche. We interpret these results as related to the effect of estrogen. The beginning of sexual development involves a gradual increase in estrogen plasma concentrations. At one point serum levels of estrogen reach a level high enough to allow for maximum RER values, i.e. causing the optimium anaerobic capacity of the examinee. this threshold estrogen value varies between individuals

Osteogenesis imperfecta: mogućnosti kirurškog liječenja s naglaskom na današnji ortopedski pristup

The treatment of osteogenesis imperfecta should be multidisciplinary and personalized. The best option for surgical treatment is implantation of an intramedullary telescopic nail, in many specialized hospitals the preferable method is Fassier-Duval telescopic nail. The main advantages of the Fassier-Duval intramedullary nail are fewer surgical scars, reduced blood loss, decreased time of operation, less pain, and better postoperative mobility. Orthopedic surgeons who are dealing with osteogenesis imperfecta have to answer two main questions, i.e. when to start with surgical procedures and which type of intramedullary nailing to use. There are a few things that are necessary for a satisfactory outcome of the surgical procedure: precise preoperative planning, all sizes of Fassier- Duval nail available in the operating room during the surgery, and intraoperative radiologic C-arm guidance.Liječenje bolesti osteogenesis imperfecta treba biti multidisciplinsko i personalizirano. Najbolji način kirurškog liječenja je ugradnja intramedularnog teleskopskog čavla, pri čemu većina specijaliziranih bolnica prednost daje metodi Fassier-Duvalova teleskopskog čavla. Glavne prednosti Fassier-Duvalova intramedularnog čavla su manje kirurških ožiljaka, manji gubitak krvi, skraćeno vrijeme operacije, manja bolnost i bolja poslijeoperacijska mobilnost. Ortopedski kirurzi koji se bave liječenjem osteogenesis imperfecta moraju odgovoriti na dva glavna pitanja: kada započeti kirurške zahvate i koji tip intramedularnog čavla primijeniti. Nekoliko je stvari neophodno ispuniti da bi ishod kirurškog zahvata bio zadovoljavajući: precizno prijeoperacijsko planiranje, dostupnost svih veličina Fassier-Duvalova čavla u operacijskoj sali za vrijeme operacije te intraoperacijsko radiološko vođenje pomoću C-ruke

Osteogenesis imperfecta type III – a short review and an example of personalized surgery approach

Osteogenesis imperfecta (OI) or brittle bone disease, a heritable disorder of connective tissue, is the most common of the inherited disorders primarily affecting bone. There are approximately 400 individuals with OI in Croatia alone. The basis of this disease in European populations is mostly the result of defects in the structure or processing of collagen type I, an important protein of the extracellular matrix in many tissues. Although fractures occurring with no injury or minor injury are the hallmark of OI, other non-mineralized tissues can be affected as well. Four different types of the disease are commonly distinguished, ranging from a mild condition (type I) to a lethal one (type II). Types III and IV patients present with severe forms. Due to the relatively low prevalence in the general population, treating physicians have limited experience with this disease, both with children or adults. As an example of personalized surgery approach, we present an 11-year-old patient with OI type III. Before referral to our hospital, she was treated with 18 cycles of bisphosphonates as well as with several different surgical procedures. The patient underwent two surgeries at our hospital with a 5-month interval between them. Using the Fassier-Duval intramedullary telescoping nail, correction osteotomies of both femurs and lower legs in two separate settings were performed, with a very good final result

Osteogenesis imperfecta type III – a short review and an example of personalized surgery approach

Osteogenesis imperfecta (OI) or brittle bone disease, a heritable disorder of connective tissue, is the most common of the inherited disorders primarily affecting bone. There are approximately 400 individuals with OI in Croatia alone. The basis of this disease in European populations is mostly the result of defects in the structure or processing of collagen type I, an important protein of the extracellular matrix in many tissues. Although fractures occurring with no injury or minor injury are the hallmark of OI, other non-mineralized tissues can be affected as well. Four different types of the disease are commonly distinguished, ranging from a mild condition (type I) to a lethal one (type II). Types III and IV patients present with severe forms. Due to the relatively low prevalence in the general population, treating physicians have limited experience with this disease, both with children or adults. As an example of personalized surgery approach, we present an 11-year-old patient with OI type III. Before referral to our hospital, she was treated with 18 cycles of bisphosphonates as well as with several different surgical procedures. The patient underwent two surgeries at our hospital with a 5-month interval between them. Using the Fassier-Duval intramedullary telescoping nail, correction osteotomies of both femurs and lower legs in two separate settings were performed, with a very good final result

PLANTAR FASCIITIS

Plantarni fascitis spada u sindrome prenaprezanja,a oèituje se pojavom boli u području medijalne kvrge petne kosti i / ili uzduž medijalnog uzdužnog svoda stopala. Nastaje zbog dugotrajnih ponavljajućih opterećenja (stress) na plantarnu fasciju te dolazi do mikroruptura ili u završnoj fazi i do djelomične i/ili potpune rupture fascije blizu njenog polazišta na petnoj kosti. Plantarna fascija ima veliki značaj u biomehanici stopala i ona tijekom hoda ublažava mehaničke udare na stopalo i odrazuje stopalo prema naprijed po sistemu dizalice. Ukoliko doðe do poremećaja biomehanike stopala osobito naglašene pronacije stopala, zatim ako postoji udubljeno stopalo, skraćena Ahilova teiva, izrazito spušteno stopalo, itd. dolazi do pojačanih rastezanja plantarne fascije,a zbog same graðe fascije izrazito je mala mogućnost prilagodbe na ta povećana rastezanja. U sportaša plantarni fascitis češće se javlja kod trkača na duge pruge, a veća incidencija nalazi se i kod tenisaèa, košarkaša te plesača. Obično je unilateralan a u 15% pacijenata pojavljuje se obostrano. Klinička manifestacija plantarnog fascitisa je bolno stopalo, odnosno bolnost plantarnog dijela petne kosti.Dijagnoza plantarnog fascitisa se kod većine pacijenata postavlja na osnovi anamneze i klinièkog pregleda. Točka najjače bolne osjetljivosti je medijalni nastavak petne kvrge a bol se pojaèava pasivnim rastezanjem fascije. U dijagnostici plantarnog fascitisa koriste se radiološke pretrage koje često otkrivaju postojanje koštanog trna (calcar calcanei), ultrazvučna dijagnostika i danas sve više i MRI otkrivaju zadebljanje fascije, burze i rupture a uz scintigrafsku pretragu MRI je koristan i u diferncijalnoj dijagnozi prijeloma zamora petne kosti. U lijeèenju plantarnog fascitisa pogotovo u sportaša prvenstveno treba primjenom individualno izraðenih ortotskih pomagala korigirati poremećenu biomehaniku stopala, što treba provoditi i u preventivne svrhe. U konzervativno liječenje spadaju i svi inače uobičajeni postupci fizikalne medicine od krioterapije,vježbi rastezanja , primjene noćne udlage, lokalne primjene ultrazvuka ili u novije vrijeme udarnih valova velike energije do posebnih bandaža stopala. Kirurško liječenje otvorenom ili endoskopskom metodom sastoji se u opuštanju,presijecanju ili/i djelomiènom odstranjenju promijenjene plantarne fascije.Kirurško liječenje poduzima se najčešće upravo u sportaša nakon 6-12 mjeseci neuspješnog konzervativnog liječenja.Plantar fasciitis is an overuse injury characterized by pain at the medial tubercle of the calcaneus and/or along the medial longitudinal arch of the foot. It usually develops when repetitive and prolonged stress is placed on plantar fascia, which may cause microtears and/or partial or total tears of the fascia near its insertion to the calcaneus. Plantar fascia plays significant role in the foot biomechanics. It absorbs mechanical forces placed on the foot and propels foot forward by utilizing the windlass effect. In deranged foot biomechanics, like in pronation of the foot, pes cavus, shortened Achilles tendon, extreme pes planus, etc., additional stress and elongation of plantar fascia is observed, which the fascia, because of its anatomy, is unable to compensate. In athletes, plantar fasciitis is more common in long distance runners and increased incidence is observed in tennis players, basketball players and in dancers. It is usually unilateral whereas in 15% of patients it is bilateral. Clinical findings include painful foot with pain across the plantar aspect of the calcaneus. Diagnosis is usually made after anamnesis and clinical examination. The most painful spot is located at the medial tubercle of the calcaneus and pain is aggravated by passive stretching of the fascia. X-rays could be useful for diagnosing bony spur (calcar calcanei) and ultrasound and MRI are useful for diagnosing thickened fascia, bursa or rupture. MRI and scintigraphy are also useful for differentiating plantar fasciitis and stress fracture of the calcaneus. For the treatment of the plantar fasciitis, especially in athletes, custom made orthothic devices are used for correction of the deranged foot biomechanics, even for prevention. For conservative treatment all usual methods are used (physiotherapy, cryotherapy, stretching exercises, orthoses through the night, local ultrasound and shock wave therapy and foot taping). Surgical treatment with endoscopic or open methods includes release and complete or partial removal of deranged plantar fascia. Surgical treatment is most commonly performed in athletes after 6-12 months of unsuccessful conservative treatment

PLANTAR FASCIITIS

Plantarni fascitis spada u sindrome prenaprezanja,a oèituje se pojavom boli u području medijalne kvrge petne kosti i / ili uzduž medijalnog uzdužnog svoda stopala. Nastaje zbog dugotrajnih ponavljajućih opterećenja (stress) na plantarnu fasciju te dolazi do mikroruptura ili u završnoj fazi i do djelomične i/ili potpune rupture fascije blizu njenog polazišta na petnoj kosti. Plantarna fascija ima veliki značaj u biomehanici stopala i ona tijekom hoda ublažava mehaničke udare na stopalo i odrazuje stopalo prema naprijed po sistemu dizalice. Ukoliko doðe do poremećaja biomehanike stopala osobito naglašene pronacije stopala, zatim ako postoji udubljeno stopalo, skraćena Ahilova teiva, izrazito spušteno stopalo, itd. dolazi do pojačanih rastezanja plantarne fascije,a zbog same graðe fascije izrazito je mala mogućnost prilagodbe na ta povećana rastezanja. U sportaša plantarni fascitis češće se javlja kod trkača na duge pruge, a veća incidencija nalazi se i kod tenisaèa, košarkaša te plesača. Obično je unilateralan a u 15% pacijenata pojavljuje se obostrano. Klinička manifestacija plantarnog fascitisa je bolno stopalo, odnosno bolnost plantarnog dijela petne kosti.Dijagnoza plantarnog fascitisa se kod većine pacijenata postavlja na osnovi anamneze i klinièkog pregleda. Točka najjače bolne osjetljivosti je medijalni nastavak petne kvrge a bol se pojaèava pasivnim rastezanjem fascije. U dijagnostici plantarnog fascitisa koriste se radiološke pretrage koje često otkrivaju postojanje koštanog trna (calcar calcanei), ultrazvučna dijagnostika i danas sve više i MRI otkrivaju zadebljanje fascije, burze i rupture a uz scintigrafsku pretragu MRI je koristan i u diferncijalnoj dijagnozi prijeloma zamora petne kosti. U lijeèenju plantarnog fascitisa pogotovo u sportaša prvenstveno treba primjenom individualno izraðenih ortotskih pomagala korigirati poremećenu biomehaniku stopala, što treba provoditi i u preventivne svrhe. U konzervativno liječenje spadaju i svi inače uobičajeni postupci fizikalne medicine od krioterapije,vježbi rastezanja , primjene noćne udlage, lokalne primjene ultrazvuka ili u novije vrijeme udarnih valova velike energije do posebnih bandaža stopala. Kirurško liječenje otvorenom ili endoskopskom metodom sastoji se u opuštanju,presijecanju ili/i djelomiènom odstranjenju promijenjene plantarne fascije.Kirurško liječenje poduzima se najčešće upravo u sportaša nakon 6-12 mjeseci neuspješnog konzervativnog liječenja.Plantar fasciitis is an overuse injury characterized by pain at the medial tubercle of the calcaneus and/or along the medial longitudinal arch of the foot. It usually develops when repetitive and prolonged stress is placed on plantar fascia, which may cause microtears and/or partial or total tears of the fascia near its insertion to the calcaneus. Plantar fascia plays significant role in the foot biomechanics. It absorbs mechanical forces placed on the foot and propels foot forward by utilizing the windlass effect. In deranged foot biomechanics, like in pronation of the foot, pes cavus, shortened Achilles tendon, extreme pes planus, etc., additional stress and elongation of plantar fascia is observed, which the fascia, because of its anatomy, is unable to compensate. In athletes, plantar fasciitis is more common in long distance runners and increased incidence is observed in tennis players, basketball players and in dancers. It is usually unilateral whereas in 15% of patients it is bilateral. Clinical findings include painful foot with pain across the plantar aspect of the calcaneus. Diagnosis is usually made after anamnesis and clinical examination. The most painful spot is located at the medial tubercle of the calcaneus and pain is aggravated by passive stretching of the fascia. X-rays could be useful for diagnosing bony spur (calcar calcanei) and ultrasound and MRI are useful for diagnosing thickened fascia, bursa or rupture. MRI and scintigraphy are also useful for differentiating plantar fasciitis and stress fracture of the calcaneus. For the treatment of the plantar fasciitis, especially in athletes, custom made orthothic devices are used for correction of the deranged foot biomechanics, even for prevention. For conservative treatment all usual methods are used (physiotherapy, cryotherapy, stretching exercises, orthoses through the night, local ultrasound and shock wave therapy and foot taping). Surgical treatment with endoscopic or open methods includes release and complete or partial removal of deranged plantar fascia. Surgical treatment is most commonly performed in athletes after 6-12 months of unsuccessful conservative treatment

Unrecognized posterior dislocation of the shoulder - a case report

Stražnja luksacija ramena rijedak je klinički i radiološki entitet. Od svih luksacija humeroskapularnog zgloba na stražnju luksaciju otpada manje od 2%. Način liječenja određen je veličinom defekta na glavi nadlaktične kosti, te trajanjem luksacije. Predstavljamo slučaj 66-godišnje žene s neprepoznatom stražnjom luksacijom ramena zadobivenom padom s bicikla. Nakon CT-a desnoga ramena, učinjena je otvorena repozicija humeroskapularnoga zgloba i transpozicija gornje trećine tetive m. subskapularisa u područje defekta na glavi humerusa. Deset mjeseci nakon operacijskoga zahvata klinički se nađe zadovoljavajući opseg kretnji. Bolesnica je subjektivno izrazito zadovoljna statusom operiranoga ramena, te konačnim rezultatom operacijskoga liječenja.Posterior dislocation of the shoulder is a rare clinical and radiological entity. It accounts for less than 2 % of all dislocations of the shoulder. The method of treatment is determined by the size of the defect and the duration of the dislocation. We present a case of a 66-year-old woman with unrecognized posterior dislocation of the shoulder after falling from a bicycle. Following a CT scan we performed an open reposition of the humeroscapular joint and transposition of the upper third of subscapularis tendon into the humeral head defect. Ten months after surgery we found a good range of motion and the patient is very satisfied with the final result of the surgical treatment

Early results of intra-articular micro-fragmented lipoaspirate treatment in patients with late stages knee osteoarthritis: a prospective study

Aim To analyze clinical and functional effects of intra-articular injection of autologous micro-fragmented lipoaspirate (MLA) in patients with late stage knee osteoarthritis (KOA). Secondary aims included classifying cell types contributing to the treatment effect, performing detailed MRIbased classification of KOA, and elucidating the predictors for functional outcomes. Methods This prospective, non-randomized study was conducted from June 2016 to February 2018 and enrolled 20 patients with late stage symptomatic KOA (Kellgren Lawrence grade III, n = 4; and IV, n = 16) who received an intra-articular injection of autologous MLA in the index knee joint. At baseline radiological KOA grade and MRI were assessed in order to classify the morphology of KOA changes. Stromal vascular fraction cells obtained from MLA samples were stained with antibodies specific for cell surface markers. Patients were evaluated at baseline and 12-months after treatment with visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS).Results Three patients (15%) received a total knee replacement and were not followed up completely. Seventeen patients (85%) showed a substantial pattern of KOOS and WOMAC improvement, significant in all accounts. KOOS score improved from 46 to 176% when compared with baseline, WOMAC decreased from 40 to 45%, while VAS rating decreased from 54% to 82% (all P values were <0.001). MLA contained endothelial progenitor cells, pericytes, and supra-adventitial adipose stromal cells as most abundant cell phenotypes. Conclusion This study is among the first to show a positive effect of MLA on patients with late stages KOA

EFFICACY AND SAFETY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION USING AN H1-COIL OR FIGURE-8-COIL IN THE TREATMENT OF UNIPOLAR MAJOR DEPRESSIVE DISORDER: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique with few side effects that has been reported to be effective in the treatment of major depressive disorder (MDD). At present, no randomized controlled trials (RCT) have compared the efficacy and safety of rTMS delivered by the figure-8-coil and the H1-coil. We describe an industry-independent, randomized, controlled, single-blinded, single-center study protocol assessing the differences in efficacy and safety of rTMS for patients diagnosed with MDD with the H1-coil and figure-8-coil as an add-on to stable pharmacotherapy or pharmacotherapy alone. Stimulation protocols follow those that led to the FDA clearance of these treatments for MDD. The sample of 76 patents in each of the three groups will be enrolled and assessed with clinical and neuropsychological tests. The primary outcome is remission rate defined as Hamilton depression rating scale (HAM-D17) score ≤7 at the end of week-4. This clinical trial will address the efficacy and safety of rTMS modalities for MDD. The evaluation of biological markers will also help to elucidate the pathophysiology of MDD and the mechanisms of action of rTMS

Antioxidative and Anti-Inflammatory Activities of Chrysin and Naringenin in a Drug-Induced Bone Loss Model in Rats

Oxidative stress (OS) mediators, together with the inflammatory processes, are considered as threatening factors for bone health. The aim of this study was to investigate effects of flavonoids naringenin and chrysin on OS, inflammation, and bone degradation in retinoic acid (13cRA)-induced secondary osteoporosis (OP) in rats. We analysed changes in body and uterine weight, biochemical bone parameters (bone mineral density (BMD), bone mineral content (BMC), markers of bone turnover), bone geometry parameters, bone histology, OS parameters, biochemical and haematological parameters, and levels of inflammatory cytokines. Osteoporotic rats had reduced bone Ca and P levels, BMD, BMC, and expression of markers of bone turnover, and increased values of serum enzymes alkaline phosphatase (ALP) and lactate dehydrogenase (LDH). Malondialdehyde (MDA) production in liver, kidney, and ovary was increased, while the glutathione (GSH) content and activities of antioxidant enzymes were reduced and accompanied with the enhanced release of inflammatory mediators TNF-α, IL-1β, IL-6, and RANTES chemokine (regulated on activation normal T cell expressed and secreted) in serum. Treatment with chrysin or naringenin improved bone quality, reduced bone resorption, and bone mineral deposition, although with a lower efficacy compared with alendronate. However, flavonoids exhibited more pronounced antioxidative, anti-inflammatory and phytoestrogenic activities, indicating their great potential in attenuating bone loss and prevention of OP