Evidence based medicine in physical medicine and rehabilitation (English version)

In the last twenty years the term “Evidence Based Medicine (EBM)” has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician’s individual expertise, the patient’s needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best “external evidence”. This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management). Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed

Verletzungsmuster im Fussball

Relatório de estágio do mestrado em Ensino da Educação Física nos Ensinos Básico e Secundário, apresentado à Faculdade de Ciências do Desporto e Educação Física da Universidade de CoimbraO presente Relatório Final de Estágio surge no âmbito da unidade curricular de Relatório de Estágio, do Mestrado em Ensino da Educação Física nos Ensinos Básico e Secundário, da Faculdade de Ciências do Desporto e Educação Física da Universidade de Coimbra. Toda a prática pedagógica presente neste documento, decorreu na Escola EB 2,3/S Dr. Daniel de Matos, junto da turma do 8ºB, e surge como uma reflexão e descrição de todas tarefas e aprendizagens realizadas ao longo do ano letivo, tendo ainda uma parte relativa ao aprofundamento do tema/problema: “Caracterização dos hábitos alimentares em dias de prática de atividade física”. Este relatório final surge como uma análise e reflexão da nossa atuação enquanto docente, constituindo um documento essencial para todos os alunos estagiários. Sendo o estágio um processo reflexivo, a nossa reflexão incidiu sobre diversos pontos como o planeamento, a intervenção pedagógica e a avaliação, permitindo um desenvolvimento de competências, de modo a conseguir um bom desempenho da tarefa docente. No aprofundamento do tema/problema, o objetivo do nosso estudo foi caracterizar os hábitos alimentares dos alunos nos dias em que têm aulas de Educação Física, confrontando-os com os valores ideais para uma alimentação saudável e equilibrada. Os resultados obtidos evidenciam uma inadequada ingestão alimentar dos alunos, caracterizada por um notório défice nutricional em grande parte dos grupos alimentares. This Final Internship Report arises for the internship report subject, of the Masters' in Teaching Physical Education in Elementary and High School education, Faculty of Sport Sciences and Physical Education of the University of Coimbra. The pedagogical practice present in this document took place in the school E.B 2,3/S Dr. Daniel Matos, with the class 8ªB and appears, as a reflection and as description of all the tasks and learning carried out throughout the school year, having as well, a part relating to the development of the theme /problem: ”Characterization of eating habits in days of practice of physical activity”. This report appears as an analysis and reflection of our action as teachers, constituting an essential document for all students trainees. Our internship, as a reflective process, focuses on various points: the planning, the pedagogical intervention and the evaluation, allowing a development of skills, in order to achieve a good performance of the task of teaching. In the development of the study of our topic, our purpose was to characterize the eating habits of students on the days that had physical education classes, showing them the ideal values of eating healthy and balanced. The obtained results show an inadequate diet, characterized by a noticeable nutritional deficit in a large part of food groups

Neurofilament distribution in the superior labrum and the long head of the biceps tendon

Abstract Background The postoperative course after arthroscopic superior labrum anterior to posterior (SLAP) repair using suture anchors is accompanied by a prolonged period of pain, which might be caused by constriction of nerve fibres. The purpose was to histologically investigate the distribution of neurofilament in the superior labrum and the long head of the biceps tendon (LHBT), i.e. the location of type II SLAP lesions. Methods Ten LHBTs including the superior labrum were dissected from fresh human specimen and immunohistochemically stained against neurofilament (NF). All slides were scanned at high resolution and converted into tagged image file format, and regions of interest (ROIs) were defined as follows: ROI I—superior labrum anterior to the LHBT origin, ROI II—mid-portion of the superior labrum at the origin of the LHBT, ROI III—superior labrum posterior to the LHBT origin and ROI IV—the most proximal part of the LHBT before its attachment to the superior labrum. The entire images were automatically segmented according to the defined ROIs and measured using a programmed algorithm specifically created for this purpose. The NF-positive cells were counted, and their total size and the area of other tissue were measured separately for the different ROIs. Results Distribution of NF-positive cells in absolute numbers revealed a clear but insignificantly higher amount in favour of ROI I, representing the superior labrum anterior to the LHBT origin. Setting ROI I at 100%, a significant difference could be seen compared to ROI III, representing the superior labrum posterior to the LHBT origin (ROI I vs. ROI III with a p value < 0.05). Conclusions Summarizing, the density of neurofilament is inhomogeneously distributed throughout the superior labrum with the highest number of neurofilament in the anterior superior labrum. Thus, suture placement in type II SLAP repair could play an important role for the postoperative pain-related outcome

Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair—a prospective study

Abstract Background One of the currently used surgical techniques in isolated type II SLAP lesions is arthroscopic SLAP repair. Postoperatively, patients tend to suffer from a prolonged period of pain and are restricted in their sports activities for at least 6 months. The aim of this study was to prospectively evaluate the clinical outcome as well as the postoperative course of pain after arthroscopic type II SLAP repair. Methods Outcome measures were assessed using the Individual Relative Constant Score (CSindiv), the American Shoulder and Elbow Surgeons (ASES) Score, the Visual Analogue Scale (VAS), and the Short Form 36 (SF-36). Data were collected preoperatively, as well as at 3, 6, 12 and >24 months postoperatively. Results Eleven patients with an average age of 31.8 years (range: 22.8-49.8 years) underwent arthroscopic repair of isolated type II SLAP lesions. Mean follow-up time was 41.9 months (range: 36.1–48.4 months). 6 months after surgery, there was a statistically significant improvement of function according to the CSindiv (p = 0.004), the ASES Score (p = 0.006), and the SF-36 subscale “physical functioning” (p = 0.014) and a statistically significant decrease of pain according to the VAS (p = 0.007) and the SF-36 subscale “bodily pain” (p = 0.022) compared to preoperative levels. Conclusions Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery. Thus, a return to sports should not be allowed earlier than 6 months after surgery, when patients have reached pain-free function and recovered strength. Trial registration Researchregistry1761 (UIN)

Associated Pathologies following Luxatio Erecta Humeri: A Retrospective Analysis of 38 Cases

Inferior shoulder dislocation in fixed abduction, also known as luxatio erecta humeri (LEH), is a rare injury with little data available. Therefore, the primary aim of this study was to evaluate and present our case series of this type of injury with special emphasis on associated pathologies; the secondary aim was to present diagnostic recommendations to detect for potential associated pathologies typically seen with this injury. A total of 38 patients (13 females, average age 72.8 years and 25 males, average age 41.4 years), who have been treated for inferior shoulder dislocation between 1992 and 2020, were included in this study. Associated pathologies after LEH were found in 81% of the cases. Twenty-one of these patients presented with secondary bony pathologies. Six patients revealed rotator cuff injuries diagnosed by magnetic resonance imaging (MRI). Seven patients exhibited pathological findings at the capsule-ligament complex. Eight patients presented with neurological findings. All neurologic symptoms except one axillary nerve palsy and a radialis paresis dissolved during the follow-up period. Five patients received surgical treatment of the affected shoulder. Inferior shoulder dislocation is a rare condition presenting with a high number of associated injuries. According to the findings of the present study, we want to raised awareness of the high rate of potential secondary shoulder pathologies associated with LEH. Beside a thorough clinical examination and immediate standard radiographs in two planes, we recommend to perform computed tomography scanning and an MRI of the shoulder as soon as possible. In the case of neurologic deficiencies, a determination of nerve conduction should be performed

TIS7 interacts with the mammalian SIN3 histone deacetylase complex in epithelial cells

The mammalian SIN3 complex consists of histone deacetylases (HDAC1, HDAC2), several known proteins (SAP30, N-CoR) and as yet unidentified proteins. Here we show that the mouse tetradecanoyl phorbol acetate induced sequence 7 (TIS7) protein is a novel transcriptional co-repressor that can associate with the SIN3 complex. We have identified tis7 as a gene that is up-regulated upon loss of polarity in a mouse mammary gland epithelial cell line expressing an estrogen-inducible c-JunER fusion protein. In unpolarized cells, TIS7 protein levels increase and TIS7 translocates into the nucleus. Overexpression of tis7 causes loss of polarity and represses a set of genes, as revealed by cDNA microarray analysis. We have shown that TIS7 protein interacts with several proteins of the SIN3 complex (mSin3B, HDAC1, N-CoR and SAP30) by yeast two-hybrid screening and co-immunoprecipitations. TIS7 co-immunoprecipitated HDAC complex is enzymatically active and represses a GAL4-dependent reporter transcription. The transcriptional repression of endogenous genes by tis7 overexpression is HDAC dependent. Thus, we propose TIS7 as a transcriptional co-repressor affecting the expression of specific genes in a HDAC activity-dependent manner during cell fate decisions, e.g. scattering