Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

Background Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium. Aim Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the efectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients. Methods We divided the study into two parts. In the frst part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise. Results Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a signifcant improvement in blood levels of magnesium (2.11±0.15 vs. 1.94±0.11; p<0.05), on the NRS scale (5.7±0.81 vs. 6.6±1.18; p<0.05), the Tinetti scale (17.3±1.15 vs. 15.2±2.98; p<0.05) and the SarQoL questionnaire (47.3±5.21 vs. 44.9±5.54; p<0.05). Conclusions More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifable risk factors for osteoporosis

Adolescent idiopathic scoliosis screening: Could a school-based assessment protocol be useful for an early diagnosis?

BACKGROUND: Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE: This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS: In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam’s test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS: The sensitivity and diagnostic specificity of Adam’s test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams’s test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS: Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis

Hybrid Hyaluronic Acid versus High Molecular Weight Hyaluronic Acid for the Treatment of Hip Osteoarthritis in Overweight/Obese Patients

Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500–2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patient

Risk Factors, Lifestyle and Prevention among Adolescents with Idiopathic Juvenile Scoliosis: A Cross Sectional Study in Eleven First-Grade Secondary Schools of Palermo Province, Italy

Adolescent idiopathic scoliosis (AIS) has an incidence of 2–3% in the general population and a multifactorial etiology. The present study aims to analyze modifiable risk factors and their interactions in the development of AIS in order to increase knowledge about the disease and to prevent the evolution of AIS in young students with tailored public health strategies. A crosssectional study was conducted over two consecutive school years among students attending 11 firstgrade secondary schools in the province of Palermo, Italy. A self-administered questionnaire that investigated socio-demographical, physical and anamnestic characteristics and habits, focusing on possible risk factors associated with idiopathic scoliosis, was administered. In addition, a clinical evaluation was performed with Adams’ test and Bunnel’s inclinometer. Suspected AIS cases were associated with the practice of high-risk sports (p < 0.05), weekly physical activity lasting 3 h (p < 0.05), lower back pain (p < 0.001), posture disorders (p < 0.01) and having had no contact with a physician (p < 0.01). Practice of high-risk sports (adj OR = 1.83; CI 95% 1.11–4.76) and suffering of posture disorders (adj OR = 1.67; CI 95% 1.12–3.60) showed a significant association with a confirmed diagnosis of AIS (Cobb angle 10 at X-ray). The risk factors associated with AIS are still unclear. Therefore, it is crucial to identify early modifiable and multiple risk factors to prevent the evolution of scoliosis in school-age children

Early Denosumab for the prevention of osteoporotic fractures in breast cancer women undergoing aromatase inhibitors: A case-control retrospective study

BACKGROUND:Aromatase inhibitors (AIs) might have a detrimental impact on bone health in breast cancer (BC) women.Denosumab has been shown to reduce the risk of fractures, but the appropriate time for starting is yet to be clearly defined.OBJECTIVE:To evaluate the effects of early treatment with Denosumab (612 months after starting AIs) compared to a delayedtreatment in BC women.METHODS:In this retrospective case-control study, we included medical records of BC post-menopausal women, treated withAIs therapy; they were divided as: study group (starting Denosumab612 months after AIs) and control group (>12 months). Atthe baseline (T0) and at 18 months (T1), we evaluated the lumbar spine (LS) Tscore and femoral neck (FN) Tscore. Furthermore,at T1 we assessed the incident fragility fractures.RESULTS:Fifty-nine BC survivors (mean age: 61.5±11.5 years) were included: 28 with Early Denosumab and 31 with LateDenosumab. At T1, the study group did not show any incident hip or vertebral fragility fracture, whereas the Late Denosumabgroup showed 2 incident hip fractures (6.5%) and 4 (12.9%) vertebral fragility fractures. Early Denosumab showed a significantpositive effect on both LS (p=0.044) and FN (p=0.024) Tscore variations.CONCLUSION:Taken together, our findings suggest that an early start of Denosumab might be considered for the osteoporosismanagement in BC women undergoing AIs

Rehabilitative interventions for ischaemic digital ulcers, pain, and hand functioning in systemic sclerosis: a prospective before-after study

Background: Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vasculopathy, cellular infammation, fbrosis of the skin associated with multiple internal organs involvement. Ischaemic digital ulcers (IDU) of the hands commonly occur in patients with SSc adversely afecting functional independence. Purpose: Aim of the study is to investigate the efectiveness of a rehabilitation protocol based on the combined use of ultrasound (US) therapy and therapeutic exercise in terms of ulcers healing, pain relief, and hand functioning in patients afected by SSc with IDUs. Moreover, we also investigated the safety of the proposed intervention. Study design: Prospective before-after study. Methods: We included 20 patients with IDUs secondary to SSc. All patients were treated with US combined with manual therapy, including McMennel joint manipulation, pompage mobilization technique and connective tissue massage, for 10 sessions. We evaluated softness, dyschromia, pain, and hand mobility using the Pressure Sore Status Tool (PSST), the Numerical Rating Scale (NRS), and the Duruoz Hand Index (DHI) at T0 and at the end of the treatment (T1). Results: Treatment with US combined with manual therapy signifcantly reduced ulcers depth, improved ulcers margins, and reduced periwound skin damage (median PSST score 16 at T1, p<0.0001). Moreover, signifcant benefts were reported in terms of pain relief (NRS 3 at T1; p<0.0005), and hand function (DHI score 19 at T1; p<0.0005). Finally, this approach seems to be safe, without side efects reported at the end of treatment, along with an optimal compliance. Conclusion: Therapeutic US combined with manual therapy should be used as additional intervention to manage IDUs in SSc patient

Rehabilitative interventions for ischaemic digital ulcers, pain, and hand functioning in systemic sclerosis: a prospective before-after study

Background: Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vasculopathy, cellular infammation, fbrosis of the skin associated with multiple internal organs involvement. Ischaemic digital ulcers (IDU) of the hands commonly occur in patients with SSc adversely afecting functional independence. Purpose: Aim of the study is to investigate the efectiveness of a rehabilitation protocol based on the combined use of ultrasound (US) therapy and therapeutic exercise in terms of ulcers healing, pain relief, and hand functioning in patients afected by SSc with IDUs. Moreover, we also investigated the safety of the proposed intervention. Study design: Prospective before-after study. Methods: We included 20 patients with IDUs secondary to SSc. All patients were treated with US combined with manual therapy, including McMennel joint manipulation, pompage mobilization technique and connective tissue massage, for 10 sessions. We evaluated softness, dyschromia, pain, and hand mobility using the Pressure Sore Status Tool (PSST), the Numerical Rating Scale (NRS), and the Duruoz Hand Index (DHI) at T0 and at the end of the treatment (T1). Results: Treatment with US combined with manual therapy signifcantly reduced ulcers depth, improved ulcers margins, and reduced periwound skin damage (median PSST score 16 at T1, p<0.0001). Moreover, signifcant benefts were reported in terms of pain relief (NRS 3 at T1; p<0.0005), and hand function (DHI score 19 at T1; p<0.0005). Finally, this approach seems to be safe, without side efects reported at the end of treatment, along with an optimal compliance. Conclusion: Therapeutic US combined with manual therapy should be used as additional intervention to manage IDUs in SSc patient

Presbyastasis: from diagnosis to management

Currently, the elderly population (>65 years old) is in very growth. In fact, in Italy old age index (number of elderly per 100 persons under the age of 14 years) is estimated to be 157,7 and is projected to increase to 257,9 in the year 20651,2. The increase of the elderly population determines the increase of the age-dependent diseases including also impairment of the vestibular function, this problem is defined "presbiastasia". Patient suffering from this condition exhibit disturbances of static and dynamic postural control with far less frequent cases of relapsing objective rotatory vertigo. Occasionally, they also report a feeling of insecurity in new or unknown environments, increasing the risk of falls. These balance disorders significantly affect patients\u2019 private and social life, as they interfere with a large number of daily activities, as transfer into bed, ambulation, car transfers, eating, using of telephone. The number of patients with this disease is expected to increase with the rise in the number of elderly population and this has important implications on the national health system's resources. Thus, the rehabilitation of these balance disorders presents serious difficulties. This explains the great number of techniques, with or without the use of equipment, which have so far been proposed. Some authors suggested to apply actual protocols, more or less modifiable according to patient characteristics; others recommended individual exercises or special equipment-aided techniques. In these cases, vestibular rehabilitation allows to stimulate the equilibrium system by preventing and slowing down the effects of aging, through the use of "adaptive, substitutive and custom" strategies

Human alfa-fetoprotein produced from hep G2 cell line: Structure and heterogeneity of the oligosaccharide moiety

The carbohydrate moiety of human -fetoprotein, an RMM 67000 glycoprotein produced in a hepatoma cell line (Hep G2), was investigated by the combined use of high-resolution chromatographic techniques and mass spectrometry. Fast atom bombardment mass spectrometric (FABMS) and reversed-phase high-performance liquid chromatographic analysis of -fetoprotein obtained from a large-scale cell culture following tryptic and peptide N-glycanase F hydrolysis demonstrated that the protein contains a single glycosylation site at level of asparagine 232. Further, electrospray mass spectrometric measurement of the intact protein molecular mass showed that two main glycoforms are present. The complete definition of the structural heterogeneity of the oligosaccharide moiety was achieved by high-performance anion-exchange chromatography with pulsed amperometric detection together with carbohydrate mapping by FABMS of the released oligosaccharides demonstrating (i) that the glycosylation produced by cell culture is of the biantennary complex type typical of human hepatoma -fetoprotein and (ii) the presence of two main structures in a ratio of about 2:1 differing in the presence of a fucose residue in the N-acetylglucosamine in the non reducing portion of the molecule