Patellar tendinopathy:Causes, consequences and the use of orthoses

Patellar tendinopathy (PT), also known as jumper’s knee, is a painful overuse injury of the patellar tendon. This injury is common in jumping athletes. There are numerous treatment options currently available for PT, yet none of them guarantee full recovery. As a result, many athletes have long-lasting symptoms, even after ending their athletic career. The scope of this thesis was to gain more insight into the causes and consequences of PT, and to study the effectiveness of commonly used orthoses, like patellar straps, on pain and knee joint proprioception. This thesis shows that male jumping athletes who have physically demanding work have a bigger chance of developing PT, hence when taking preventive measures it is important to consider the type of work an athlete does. This thesis also showed that PT has a negative impact on sports and work, as 55% of the athletes had substantial problems during sports: 16% had low work ability and 35% reduced work productivity. This thesis demonstrated further that pain during and after sports can be reduced by using a patellar strap. A patellar strap also seems to improve knee joint proprioception, which may play a role in injury prevention. The long-term effect of using a patellar straps remains unknown though. This thesis provides more insight into the severity and etiology of PT, possible working mechanisms, and the effectiveness of the use of patellar straps

Pseudo-wound infection after a caesarean section:Case report of unrecognized Pyoderma Gangrenosum

Background: Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disease, characterized by painful ulcerative skin-lesions often developing at sites of injury or surgery because of the typical pathergy phenomena. We describe an unusual case of PG after a caesarean section with excessive extra-cutaneous manifestation within internal organs. Presentation of case: A 21-year-old Dutch primigravida developed signs of sepsis after a caesarean section. Despite antibiotic treatment, fast clinical deterioration occurred. Exploration of the wound showed necrosis of the uterus and surrounding tissues. Due to the progression of necrosis, consecutive debridement procedures were executed resulting in a substantial abdominal wall defect. The progressive clinical course of the necrosis combined with absence of positive wound cultures and histology of prominent interstitial neutrophilic infiltration, led to the diagnosis ‘Pyoderma Gangrenosum’. Treatment with high dose corticosteroids led to rapid regression of the disease. After several weeks, the abdominal wall defect was surgically corrected under systemic corticosteroid therapy. Discussion: This case of PG is unique due to the excessive extra-cutaneous presentation, which contributed to delayed diagnosis. Several surgical interventions in the active stage of disease resulted in expansion of PG and substantial morbidity for the patient. Conclusion: Post-operative PG can mimic infectious diseases, but treatment is substantially different. This case of extensive PG highlights the importance of timely recognition and treatment of the disease to reduce iatrogenic morbidity

Особливості імуно-гормонального та мікробіологічного статусу у жінок з різними морфологічними формами поліпів ендометрія

Обследовано 58 женщин с полипами эндометрия. Выявлены особенности микробиологического пейзажа, гормонального и иммунного статуса в зависимости от морфологических форм полипов эндометрия. проведенный анализ позволил выделить группы риска по развитию полипов эндометрия. показано, что полип эндометрия следует рассматривать не как местный процесс, а как реакцию эндометрия в ответ на повреждение гормонального и иммунного гомеостаза, что необходимо учитывать при выборе лечения данной патологии58 women with endometrial polyps were investigated. Specific microflora and hormonal and immune status depending on the morphological forms of endometrial polyps were found. The analysis performed allowed to allocate risk groups according to development of endometrial polyp. It was shown that endometrial polyp shall be considered as endometrial reaction in response to hormonal and immune homeostasis disorder, rather than local process. This should be borne in mind when choosing treatment for this patholog

Determination of the structural integrity and stability of polysialic acid during alkaline and thermal treatment

Polysialic acid (polySia) is a linear homopolymer of varying chain lengths that exists mostly on the outer cell membrane surface of certain bacteria, such as Escherichia coli (E. coli) K1. PolySia, with an average degree of polymerization of 20 (polySia avDP20), possesses material properties that can be used for therapeutic applications to treat inflammatory neurodegenerative diseases. The fermentation of E. coli K1 enables the large-scale production of endogenous long-chain polySia (DP ≈ 130) (LC polySia), from which polySia avDP20 can be manufactured using thermal hydrolysis. To ensure adequate biopharmaceutical quality of the product, the removal of byproducts and contaminants, such as endotoxins, is essential. Recent studies have revealed that the long-term incubation in alkaline sodium hydroxide (NaOH) solutions reduces the endotoxin content down to 3 EU (endotoxin units) per mg, which is in the range of pharmaceutical applications. In this study, we analyzed interferences in the intramolecular structure of polySia caused by harsh NaOH treatment or thermal hydrolysis. Nuclear magnetic resonance (NMR) spectroscopy revealed that neither the incubation in an alkaline solution nor the thermal hydrolysis induced any chemical modification. In addition, HPLC analysis with a preceding 1,2-diamino-4,5-methylenedioxybenzene (DMB) derivatization demonstrated that the alkaline treatment did not induce any hydrolytic effects to reduce the maximum polymer length and that the controlled thermal hydrolysis reduced the maximum chain length effectively, while costeffective incubation in alkaline solutions had no adverse effects on LC polySia. Therefore, both methods guarantee the production of high-purity, low-molecular-weight polySia without alterations in the structure, which is a prerequisite for the submission of a marketing authorization application as a medicinal product. However, a specific synthesis of low-molecular-weight polySia with defined chain lengths is only possible to a limited extent

Вплив глобалізації на модифікацію стратегії соціально-економічного розвитку Бразилії

У статті розкрито характер та напрями модифікації національної стратегії розвитку Бразилії, яка зазнала значних змін унаслідок посилення глобалізації світового господарства. Значну увагу приділено дослідженню особливостей і результатів економічних реформ, які були впроваджені Бразилією з метою побудови ефективної соціально-економічної системи.В статье раскрываются характер и направления модификации национальной стратегии развития Бразилии, которая претерпела значительные изменения вследствие усиления глобализации мирового хозяйства. Значительное внимание уделяется исследованию особенностей и результатов экономических реформ, которые были осуществлены Бразилией с целью построения эффективной социально-экономической системы.This article focuses on the nature and direction of modification of the national strategy of Brazil, which has undergone significant changes due to increasing globalization of world economy. Special attention is paid to analysis of peculiarities and results of economic reforms that were implemented in order to build effective social and economic systems of Brazil

Functional diversity in Dichomitus squalens monokaryons

Abstract Dichomitus squalens is a white-rot fungus that colonizes and grows mainly on softwood and is commonly found in the northern parts of Europe, North America, and Asia. We analyzed the genetic and physiological diversity of eight D. squalens monokaryons derived from a single dikaryon. In addition, an unrelated dikaryon and a newly established dikaryon from two of the studied monokaryons were included. Both growth and lignocellulose acting enzyme profiles were highly variable between the studied monokaryotic and dikaryotic strains, demonstrating a high level of diversity within the species

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Objective: The internally validated fulIPIERS model predicts adverse maternal outcomes in women with pre-eclampsia within 48 h after eligibility. Our objective was to assess generalizability of this prediction model. Study design: External validation study using prospectively collected data from two tertiary care obstetric centers. Methods: The existing PETRA dataset, a cohort of women (n = 216) with severe early-onset pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction was used. The fulIPIERS model equation was applied to all women in the dataset using values collected within 48 h after inclusion. The performance (ROC area and R-squared) of the model, risk stratification and calibration were assessed from 48 h up to a week after inclusion. Results: Of 216 women in the PETRA trial, 73 (34%) experienced an adverse maternal outcome(s) at any time after inclusion. Adverse maternal outcome was observed in 32 (15%) cases within 48 h and 62 (29%) within 7 days after inclusion. The fulIPIERS model predicted adverse maternal outcomes within 48 h (AUC ROC 0.97, 95% CI: 0.87-0.99) and up to 7 days after inclusion (AUC ROC 0.80, 95% CI: 0.70-0.87). Conclusions: The fullPIERS model performed well when applied to the PETRA dataset. These results confirm the usability of the fulIPIERS prediction model as a 'rule-in' test for women admitted with severe pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction. Future research should focus on intervention studies that assess the clinical impact of strategies using the fullPIERS model. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Jaw thrust versus the use of a boil-and-bite mandibular advancement device as a screening tool during drug-induced sleep endoscopy

STUDY OBJECTIVES: The objectives of this study were to analyze agreement in degree of obstruction and configuration of the upper airway between jaw thrust and an oral device in situ during drug-induced sleep endoscopy and to evaluate clinical decision making using jaw thrust or a boil-and-bite mandibular advancement device (MAD; the MyTAP). METHODS: This was a single-center prospective cohort study in patients with obstructive sleep apnea who underwent drug-induced sleep endoscopy between January and July 2019. RESULTS: Sixty-three patients were included. Agreement among observations in the supine position for degree of obstruction was 60% (n = 36, κ = 0.41) at the level of the velum, 68.3% (n = 41, κ = 0.35) for oropharynx, 58.3% (n = 35, κ = 0.28) for tongue base, and 56.7% (n = 34, κ = 0.14) for epiglottis; agreement among observations in the lateral position were 81.7% (n = 49, κ = 0.32), 71.7% (n = 43, κ = 0.36), 90.0% (n = 54, κ = 0.23), and 96.7% (n = 58, κ = could not be determined), respectively. In the supine position, agreement for configuration of obstruction at the level of the velum was found in 20 of 29 patients (69.0%, κ = 0.41) and in the lateral position was 100%. Thirty patients would have been prescribed a MAD using jaw thrust and 34 using the boil-and-bite MAD as a screening instrument. The main reason for being labeled as nonsuitable was complete residual retropalatal collapse during jaw thrust. Using the boil-and-bite MAD, this was caused by complete retropalatal or hypopharyngeal collapse. CONCLUSIONS: There is only slight to moderate agreement in degree of obstruction for jaw thrust and a new-generation boil-and-bite MAD during drug-induced sleep endoscopy. Greater improvement of upper airway patency at the hypopharyngeal level was observed during jaw thrust, but this maneuver was less effective in improving upper airway obstruction at the retropalatal level. CITATION: Vonk PE, Uniken Venema JAM, Hoekema A, Ravesloot MJL, van de Velde–Muusers JA, de Vries N. Jaw thrust versus the use of a boil-and-bite mandibular advancement device as a screening tool during drug-induced sleep endoscopy. J Clin Sleep Med. 2020;16(7):1021–1027