Supine fulcrum bending test and in-cast correction of Scheuermann juvenile kyphosis

Background: Patients with Scheuermann disease often require conservative management with a series of corrective casts, followed by anti-kyphotic brace. Flexibility of the kyphosis can be assessed during a supine fulcrum bending test. The aim of the study was to analyze the radiological flexibility of kyphosis and immediate in-cast correction in a series of patients conservatively treated.Methods: Eighty-six adolescents were conservatively treated for Scheuermann disease of thoracic location. Charts of 55 patients, 39 boys and 16 girls, were accessible. The mean age was 14.6±1.6 years. On the lateral full-cassette standing radiograph, the angle of thoracic and lumbar lordosis were measured. The flexibility of kyphosis was assessed on a supine fulcrum bending lateral radiograph. The in-cast kyphosis angle was measured on a standing lateral radiograph.Results: In 18 patients, a mild non-progressive scoliotic curvature was present; it did not exceed a Cobb angle measurement of 25°. The initial kyphosis angle was 59.2°±9.3°. The lordosis angle was 76.3°±9.3°. The kyphosis angle on supine fulcrum bending test was 30.4°±9.7°. The kyphosis angle in the reclining cast was 44.3°±12.5°. There was no correlation between age and the supine bending correction. There was a correlation between the correction obtained with the supine bending test and the immediate correction in the cast (r=0.64, p=0.0012).Conclusions: The reduction of the kyphosis Cobb angle by supine fulcrum bending was 50% on average, while in the cast in standing position, only half of this correction was maintained

Покращення показників імунітету у ВІЛ-інфікованих осіб з хронічною токсоплазмовою інвазією та недостатньою імунореконституцією на тлі антиретровірусної терапії за допомогою препарату рибонуклеїнової кислоти

Aim of the work. To study the possibility of additional correction of immunologic imbalance by ribonucleic acid medication in HIV-infected persons, infested by Toxoplasma gondii, who receive antiretroviral therapy and did not attain immunoreconstitution.Methods of research. 60 HIV-infected persons, seropositive as to Toxoplasma gondii infestation were examined. All patients received antiretroviral therapy (ART) during no less than 6 months, but the number of СD4+Т-lymphocytes in them did not exceed 350 kl/mcl of blood. The immune-enzyme method was used for determination of titres of specific anti-toxoplasmosis IgG and IgМ; general IgM, IgA, IgG, and also IL-2, IL-4, IL-10, INF-γ, TNF-2α. The number of CD4+ Т –lymphocytes was determined by cytofluorimetric method. The one group of 30 persons received ribonucleic acid medication in dose 1500 mg a day during 1-st month and during 2-d and 3-d month - 750 mg a day; other group of 30 patients did not receive medication. The statistical processing was carried out in Exсel, using Student t-criterion.Results. In HIV-infected persons with toxoplasmosis infestation comparing with healthy ones were revealed the increased levels of proinflammatory cytokines - TNF-α (2,47±0,11 pg/ml against 1,90±0,04 pg/ml, P<0,001), INF-γ (10,82±0,38 pg/ml against 4,13±0,12 pg/ml, P<0,001), and anti-inflammatory ones IL -4 (1,74±0,08 pg/ml against 0,81±0,09pg/ml, P<0,001) and IL-10 (11,64±0,31 pg/ml against  6,70±0,13 pg/ml, P<0,001). The persons, who received ribonucleic acid medication comparing with ones, who did not receive it, demonstrated the increase of IL-2 (2,83±0,11 pg/ml against 2,28±0,11 pg/ml, P<0,001) and INF-γ (11,29±0,25 pg/ml against 9,98±0,26pg/ml, P<0,001), instead of it TNF-α decreased (2,25±0,08 pg/ml against 2,50±0,09 pg/ml, P<0,05). After 3-d month of treatment IL-10 (7,73±0,22 pg/ml against 9,83±0,30 pg/ml, P<0,001), TNF-α (2,23±0,10 pg/ml against 2,53±0,09 pg/ml, P<0,05)levels decreased, and INF-γ increased (10,37±0,11 pg/ml against 9,86±0,20 pg/ml, P<0,05). In the group of patients, who did not receive medication the relapse of toxoplasmatic encephalitis appeared in two cases.Conclusion. It was established, that HIV-infected persons, with Toxoplasma gondii infestation, who took ART but with insufficient immunoreconstruction, demonstrated the increased levels of several proinflammatory (TNF-α, INF-γ) and anti-inflammatory (IL-4, IL-10) cytokines. After the treatment using ribonucleic acid medication the levels of СD4 + Т-lymphocytes, IL-2 and INF-γ increased and IL-10 decreased that eliminated the risk of toxoplasmatic encephalitis developmentВстановлено, що у ВІЛ-інфікованих осіб із токсоплазмовою інвазією були підвищеними рівні цитокінів: TNF-α, INF-γ, ІЛ-4, ІЛ-10. Після застосування препарату рибонуклеїнової кислоти впродовж 1місяця спостерігалося зростання рівнів ІЛ-2 та INF-γ, натомість, знижувався TNF-α. Після 3-го місяця лікування знизилися рівні ІЛ-10 та TNF-α, зросла кількість CD4+Т-лімфоцитів та усувався ризик токсоплазмозного енцефаліт

Does structural leg-length discrepancy affect postural control? Preliminary study

Abstract Background Leg-length inequality results in an altered position of the spine and pelvis. Previous studies on the influence of leg asymmetry on postural control have been inconclusive. The purpose of this paper was to investigate the effect of structural leg-length discrepancy (LLD) on the control of posture. Methods We studied 38 individuals (19 patients with structural LLD, 19 healthy subjects). The examination included measurement of the length of the lower limbs and weight distribution as well as a static posturography. All statistical analyses were performed with Statistica software version 10.0. Non-parametrical Kruskal-Wallis with Dunn’s post test and Spearman test were used. Differences between the groups and correlation between mean COP sway velocity and the value of LLD as well as the value of LLD and weight distribution were assumed as statistically significant at p  0.05). Meaningful differences in mean COP velocity in mediolateral direction between tandem stance with eyes open and closed were detected in both groups (in controls p = 0.000134, in patients both with the shorter leg in a front and rear position, p = 0.029, p = 0.026 respectively). There was a positive moderate correlation between the value of LLD and the value of mean COP velocity in normal standing in mediolateral direction with eyes open (r = 0.47) and closed (r = 0.54) and in anterioposterior plane with eyes closed (r = 0.05). Conclusions The fact that there were no significant differences in posturography between the groups might indicate compensations to the altered posture and neuromuscular adaptations in patients with structural leg-length inequality. LLD causes an increased asymmetry of weight distribution. This study confirmed a fundamental role of the sight in postural control, especially in unstable conditions. The analysis of mean COP sway velocity may suggest a proportional deterioration of postural control with the increase of the value of leg-length asymmetry. Trial registration number Trial registry: ClinicalTrials.gov NCT03048656 , 8 February 2017 (retrospectively registered)