Is the Zumba fitness responsible for low back pain?

PURPOSE

Zumba fitness requires aerobic repetition exercises, involving the whole body including the spine. Our study is aimed at verifying whether this sport may cause low back pain.

METHODS

Young healthy females were recruited. They were allocated to a "Zumba group" (n = 25) or an "inactivity control group" (n = 25). The Roland-Morris Disability, the Oswestry, the SF-36 and the Spinal Functional Sort Questionaries of all subjects were measured at the baseline (T0) and at 6 months (T1). During this 6-month study, the number of episodes of low back pain was recorded.

RESULTS

At T1, improvements were seen in the "Zumba group." The "inactivity control group" showed worsening in each test at T1. The differences between the two groups were statistically significant for the items Role limitations and physical problems, Physical functioning, Pain and Social activity of SF-36 (p < 0.05). There were no any statistically significant differences in either group of episodes of back pain (p > 0.05).

CONCLUSIONS

We verified that Zumba is not responsible for low back pain. Furthermore, we revealed that Zumba can increase the normal functional activity of the spine. On the basis of this data, we can recommend the practice of this sport on a regular basis for the healthy population, without worrying about the risk of overloading the spine. Further studies are necessary to check whether the patients with chronic spine disease may practice Zumba.

Possible interplay between interleukin-15 and interleukin-17 into the pathogenesis of idiopathic inflammatory myopathies

The aim of this study was to assess the serum levels of interleukin (IL)-15 and IL-17 in patients with idiopathic inflammatory myopathies (IIM) and correlate them with IL-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), MIP-1β levels. Possible correlations with disease activity parameters were also evaluated. Sera from 14 polymyositis (PM), 10 dermatomyositis (DM), 7 anti-synthetase syndrome new onset patients and 19 healthy controls (HCs) were analyzed by multiplex immunoassay. Sera from 19 patients were analyzed after 5 months median follow-up. All patients underwent physical examination, the 5-points manual muscle test (MMT), the health assessment questionnaire and serum creatine kinase measurement. All patients received glucocorticoids, and 13 were taking also immunosuppressive therapy. At baseline, serum levels of IL-15, IL-17, MCP-1 and MIP-1β were significantly higher in IIM patients than in HCs. IL-17 serum levels were directly correlated with disease duration (r=0.39, P=0.02), while a significant inverse correlation was detected between IL-17 levels and MMT scores (r=-0.4, P=0.02). The highest IL-15 levels were present in DM patients (P=0.02 vs PM). The most striking finding was the strong correlation between IL-15 and IL-17 levels (r=0.60, P=0.0001), and this correlation was even stronger in DM patients (r=0.82, P=0.006). The strong correlation between IL-15 and IL-17 in IIM patients, and especially in DM, suggests that there may be a interplay between the two cytokines in the pathogenesis of myositis. Further studies of larger patient cohorts and muscle biopsies are needed to confirm these preliminary data.

Daily pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study

BACKGROUND

Studies have shown the effectiveness of a few weekly pilates sessions as helping to reduce lower back pain (LBP). However many patients fear that physical activity can actually make the pain and disability worse.

DESIGN

We carried out this observational prospective clinical study to look at the effects that taking part in daily pilates has one on side and on the other the effects of LBP management without physical exercise.

SETTING

The volunteers who participated in this study were recruited from among some local cultural associations.

POPULATION

Patients affected by LBP were evaluated.

METHODS

The subjects were 60 volunteers (27 males and 33 females) with a mean age of 51.2 years who had chronic low back pain (CLBP). They were allocated to pilates group (N.=30) or inactivity control group (N.=30). The pilates group performed one-hour lesson of pilates exercise, 5 lessons per week during the following 6 months. The inactivity group continued with their normal daily activities. The Roland-Morris Disability, the Oswestry, the SF-36 and the Spinal Functional Sort Questionaries of all subjects were measured at the baseline (T1) and at 6 months (T2).

RESULTS

At T2 improvements were observed in the pilates group with increases in physical and social functioning, general health and vitality (P<0.05) and decreases in disability and pain (P<0.05). The inactivity group showed worsening in the same measures at T2.

CONCLUSION

We found an important improvement of pain, disability and physical and psychological perception of health in individuals who did the daily sessions of pilates.

CLINICAL REHABILITATION IMPACT

Some authors underlined the possible risk of a lack of adherence to an exercise program at home. This study suggests that a daily pilates program is effective for the management of CLBP. On the other hand, the inactivity contributes to further worsening, inducing a vicious cycle in which pain and physical activity intolerance follow each other.

The effect of hydroxyapatite coated screw in the lateral fragility fractures of the femur. A prospective randomized clinical study

Due to a growing numbers of lateral fragility fractures of the femur and their high social costs the need to work out an effective strategy in order to find a better solution for these patients is warranted. From January 2010 to July 2011, we carried out a prospective randomized clinical study comparing the results of patients with femoral lateral fractures treated by nail and cephalic hydroxyapatite coated screws (study group including 27 patients) compared to the patients with the same fractures treated with nail and head standard screws (control group including 27 patients). We defined the two parts of the femoral neck as ROI 1 (under the head screw) and ROI 2 (above the femoral screw) on the AP view. The bone density of the two areas was calculated using DEXA at T0 (1st day post-surgery), at T1 (40th day post-surgery), at T2 (3 months later), at T3 (1 year later). The clinical-radiography evaluations were based on the Harris Hip Score (HHS), ADL test and x-ray views of the hip. As far as the bone mineral density average of ROI 1 and ROI 2 is concerned, we found a significant statistical increase at T1 and T3 in the study group, while it was not significant in the control group. We could account for this data through the higher mechanical stability of hydroxyapatite coated screws than standard screws. In fact, this material was responsible for improved implant osteointegration. Thanks to a 1 year follow-up we were able to demonstrate the implant utility associated with augmentation and the importance of densitometry exams such as easily repeatable and low cost diagnostics to prevent the onset of complications linked to screw loosening.

First case report of vanadium metallosis after ceramic-on-ceramic total hip arthroplasty

The development of metallosis as a complication following rupture of a hip replacement is known to occur as a result of contact with metal components of the prosthesis (1).In such cases, high cobalt (Co), chromium (Cr) and molybdenum (Mo) levels in the blood have been reported by several Authors (2).Recently, it has been stressed that the clinical investigation should focus on general reactions to high circulating metal levels, such as toxicity for the central nervous system (CNS) and the immune system (3).Despite the increasing interest of literature in ceramic-on-ceramic hip arthroplasty (4),little is known about these complications, and in particular of metallosis. To our knowledge this is the first description of a condition of extensive metallosis and radiographic signs presenting as a result of wear of a ceramic-on-ceramic prosthesis.

Overload and neovascularization of Achilles tendons in young artistic and rhythmic gymnasts compared with controls: an observational study

The incidence of Achilles tendinopathy is very high in young female gymnasts (17.5 %). According to literature, ecography screenings show the tendons thickening, but at the same time it does not reveal a direct link to the clinical picture. The neovessels are involved in the pathophysiological process of Achilles tendinopathy. For this reason, we wanted to verify there between perfusion tendon values and the type of sport activity. We performed a clinical observational study monitoring the oximetry of the Achilles tendon and the epidemiological data of 52 elite female (artistic and rhythmic) gymnasts versus 21 age-matched controls. Analyzing the main limb, we revealed statistically higher oximetry values in the artistic gymnasts group (69.5 %) compared to the rhythmic gymnasts group (67.1 %) (t = 2.13; p = 0.01) and the sedentary group (66.2 %) (t = 2.70; p = 0.004), but we did not find any differences between rhythmic gymnasts group and the sedentary group (t = 0.68; p = 0.24). The multiple logistic regression model highlighted that the oximetry value of the main limb is not influenced by age, knowledge of the main limb, years of general and gymnastic sports activity (p > 0.05). We discovered an increase of Achilles tendon perfusion in the main limb in the artistic gymnast group. We hypothesize that specific figures of artistic sports activity are responsible for muscle overload and gastrocnemius-soleus group and, at the same time, these figures cause hyperperfusion of the tendon. Prospective longitudinal studies could explain if this could become a predictive sign of the next Achilles tendinopathy onset.

Possible role of oral ibandronate administration in Osteonecrosis of the Jaw: a case report

We describe a case of Osteonecrosis of the Jaw (ONJ) that developed in a 65-year-old Caucasian woman with osteopenia and other risk factors who was receiving low doses of oral bisphosphonate therapy (ibandronate, 150 mg monthly). Computed tomography (CT), panoramic radiographs (OPT), 99mTc-Sn-MDP scintigraphy, and magnetic resonance imaging (MRI) were performed to study the diseased area; cytological examination also revealed the presence of suppurative material around the area of exposed bone. A diagnosis of bisphosphonate-related osteonecrosis of the jaw complicated by osteomyelitis was made. The patient was prescribed a drug protocol consisting of metronidazole 250 mg 2 times daily, chlorhexidine mouthwashes 3 times daily and chewing exercises for two months. Ibandronate was stopped and replaced with strontium ranelate. The symptoms improved and the patient is still under close follow-up. Assessment of the benefits versus risks is particularly necessary in patients with several risk factors to ascertain their eligibility for treatment with antiresorptive drugs and when this is not possible to choose alternative medications.

Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department

AIM

To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes positioned near the wound] sampling systems.

METHODS

Sampling was performed between January 2010 and January 2011 in the operating theatre of the orthopaedics department in a university hospital in Southern Italy.

FINDINGS

During surgery, the mean bacterial loads recorded were 2232.9 colony-forming units (cfu)/m(2)/h with the IMA method, 123.2 cfu/m(3) with the SAS method and 2768.2 cfu/m(2)/h with the nitrocellulose membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and three operations (5%) with the IMA method.

CONCLUSION

Use of nitrocellulose membranes placed near a wound is a valid method for measuring the microbial contamination of air. This method was more sensitive than the IMA method and was not subject to any calibration bias, unlike active air monitoring systems.

"Syndrome in syndrome": Wernicke syndrome due to afferent loop syndrome. Case report and review of the literature

Wernicke syndrome is a rare neurological pathology due to a deficit in vitamin B1. The syndrome is common among alcohol abusers, patients with malignant tumor or gastrointestinal diseases, those who undergo hemodialysis or long-term peritoneal dialysis, pregnant women with hyperemesis, women who breast-feed, patients with hyperthyroidism or anorexia nervosa or gastric or jejunal-ileal bypass surgery for obesity, patients submitted to gastric surgery or prolonged total parenteral nutrition or prolonged intravenous therapy. We report a case of Wernicke syndrome due to afferent loop syndrome characterized by incoercible vomiting.

Relevance of orthostatic posturography for clinical evaluation of hip and knee joint arthroplasty patients

In order to verify whether orthostatic posturography (OP) can support clinical assessment of total hip (THA) and knee arthroplasty (TKA), 81 subjects with THA and 100 with TKA were recruited and compared with 59 healthy volunteers. All patients were tested one or two days prior to surgery; 42 subjects (20 THA and 22 TKA) were tested again after six months, and 34 (14 THA and 20 TKA) yet again after 12 months. OP was performed using a Kistler 9286A piezoelectric force plate and the following postural parameters (PPs) were adopted on account of their functional meaning: mean velocity and the root mean square of the distance of the centre of pressure (CoP), sway area, and 95% of the CoP power frequency. Eye condition and fatigue related to the test duration were also examined. The three most meaningful PPs were identified and a logarithmic transformation was then applied to these, as well as standardization. Almost all the PP values were higher preoperatively in the patients as compared with the healthy subjects and it was possible to detect many statistically significant differences between patients and healthy subjects. However, when examining the 181 subjects at the preoperative stage, the PPs did not show congruence with the clinical scores as well as they did during follow-up. Therefore, the use of the OP is not recommended to monitor patients undergoing THA or TKA.

Severe osteoporosis treated with teriparatide in a patient affected by recessive epidermolysis bullosa dystrophica

In this work, we describe the clinical and instrumental results of our experience, the first reported in the literature, of the administration of teriparatide to treat severe osteoporosis secondary to epidermolysis bullosa. Already after 2 months of therapy, the patient, a 20-year-old affected by a recessive form of epidermolysis bullosa dystrophica, had less pain and a functional recovery resulting in an improved autonomy; a satisfactory increase in the densitometric values was documented.

Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid

The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder.

Extracorporeal shock waves increase interleukin-10 expression by human osteoarthritic and healthy osteoblasts in vitro

OBJECTIVE

Extra corporeal shock waves (ESW) have been proposed as additional therapy in bone fracture repair and osteoarthrtitis (OA). However, little is known on the effects of ESW on osteoblast metabolism. The aim of this study was to evaluate phenotype changes of healthy and OA human osteoblasts following ESW treatment.

METHODS

Osteoblasts were isolated from subchondral bone of 13 OA patients and 7 healthy donors. Osteoblasts were treated or not with ESW at different levels of energy and impulses. IL-10, TNF-alpha, CD29/Beta1 integrin, and CD105/endoglin expression was evaluated by flowcytometry.

RESULTS

Intracellular IL-10 significantly increased using 1000 impulses at 0.055 mJ/mm2 in both healthy and OA osteoblasts in comparison with untreated osteoblasts (p<0.01). Only in the OA osteoblasts CD29 and CD105 expression significantly increased at 500 impulses and 0.17 mJ/mm2 ESW treatment (p<0.05).

CONCLUSION

ESW are capable of modifying IL-10 expression in osteoblasts. There is evidence that IL-10 can play a role in bone remodelling by inhibiting osteoclast differentiation and this suggests that ESW may favour bone growth and healing. This further supports the use of ESW in treating bone fracture to promote callus formation. However, the possible use of ESW in OA therapy needs further studies since in OA, osteoblast metabolism is already enhanced with bone sclerosis and ESW application may further increase bone deposition and osteophyte formation, leading to a subsequent worsening of the disease.

[Early colorectal reoperation: risk factors]

The aim of the study was to analyse the risk factors in colorectal reoperation. Over the period from January 1987 to December 1999, 371 patients (191 male and 180 female, aged from 16 to 88 years) underwent colorectal surgery. Eighteen reoperations (12 male, 6 female, aged from 20 to 74 years; median age: 52.6 years) were performed. These included reoperations performed within 30 days of the first operation (or patient admission). The overall incidence of reoperation after colorectal surgery was 4.8% (18/371). In 14 of 18 patients (77%) anastomotic dehiscence was the indication for reoperation. In our experience, the mortality rate was 16.6% (3/18), in agreement with other reports in the literature. Analysis of risk factors in colorectal reoperation poses several methodological problems because we have no randomized multicentre studies that analyse risk factors in colorectal reoperation and the related surgical mortality.

[Appendiceal carcinoid. Clinical observations and therapeutic considerations]

The Authors report 3 cases of carcinoid of the appendix discussing the difficult preoperative diagnosis and the different therapeutical options. Between May 1998 and August 1999 36 appendicectomies were performed, in 18 males and 18 females (age 14-89 years; m. a.: 51.5 years). In 3 cases histological response was positive for carcinoid of the appendix. No postoperative mortality or morbility was reported. In one case, the malignancy of histological response made a second operation of typhlectomy necessary, without postoperative complications. The Authors analyze the biological peculiarities and the prognostic factors of appendiceal carcinoid tumors, as size of the tumor and the lymphatic or vascular infiltration of the mesoappendix (and the relative more aggressive surgical treatments) and recommend an appropriate postoperative follow-up since synchronous or metachronous bowel carcinomas are likely to occur.

[The indications and surgical treatment in the complications of colonic diverticular disease]

In this work the authors describe the different stages of diverticulosis and analyze the pathogenetic principal factors. During the period from 1979 to 1998 they observed 420 patients affected by diverticular disease (224 M; 196 F), 42 (10%) of them were operated on for complications. Fifteen patients operated on in elective time underwent a one stage procedure of resection and anastomosis with derivative colostomy; 27 patients were operated on in emergency: 6 patients had one stage procedure of resection and anastomosis with derivative colostomy, 16 patients Hartmann's procedure, 3 patients Mikulicz's procedure and 2 patients colostomy and peritoneal drainage. Two patients died from septic shock. There was absence of postoperative complications for the patients operated on in elective time, while 8 cases (29.6%) showed peritoneal sepsis and 4 cases (14.8%) infection of wound in the patients operated on in emergency. The Authors describe the different surgical options in the treatment of colonic complicated diverticular disease and conclude that the surgical treatment is not definite. A tendency is to make a one-stage procedure of resection and anastomosis and to reduce the Hartmann's procedure or the simple colostomy with drainage of abdominal cavity.

Lipophilicity and disposition of 1-aryl-piperazines in the rat

The disposition of eight 1-aryl-piperazines was investigated in rats after i.v. administration. The concentration of 1-aryl-piperazine in body fluids and tissues was determined by h.p.l.c. or electron-capture g.l.c. Correlations of kinetics and physiological parameters with the lipophilicity of each 1-aryl-piperazine, determined by h.p.l.c. retention on a reverse-phase C18 column at neutral pH, were investigated. Binding to rat plasma proteins varied within the series, increasing with lipophilicity. For the majority of the derivatives the blood-to-plasma ratio was close to unity, implying an almost equal distribution between erythrocytes and plasma. The most lipophilic 1-aryl-piperazine of the series partitioned more into erythrocytes. The eight compounds differed widely in Vss and total Cl values and as a general trend both values increased with lipophilicity. The percentage of the dose excreted unchanged in the urine decreased progressively with increasing lipophilicity. 1-Aryl-piperazines were distributed extensively in all the tissues examined, concentrating particularly in the eliminating organs and lung. They easily entered the rat brain, Cmax values generally being reached within five minutes of parenteral injection. 1-Aryl-piperazine brain uptake increased with lipophilicity.

In-vivo metabolism in the rat and mouse of antrafenine to 1-m-trifluoromethylphenylpiperazine

The analgesic antrafenine forms 1-m-trifluoromethylphenylpiperazine (mCF3PP) during its biotransformation in the rat and mouse. At least 14 and 3% of an antrafenine dose (25 mg kg-1 p.o.) reaches the systemic circulation as mCF3PP in the mouse and rat respectively. The metabolite easily enters the brain, reaching concentrations several times those in body fluids. This, together with the fact that mCF3PP is known to produce several pharmacological effects compatible with a stimulatory action on 5-hydroxytryptamine postsynaptic receptors, suggests that this metabolite may contribute to the parent drug's pharmacological effects.

Identification and quantitation of 1-arylpiperazines, metabolites resulting from side-chain cleavage of (4-substituted aryl-1-piperazinyl)alkyl heterocyclic derivatives in rat plasma and brain

Many drugs contain the arylpiperazine moiety in the side-chain of their molecules. A common metabolic pathway of such drugs is cleavage of the side-chain with the formation of 1-arylpiperazines. This has been verified by combined gas chromatography-mass spectrometry of biological samples from rats given orally a series of heterocyclic derivatives bearing a 4-aryl(phenyl, pyrimidinyl, pyridyl or thiazolyl)-1-piperazinylalkyl moiety (oxypertine, zolertine, millipertine, empiprazole, dapiprazole, antrafenine, piribedil, azaperone). A sensitive and selective electron-capture gas-liquid chromatographic procedure for 1-arylpiperazines in rat plasma and brain is described. The overall recovery from plasma and brain was 70-90%. The limit of detection for substituted (halogenated) phenylpiperazines was 10-25 ng/ml or ng/g and 25-100 ng/ml or ng/g for other derivatives. Preliminary data are reported on the time course of the production and elimination of 1-arylpiperazines after oral administration of representative compounds with the arylpiperazine moiety (oxypertine, azaperone and S-3608).

Relative ability of N-methyl nalorphine and N-methyl levallorphan to prevent antinociception and intestinal transit inhibition in morphine treated rats

Nalorphine, levallorphan and their quaternary analogs, N-(eq)allyl derivatives of the two diastereoisomers at the nitrogen atom (N-methyl nalorphine and N-methyl levallorphan) were tested for their peripheral selectivity. We compared their relative ability to prevent morphine-induced (5 mg/kg i.v.) antinociception (central antagonism) and constipation (peripheral antagonism) in the same rats. Nalorphine and levallorphan reduced morphine-induced antinociception to half maximal response at doses of 5.1 and 0.89 mg/kg s.c. and restored the intestinal transit to 50% of controls (AD50) respectively at doses of 0.25 and 0.12 mg/kg. N-methyl nalorphine up to 24 and N-methyl levallorphan up to 30 mg/kg given s.c. 10 min before morphine did not antagonize narcotic-induced antinociception, fully preventing constipation (AD50 0.65 and 0.32 mg/kg respectively), but when injected 50 min before morphine they partially lost their antagonist potency (AD50 2.3 and 2.6 mg/kg respectively) and peripheral selectivity. N-methyl nalorphine and N-methyl levallorphan thus seem more peripherally selective than their tertiary analogs and more potent than quaternary narcotic antagonists tested to date.

Inhibition of gastrointestinal transit by morphine and FK 33-824 in the rat and comparative narcotic antagonist properties of naloxone and its N-methyl quaternary analog

Morphine and the enkephalin-like peptide FK 33-824 given i.p. to rats potently inhibit gastrointestinal transit of a charcoal test meal, the doses inhibiting transit by 50% being respectively about 10 and 1 microgram/kg. These intestinal effects are opiate-specific, locally elicited and presumably involve the same action site since they are reversed by the "peripherally selective" narcotic antagonist N-methyl naloxone with apparent pA2 values of 7.34 and 7.10 respectively against morphine and FK 33-824. The calculated pA2 value for naloxone/morphine with the same in vivo test procedure (8.83) and the relative ability of naloxone and N-methyl naloxone to prevent 3H-etorphine binding to rat brain membranes (IC50 43 and 541 nM), indicate different potency ratios between the two narcotic antagonists in the in vitro binding cell-free system (about 1:10) and in vivo (about 1:30), but the latter ratio agrees with published findings in the isolated guinea pig ileum.