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Unlabelled: Perthes disease is one of the most common forms of pediatric femoral head osteonecrosis with an unknown etiology. Coagulation factors were the first genetic factors suspected to have a role in the pathogenesis of this disease, but studies showed inconsistent results. It is described that inflammation is present during early stages of Perthes disease, but its genetic aspect has not been studied extensively. Little is known regarding the status of apoptotic factors during the repair process that leads to the occurrence of hip deformity in patients. Therefore, the aim of this study was to analyze major mediators involved in coagulation, inflammation, and apoptotic processes as possible causative factors of Perthes disease. The study cohort consisted of 37 patients. Gene variants of TNF-α, FV, FII, and MTHFR genes were determined by PCR-RFLP, while IL-3 and PAI-1 were genotyped by direct sequencing. The expression level of Bax, Bcl-2, Bcl2L12, Fas and FasL was analyzed by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) technique. Our results showed a significantly increased level of expression of pro-apoptotic factor Bax along with significantly higher Bax/Bcl-2 ratio in the patient group., Conclusion: The results presented indicate that apoptosis could be one of the factors contributing to the lack of balanced bone remodeling process in Perthes patients.

Background/aim: Matrix metalloproteinase-9 (MMP-9) index is the ratio of active MMP-9 and total MMP-9 levels. It reflects the importance of MMP-9 in acute coronary syndrome (ACS)., Methods: The study included 3 groups of patients (n = 87): the group 1 - non-diabetic subjects without ACS (control); the group 2 - diabetic patients with ACS [subgroups with unstable angina pectoris (UAP), myocardial infarction (MI) or reinfarction]; and the group 3 non-diabetics patients with ACS. Total and active MMP-9 were measured and used to create MIP-9 index., Results: MMP-9 index, as a marker showed good sensitivity and specificity, of ACS in diabetics, with a cut-off value over 58.2. MMP-9 was higher in the study groups than in the control one. MMP-9 correlated with ACS occurrence and type of cardiovascular event. A statistically significant difference was found among the groups according to active MMP-9 (p < 0.001). The same was found with active MMP-9 between the control and the group with MI (p < 0.001). The control was highly statistically significantly different from the group of patients with UAP (p < 0.01). Statically significant differences in MMP-9 index was found between the control and the diabetics with ACS (P < 0.001). Statistically significant difference of MMP-9 index was also found in the controls compared to the value in non-diabetic patients with ACS (p < 0.01)., Conclusion: MMP-9 index may be a possible marker of atheromatous plaque rupture in diabetics.

Introduction: Perthes disease is idiopathic avascular osteonecrosis of the hip in children, with unknown etiology. Inflammation is present during development of Perthes disease and it is known that this process influences bone remodeling., Objective: Since genetic studies related to inflammation have not been performed in Perthes disease so far, the aim of this study was to analyze the association of frequencies of genetic variants of immune response genes, toll-like receptor 4 (TLR4) and interleukin-6 (IL-6), with this disease., Methods: The study cohort consisted of 37 patients with Perthes disease and 50 healthy controls. Polymorphisms of well described inflammatory mediators: TLR4 (Asp299Gly, Thr39911e) and 11-6 (G-174C, G-597A) were determined by polymerase chain reaction restriction fragment length polymorphism method. Results IL-6 G-174C and G-597A polymorphisms were in complete linkage disequilibrium. A statistically significant increase of heterozygote subjects for IL-6 G-174C/G-597A was found in controls in comparison to Perthes patient group (p = 0.047, OR = 2.49, 95% CI = 1.00-6.21). Also, the patient group for IL-6 G-174C/G-597A polymorphisms was not in Hardy-Weinberg equilibrium. No statistically significant differences were found between patient and control groups for TLR4 analyzed polymorphisms. A stratified analysis by the age at disease onset also did not reveal any significant difference for all analyzed polymorphisms. Conclusion Our study revealed that heterozygote subjects for the IL-6 G-174C/G-597A polymorphisms were significantly overrepresented in the control group than in the Perthes patient group. Consequently, we concluded that children who are heterozygous for these polymorphisms have a lower chance of developing Perthes disease than carriers of both homozygote genotypes.

The aim of this study was to investigate which one among possible risk factors are independently related to first nonfatal myocardial infarction (MI) in Belgrade population. Case-control study was conducted in Belgrade during the period 2005-2006. Case group comprised 100 subjects 35-80 years old who were hospitalized because of first nonfatal MI at the coronary care unit in Urgent Center, Belgrade. Control group consisted of 100 persons chosen among patients treated during the same period at the Institute of Rheumatology, Institute for Gastroenterology, and Clinic for Orthopedics, Belgrade, Serbia. Cases and controls were individually matched by sex, age (+/- 2 years) and place of residence (urban/rural communities of Belgrade). According to the multivariate analysis risk factors for MI occurrence were "good" socioeconomic conditions (OR = 2.76), total alcohol consumption (OR = 2.62) and consumption of brandy (OR = 6.73), stressful life events taken together (OR = 3.13) and stress because of close relative Ns death (OR = 3.35), great financial problems (OR = 31.64) and small financial problems (OR = 8.47), hypertension (OR = 2.39), MI among all relatives (OR = 3.66), MI in father (OR = 6.24), and low level of high density lipoprotein cholesterol (OR = 152.41). Amateur sport activity in the past was negatively associated with MI development. The results obtained are mainly in accordance with other studies results and can be of help in development of strategy for coronary heart disease prevention in Serbia.

Introduction: Numerous authors have indicated the beneficial effect of glycoregulation on micro- and macro-angiopathic complications., Objective: The aim of the study was to examine whether intensive treatment with maintaining blood glucose concentrations close to normal range could improve electrophysiological parameters., Methods: The study involved 81 patients with type 1 diabetes mellitus type 1 randomly assigned to intensive insulin therapy. The patients were followed for a period of 3 months by metabolic and electrophysiological control. The metabolic control included daily measurement of concentration of blood glucose and HbA1c and lipid status, while the neurophysiological control included nerve conduction velocity (NCV) of median, peroneal, tibial and sural nerve and latency of F wave., Results: In the beginning of our study blood glucose was 9.10 +/- 3.69 mmol/l and HbA1c 8.12 +/- 1.20%. After 3 months of administered intensive insulin therapy, blood glucose was 7.88 +/- 2.79 mmol/l and HbA1c 6.63 +/- 1.33. After 3 months NCV improved in the tibial, median and sural nerve (p < 0.05) and latency of F wave., Conclusion: We found a significant association between the metabolic control and NCV findings which suggests that good metabolic control influences the improvement of neurophysiological parameters in patients with type 1 diabetes mellitus.

Introduction: The aim of the study was to determine to what extent severe cognitive impairment impacts short-term rehabilitation outcomes of elderly patients with proximal hip fracture., Material and Methods: A total of 337 community-dwelling elderly patients with acute hip fracture were observed during a 12-month period at a major teaching hospital in Serbia. Cognitive status was assessed at admission with the Short Portable Mental Status Questionnaire (SPMSQ). Outcome after 4 months was analysed with respect to presence of severe cognitive impairment, defined as an SPMSQ score of < 3. Outcome assessment included presence of postoperative complications, absolute motor Functional Independence Measure (FIM) gain, Activities of Daily Living index (ADL), Instrumental Activities of Daily Living score (IADL), and walking ability., Results: An SPMSQ score of < 3 was observed in 36 patients (10.7%) with acute hip fracture. Patients with an SPMSQ score of < 3 achieved worse short-term outcomes regarding all observed variables. However, cognitive status was found to be an independent predictor only with respect to mortality at 4 months (odds ratio (OR) = 0.969, 95% confidence interval (CI) = 0.947-0.992, p = 0.009). In contrast, pre-fracture motor FIM independently predicted mortality (OR = 2.982, 95% CI = 1.271-7.000, p = 0.012), and preserved walking ability at 4 months follow-up (OR = 0.945, 95% CI = 0.912-0.980, p = 0.002). Correspondingly, pre-fracture ADL was an independent predictor of absolute motor FIM gain at 4 months follow-up (OR = 0.175, 95% CI = 0.405-11.426, p = 0.035)., Conclusions: Failure to consider functional status prior to fracture might overestimate the impact of cognitive status on functional outcome of hip fracture patients.

Introduction: When treating complex regional pain syndrome (CRPS) a positive outcome can be expected when the condition is identified and therapy is begun in the first six months. Nevertheless, symptoms may not improve by standard treatment as expected. One of the possible reasons for this is the coexistence of associated compressive neuropathies in the affected hand., Case Outline: A 50-year old female patient with history of CRPS on the left hand which developed as a complication of lateral epicondilytis treated with immobilization is presented. She continued to suffer from intensive pain in her hand despite pharmacological pain relief and initiation of a complex rehabilitation program. Electrophysiologic testing revealed the coexistence of conjoined severe carpal tunnel syndrome. After she underwent surgical decompression pain relief occurred and overall functional results improved., Conclusion: Failure of therapy response in CRPS should alert the clinican to check for associated compressive neuropathy. Detection of this complication can prevent further damage of the nerve, hasten recovery of CRPS, and prevent eventual permanent disability of the hand.

Introduction: The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome., Objective: To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients., Methods: Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge- FIM admission). Absolute functional gain was analyzed in respect to cognitive status., Results: Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p < 0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p < 0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p < 0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p > 0.05)., Conclusion: The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favourable short-term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

Introduction: Limited surgical technology in treating injuries of the anterior cruciate ligament (ACL) in the past led to the development of a huge number of functional braces. Today, with the advance of the surgical techniques and a more aggressive rehabilitation approach in the postoperative course the use of functional braces after the ACL reconstruction is seriously questioned. The aim of this study was to review the basic functions of functional braces. Mechanical, and biomechanical functions of functional braces have been described, the psychological aspect of wearing them, their impact on thigh circumference, functional performance, muscle activity and postural control and propriocepation have also been addressed. Functional braces definitely increase the knee stability under low clinical loads. However, biomechanical investigations show that functional knee braces do not restore the normal knee stability under high forces related to certain activities. Furthermore, functional braces do not significantly influence proprioceptive abilities, nor functional performance, but have a negative impact on thigh atrophy, and inhibit joint muscle stabilizing activity., Conclusion: Given the generally high surgical success rates, there has been no scientific evidence so far to support the routine use of a functional knee brace following a successful anterior cruciate ligament reconstruction in the controlled rehabilitative postoperative course.

Dysphagia and aspiration are important problems among the elderly population, particularly in neurological patients and patients with cancers of the oropharingeal area or laryngs. Early detection and rehabilitation are crucial because adequate management can reduce morbidity and complications like aspiration pneumonia, dehidratation and malnutrition. We overviewed rehabilitation procedures including nutritional management, postures, maneuvers, exercises and stimulation techniques and their efficacy in treatment of patients with dysphagias.

Background/aim: [corrected] During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED., Methods: The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbAlc) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded., Results: Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26+/-1.49 points) compared with the medium improvement in the group 1 (6.27+/-1.35 points). After three months HbA1c values decreased for 2.26+/-1.62 (p < 0.001)., Conclusion: Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients.

Introduction: It is well known that polyneuropathy has been an important cause of disability in patients maintained on hemodialysis as well as on peritoneal dialysis. The present study was aimed to analyze frequency and causes of polyneuropathy in patients on continuous ambulatory peritoneal dialysis (CAPD)., Material and Methods: Sixty three CAPD patients (37 men), aged between 30 and 85 who were on dialysis from 1 to 290 months, were analyzed. Biochemical parameters and dialysis adequacy (KT/V) were determined. Motor conduction velocity (MCV) of peroneal and tibial nerve, and sensitive conduction velocity (SCV) on sural nerve were measured., Results and Discussion: Biochemical parameters and dialysis adequacy were satisfactory in patients on CAPD. Polyneuropathy symptoms like paresthesias, pain, cramps and disability were found in more than 50% of patients. Over 80% of analyzed patients had pathological neurophysiological parameters: latency of F wave of n. peroneus and all analyzed parameters of n. tibialis, as the well as SCV on the sural nerve. A significant correlation was found between peroneal MCV and age, glycemia and serum creatinine; peroneal terminal latency (TL) and age; peroneal F wave and glycemia and serum urea; tibial MCV and glycemia; tibial F wave and glycemia, serum urea and KT/V., Conclusion: The most frequent signs of uremic polyneuropathy are reduced SCV on sural nerve and prolonged latency of F wave on peroneal and tibial nerves. Neurophysiological parameters on the lower extremities in patients on CAPD are in correlation with dialysis adequacy, glycemia and age.

Introduction: Optimal treatment of ACL (anterior cruciate injury) injuries is one of the most dynamic topics of contemporary orthopedics. Despite huge amount of publications on this subject, golden rehabilitation standard has not been established yet., Objective: The aim of our study was to compare two different rehabilitation groups in respect to dynamics and safety of recovery, and accordingly to recommend contemporary rehabilitation approach., Method: A prospective study included 45 patients with unilateral ACL rupture who were randomized into conservative (TH-C) and intensive rehabilitation (TH-I) group. The arthroscopic reconstruction of ACL was performed using the BTBP or STG graft. After the operation, in the TH-C group, ROM was limited to 0-0-90 degrees and weight bearing was not allowed in the first 4 postoperative weeks. In the TH-I group, progression depended only on the knee edema and pain. The groups were compared in relation to demographic, anamnestic, and clinical characteristics (knee circumference, thigh circumference, stability tests, Lysholm, Tegner and one-leg hop test, and single stance test). Data were recorded preoperatively and postoperatively after 6 weeks, 4, 6, 9 and 12 months, and compared with parametric and non-parametric statistical tests., Results: The investigated groups clearly differed already after 6 weeks by range of motion (p < 0.05), thigh circumference (p < 0.01) and Lysholm test score (p < 0.01), after 4 months in relation to one leg hop test (p < 0.05), and after 6 months according to Tegner test (p < 0.01). In the TH-I group, graft integrity was not compromised in any of these patients, nor did postoperative arthrofibrosis develop., Conclusion: Our investigation has undoubtedly revealed that early intensive rehabilitation approach leads to faster functional recovery without complications compared to conventional rehabilitation treatment.

Rehabilitation after ACL (anterior cruciate ligament) reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.

ACL injury leads to a decrease in proprioceptive abilities, which can be improved with ACL surgery and postoperative rehabilitation. The goal of our study was to investigate whether the impact of coordinative training can be differentiated from the influence of surgery on proprioceptive improvement, and whether there is a correlation between improvement in coordinative abilities and other objective parameters of functional recovery. This follow-up study included 45 patients who had undergone ACL reconstruction and who were randomised into a conservative (TH-C) and an intensive (TH-I) rehabilitation group. In the TH-I group, coordinative training began earlier due to unrestricted weight-bearing. The groups were first compared preoperatively, then postoperatively, after 6 weeks, 4, 6, 9, and 12 months via the single leg stance test, the one leg hop test, the Lysholm knee score, and the Tegner score. A faster recovery of coordinative skills was registered in the TH-I group. Already after 6 weeks, highly statistically significant progress in one leg stance abilities was noticed, while in the TH-C group the same was not noticed until 4 months after surgery (p < 0.01). Such a result speaks for the distinct influence of proprioceptive training on coordinative abilities. Also, a highly statistically significant correlation was noticed between the single leg stance, one leg hop, Lysholm, and Tegner tests (p < 0.01), which points out the importance of a good rehabilitation programme, since neuromuscular performance cannot be separated from other parameters of functional recovery.

Boleslas Matuszewski, born in 1856, was a pioneer in medical film-making. He worked simultaneously on improving his movie camera, film-making, collecting film documentation, and the idea of establishing an archive of medical films. Although his first attempts at filming and showing surgical operations didn't gain widespread approval, he was not discouraged, and succeeded in garnering support from a number of French doctors, who realised the importance of his ideas, not only in filming and forming medical film documentation, but also in the use of film for educative purposes. His visionary ideas gained acceptance when Dr. Doyen, on the occasion of the 66th Convention of the British Medical Society, in 1898, used film material as part of his lecture. Shortly afterwards, the Medical Academy took steps to show certain operative techniques, which represented both the confirmation and fruition of Matuszewski's ideas about filmmaking and the establishment of an archive of medical films.

Introduction: In clinical practice, physical therapy is more often applied in patients with obstructive pulmonary disease than in other pulmonary diseases. One of them is pulmonary sarcoidosis. Depending on the stage, there are a few different types of pulmonary dysfunctions. With early disease progression pulmonary obstruction is expected and later interstitial fibrosis may lead to restrictive syndrome and development of bronchiectasias., Respiratory Rehabilitation: Respiratory rehabilitation may improve pulmonary ventilation and the choice depends on lesion features. The objectives of respiratory rehabilitation are. to establish the optimal respiratory rate, sustain opened airways, achieve automatic diaphragm breathing and improve ventilation. For these purposes different techniques are used: aerosol therapy, breathing exercises, forced expiration, postural drainage, kinesitherapy. Using more than one of these techniques in the same patient we can prevent or delay consequences of respiratory failure and early disability. Early respiratory rehabilitation in these patients is an opportunity to reduce disability and improve quality of life.

A panel of monoclonal antibodies (mAb) raised to antigens of rat thymic non-lymphoid cells (predominantly macrophages and granulocytes) was immunohistochemically characterized. Based on their staining patterns on cryostat thymic sections and double labellings using acid phosphatase activity, anti-cytokeratin mAb to exclude binding to epithelium or ED1 and ED2 mAb, specific for rat macrophages, antibodies were subdivided into four groups: (i) R-MC 39 mAb strongly reactive with macrophages in the cortex and cortico-medullary zone (CMZ) and weakly with some scattered macrophages in the medulla, blood vessels and thymocytes; (ii) R-MC 40, 41 and 42 mAb specific for cortical macrophages and most CMZ macrophages; (iii) R-MC 43 and 44 mAb predominantly recognizing CMZ and medullary macrophages; (iv) R-MC 45 mAb strongly labelling granulocytes and weakly a subset of macrophages throughout the thymus and isolated cells in the medulla. The obtained results show considerable heterogeneity within mobile thymic non-lymphoid cells and the presence of specific or common antigens in macrophages of particular topographic localization in the rat thymus.

Immunohistochemical characterization of rat TEC has been studied using a panel of monoclonal anti-keratin antibodies. These mAbs identified three distinct patterns of keratin subunit expression within thymic epithelium assessed by streptavidin-biotin immunoperoxidase staining and double immunofluorescence staining. K8 and KII mAbs labelled almost all epithelium, while K18 stained cortical epithelium and a subpopulation of medullary TEC. KI, K7 and K19 mAbs bound to the subcapsular/subtrabecular flat epithelial cell layer, TEC lining some perivascular spaces in the cortex, a subpopulation of medullary TEC and interstitial epithelial cystic structures. Double immunostaining revealed further heterogeneity of subunit keratin compositions in epithelial cells of particular thymic microenvironments suggesting their different origin or development stage.

Molecular microenvironmental heterogeneity within rat thymus was studied by a panel of 13 monoclonal antibodies (mAbs) raised to thymic epithelial (TE) cells and mesenchymal stroma. Based on their anatomical distribution patterns observed with immunohistological techniques on frozen sections and double immunostaining using anti-keratin antibodies to identify epithelium, they were subdivided into five groups: (i) pan TE cells antibodies (R-MC 2, 3 and 8); (ii) cortical TE cells antibodies (R-MC 13-17); (iii) antibodies detecting subcapsular and subtrabecular TE cells and most medullary TE cells (R-MC 18-20); (iv) antibody to Hassall's corpuscles (HC) and a small subpopulation of medullary TE cells (R-MC 22); (v) mesenchymal stroma antibody (R-MC 23). The obtained results show phenotypic heterogeneity of rat thymic epithelium and its distinction compared to mesodermal-derived compartment.