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Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.

The aim of this study is to design a new dynamic mechanical analysis (DMA) measurement system that can operate for shear tests at frequencies as high as 10 kHz with strain amplitudes sufficient for viscoelastic materials operating in high-frequency deformation applications, such as tire rubbers. The available DMA systems in market cannot effectively operate for accurate and direct measurement of viscoelastic material properties for applications dealing with high-frequency deformation of materials. Due to this, the available DMA systems are used for indirect measurements at low frequencies and low temperatures, followed by using time-temperature superposition principle to predict the properties at high frequencies. The goal of this study is to make the range of the test broad enough to eliminate the use of the time-temperature superposition principle in the determination of properties of viscoelastic materials. Direct measurement of viscoelastic material properties and increasing the accuracy of results are the main motivations to design a new DMA system. For this purpose, the state-of-the-art technologies to achieve high frequencies and strain amplitudes as well as instrumentation and control of the system are studied. The design process is presented in this paper.

This study presents effects of intravenous laser blood irradiation (ILBI) in a transient immunodeficiency patient with juvenile idiopathic arthritis (JIA) treated with an interleukin-6 receptor inhibitor (Tocilizumab). Biological agents induce JIA remission, but some patients do not respond favorably to this final therapeutic line of defense. ILBI was performed in a 16-year-old male patient, with JIA and transient immunodeficiency. When ILBI was introduced, the patient was receiving disease-modifying drugs, steroids, tocilizumab, and physical therapy. Because the disease was not well controlled, ILBI was applied in addition to other ongoing therapies. The patient underwent 1 session daily, and 10 successive sessions per month, repeated every 3 months, for 7 months. Patient evaluation was performed before ILBI was started and at 3, 6, 9, and 12 months after ILBI initiation, using the ACR Pediatric response. The outcome was evaluated using Pediatric 50, 70, and 90 responses and compared to initial status, after 3, 6, 9, and 12 months. At the end of study, the titre of IgA and IgG levels returned to normal. Synergistic anti-inflammatory effect of ILBI was evident, if applied additionally in combination with tocilizumab, in a patient with a therapy-resistant severe form of JIA and related subacute transient immunodeficiency.

Sublingual laser blood irradiation (SLBI) was applied into a randomized, single-blind, placebo-controlled study in juvenile idiopathic arthritis (JIA), aimed at inducing disease remission. 105 children with JIA, without an adequate response to classical treatment, were administrated a disease modifying drug (Methotrexate) and were randomly assigned to three groups. Group I (36 patients) received SLBI with the Weberneedle Lasershower Mouth Applicator with three wavelengths (635 nm, 536 nm, and 405 nm), 5 mW maximum output power each, in continuous mode, simultaneously, for 20 minutes daily, 7 successive sessions per month, repeated every 7 weeks, for three times. Group II (36 patients) received placebo SLBI. Group III (33 patients) received only treatment with Methotrexate. Evaluation was performed using American College of Rheumatology Pediatric criteria (ACR Pedi) at study enrollment and at 8, 16, 24, and 48 weeks. At the end of study, there was an improvement of the ACR Pedi 30 by 86.11% in SLBI group compared to only 61.11% in Group II, respectively, and 60.6% in Group III (P=0.001), with significant statistical differences. SLBI has reduced the pain, lowered the number of articulations with movement limitation, increased the quality of life, and made it possible to avoid the administration of biological agents.