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Neonatal brachial plexus palsy (NBPP) is a flaccid paralysis of the upper limbs that occurs in about 0.4 percent of live births. This condition can produce permanent disabilities; to date, there is no consensus on protocols to be applied for the rehabilitation of children with this condition. The aim of this article is to provide a concise overview of conservative treatment beyond traditional physical therapy for the management of the child with NBPP and to offer a number of useful options for creating the most comprehensive and functional rehabilitation treatment possible. We conducted a narrative review after analyzing articles from the past 50 years on PubMed, Cochrane Library, Scopus, and Web of Science with the following search string [("neonatal brachial plexus palsy" OR "obstetric brachial plexus palsy" OR "birth brachial plexus palsy") AND ("rehabilitation" OR "physiotherapy" OR "conservative treatment")]. We identified a potential of 1275 articles, but only 11 were exclusively about conservative approaches. The most represented rehabilitation approaches in the literature were botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping. In conclusion, the various rehabilitation approaches for NBPP are promising, but none can be considered the best option when used alone. In light of the current evidence, a multimodal approach is needed. [ABSTRACT FROM AUTHOR]

Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson's disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% (p = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% (p = 0.116), showing a significantly different trajectory of posture change (p = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies. [ABSTRACT FROM AUTHOR]

Ozone therapy (OT) is used for the treatment of multiple musculoskeletal disorders. In recent years, there has been a growing interest in its use for the treatment of osteoarthritis (OA). The aim of this double-blind randomized controlled trial was to evaluate the efficacy of OT compared with hyaluronic acid (HA) injections for pain relief in patients with knee OA. Patients with knee OA for at least three months were included and randomly assigned to receive three intra-articular injections of ozone or HA (once a week). Patients were assessed at baseline and at 1, 3, and 6 months after the injections for pain, stiffness, and function using the WOMAC LK 3.1, the NRS, and the KOOS questionnaire. Out of 55 patients assessed for eligibility, 52 participants were admitted to the study and randomly assigned into the 2 groups of treatment. During the study, eight patients dropped out. Thus, a total of 44 patients, reached the endpoint of the study at 6 months. Both Group A and B consisted of 22 patients. At 1-month follow-up after injections, both treatment groups improved statistically significantly from baseline in all outcomes measured. At 3 months, improvements remained similarly consistent for Group A and Group B. At 6-month follow-up, the outcomes were comparable between the 2 groups, showing only a worsening trend in pain. No significant differences were found between the two groups in pain scores. Both therapies have proven to be safe, with the few recorded adverse events being mild and self-limiting. OT has demonstrated similar results to HA injections, proving to be a safe approach with significant effects on pain control in patients affected by knee OA. Due to its anti-inflammatory and analgesic effects, ozone might be considered as a potential treatment for OA. [ABSTRACT FROM AUTHOR]

Background: Opioid-induced constipation (OIC) remains an important clinical obstacle despite the availability of several guidelines and pharmacological options for its management. Here, we surveyed common practices and perceptions about OIC among physicians who prescribe opioids in Italy. Methods: The online survey included 26 questions about OIC. Responses were analyzed descriptively and aggregated by physician specialty. Results: A total of 501 physicians completed the survey. Most respondents (67%) did not feel adequately educated about OIC despite general consensus regarding interest in the topic. Overall, 62– 75% of physicians regularly evaluated intestinal function or OIC symptoms in patients receiving opioid therapy. The most common method for assessment was patient diary; few physicians used a validated instrument such as the Rome IV criteria. Psychiatrists and addiction specialists showed the lowest interest and poorest practices. Most respondents (78%) preferred macrogol prophylaxis followed by macrogol plus another laxative for first-line treatment of OIC symptoms. Peripheral-acting mu opioid receptor antagonists (PAMORAs) were not widely used among physicians; 61% had never prescribed a PAMORA for OIC. Conclusion: Our findings reveal important differences in clinical practice for OIC across physician specialties. Additional formative efforts are necessary to improve awareness about best practices in OIC. [ABSTRACT FROM AUTHOR]

Background: Monofrequency bioelectrical impedance analysis (BIA) protocols seek to further quantify changes in lymphedema compared with traditional circumferential evaluations. Complex decongestive therapy (CDT) is an effective method of reducing unilateral upper limb lymphedema secondary to breast cancer treatments. Comparing lymphedema measurements between segmental tetrapolar BIA, total body BIA, and circumferential measurements during therapeutic changes can improve our quantitative assessment ability for this prevalent medical complication. Methods and Results: Twenty-two patients with breast-cancer-related unilateral upper limb lymphedema participated in this prospective observational study. Circumferential measurements, segmental tetrapolar BIA, and total body BIA were obtained and compared before CDT, immediately after 10 sessions of CDT, and 30 days post-CDT to assess lymphedema. The segmental tetrapolar BIA correlated well with improvements in circumferential measurements of the limb. We found that the resistance value cutoff point of 237 Ω could indicate a recurrence of lymphedema. Conclusions: Segmental, tetrapolar monofrequency BIA provides a simple method to monitor and evaluate the efficacy of therapy in the outpatient setting by operators with minimal training. This protocol could aid quantitative evaluations of unilateral upper limb lymphedema. [ABSTRACT FROM AUTHOR]

Ultrasound elastography (UE) is a non-invasive imaging method that allows the assessment of tissue elastic property. Different UE techniques are currently available (i.e. strain UE and acoustic radiation force impulse UE), with several potential clinical applications. Recent studies investigated the role of UE in two systemic rheumatic diseases and psoriasis. This research added interesting information to the already known applications of UE in the assessment of tendinopathies. In SS, acoustic radiation force impulse UE has shown a potential role in the diagnosis of the disease, with lower sensitivity than and similar specificity to salivary gland histology. In SSc, a potential use of UE in screening pre-clinical disease has been reported. In psoriasis, the use of strain UE in evaluating treatment response has been highlighted. UE is a promising tool in rheumatology, with a potential role in the evaluation of various tissues and pathologies. [ABSTRACT FROM AUTHOR]

Introduction: The surface area of exposed metal in a trabecular-titanium acetabular component is wider compared to traditional-titanium implants. The purpose of this study is to establish if this increase in surface area can lead to a significant increase in systemic metal levels. Methods: 19 patients with conventional acetabular component and 19 with trabecular-titanium cup were compared. Aluminum, Vanadium and Titanium in blood and urine were assessed before surgery and at intervals for 2 years. The samples were analysed using an inductively coupled plasma mass spectrometry. Results: Patients with trabecular-titanium did not have significantly higher metal ion levels compared to patients with conventional cups up to 2 years. A trend over time was statistically significant in both blood and urine for aluminum and titanium concentrations. Conclusions: The three-dimensionality and the wide surface of the trabecular-titanium acetabular component did not affect metal ion release compared to traditional implants after 2 years. [ABSTRACT FROM AUTHOR]