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The paralysed man who can ride a bike

A man who was paralysed from the chest down after a knife attack in 2010 can now ride an adapted tricycle.  In 2014, surgeons in Poland announced they had reversed Darek Fidyka’s paralysis using cells taken from his nose to repair his spinal cord.  The former fireman says he has noticed a gradual return of feeling and muscle control below his injury.

Continued...

The surgical team are now launching a search for two more paralysed patients who they will try to help walk again.  Mr Fidyka told me: “I can tell that sensation is coming back and I am getting stronger. A year ago I would not have been able to ride a tricycle. Now I can feel each muscle and each press of the foot on the pedals.”

The BBC’s Panorama program told the remarkable story of Darek Fidyka and the 40-year research programme involving scientists in Britain and Poland.  The medical team are now launching the worldwide search as they are looking for patients with an uncommon type of injury, where the spinal cord has been completely severed, which can happen after a knife injury.  The head of the project, surgeon Dr Pawel Tabakow said: “If we can bridge the gap between two spinal cord stumps then there will be no doubt that our technique works and this will be historic – if we succeed we will have found a cure for paralysis.

“Then we will be able to help other patients with the most common type of injury, caused by a crush or compression.”

The Wroclaw Walk Again Project will be conducted in Poland, but patients anywhere in the world aged 16-65 will be able to apply via the team’s website, which will be officially launched on 8th March in Wroclaw.  All the treatment will be free, but to be eligible patients must have no feeling or voluntary muscle function below the injury and they must be prepared to spend around three years in Poland.  They will undergo extensive physiotherapy before and especially after the transplant surgery.

The medical team are expecting to be inundated with applications in the months ahead.  They will make an initial shortlist based on patient scans and medical notes and then invite a few potential volunteers for assessment in Poland.  Those selected will undergo the same pioneering surgery that was performed on Darek Fidyka.

Analysis

Scientists have spent decades searching for a means of enabling the paralysed to walk again. Motorised exoskeletons, which are strapped on the body, bypassing the injury, are now available commercially. Electrical stimulation techniques use implants to enable patients to flex their lower limbs. But neither method involves repairing the damaged spinal cord.  The approach in Poland aims to reconnect the brain with the lower limbs along the neural superhighway that is the spinal cord, enabling both motor control commands to travel down the body and sensation to travel up.

Darek Fidyka’s spinal cord had been almost completely severed as a result of a knife attack, apart from a thin thread of external connective tissue and prior to the transplant, he had no feeling or control below his injury.  Now he has had to re-learn how to control his muscles and interpret sensations. He said: “I realise how important the brain is while cycling, and that thinking is more tiring than the exercise itself.”  But the results from one patient, however impressive, would never be sufficient evidence on which to base a new approach to spinal cord injury.  The forthcoming trial in Poland will be crucial if the wider scientific community is to be convinced that a patient’s own cells can be used to regenerate their spinal cord.  It is also worth stressing that the patients selected will have to show enormous determination if they are to see the full benefits of the treatment.

In the first of two operations, surgeons will remove one of the patient’s olfactory bulbs, which sit above the nasal cavity at the base of the brain, and process the sense of smell.  The bulb contains specialist cells known as olfactory ensheathing cells (OECs) which act as a pathway that enables nerve fibres in the olfactory system to continually renew.  In a second operation the patient’s OECs will be injected above and below the injury and strips of tissue laid across the gap in the cord.  The team believe the OECs will enable nerve fibres to regenerate across the cord and so repair the damage.  An independent team of assessors led by neurophysiologists from Imperial College London will also be closely involved in monitoring the research.  Peter Ellaway, emeritus professor of physiology, at Imperial said: “I’m excited because this is a novel treatment with a lot of promise.”  But he cautioned that even if it works it would take some years to refine and so would not be immediately available for patients.

The treatment in Poland will cost £250,000 per patient and is being funded by a small British charity, the Nicholls Spinal Injury Foundation. It was founded by chef David Nicholls after his 18-year-old son Daniel was paralysed from the neck down in a swimming accident.  Mr Nicholls said: “I know how important progress is to people living with spinal cord injury and am optimistic that success with the next two patients will result in an announcement that paralysis is curable.”  NSIF and the UK Stem Cell Foundation both support the research of Prof Geoff Raisman, chair of neural regeneration at University College London (UCL), who has pioneered the use of OECs to repair the damaged spinal cord and leads the British side of the Walk Again project.

Prof Raisman said: “Darek’s latest progress demonstrates the extraordinary power of (neuro) plasticity. But it depends on the patient’s own efforts. It is like a baby learning to walk. We cannot teach it how. The progress comes from inside.”  Darek underwent his transplant in April 2012, and he still spends five hours a day undergoing physiotherapy.  He can now walk slowly using crutches or a small walking frame, but usually relies on a wheelchair as it is simply quicker and less tiring.  The return of sensation below his injury has brought other benefits like bladder control and the return of sexual function.

Darek was happy to discuss sex and explained that the reawakening of the erogenous zones was a crucial part of his recovery.  He said: “The return of sexual satisfaction – which travels along the spinal cord to the brain – is very important psychologically and is another part of my growing sense of independence.”

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rugby

Doctors urge schools to ban tackling in rugby

More than 70 doctors and academics are calling for a ban on tackling in rugby matches played in UK and Irish schools.  In an open letter to ministers, they say injuries from this “high-impact collision sport” can have lifelong consequences for children.  They argue two thirds of injuries in youth rugby and most concussions are down to tackles and urge schools to move to touch and non-contact rugby.  Supporters say rugby builds character and other forms are less challenging.  The concerns have been raised as a seven-year programme headed by the Rugby Football Union is on target to introduce rugby to a million children in state schools across England.  The RFU’s programme, which began in 2012 and is running until 2019, has so far reached 400 schools, with 350 to follow.

‘Fractures and dislocations’

But, in their letter to ministers, chief medical officers and children’s commissioners in England, Scotland, Wales, Northern Ireland and the Republic of Ireland, doctors say the risks for players aged under 18 are high.  They say many secondary schools in the UK deliver contact rugby as a compulsory part of the physical education curriculum from the age of 11.  “The majority of all injuries occur during contact or collision, such as the tackle and the scrum,” the letter says.

“These injuries, which include fractures, ligamentous tears, dislocated shoulders, spinal injuries and head injuries can have short-term, lifelong and life-ending consequences for children.”  The doctors say concussion is a common injury, and they highlight a link between “repeat concussions and cognitive impairment and an association with depression, memory loss and diminished verbal abilities”.  One of the signatories of the open letter is Prof Allyson Pollock, from Queen Mary University of London, who has long campaigned about the dangers of rugby.

She said evidence collected over 12 years showed rugby players up to the age of 18 or 19 had a 28% chance of getting injured over a season of 15 matches.  “If you’re thinking of a million children playing every year with this risk of injury you’re looking at 300,000 extra injuries a year, including up to 100,000 concussions,” she said.  She added that 90% of injuries resulted in more than seven days lost from school.  There are various forms of touch or tag rugby, in which tackles are replaced by touching a player or removing a tag from their clothing. Aspects of rugby such as scrums and rucks are also excluded from these forms of the game.

Jonny Cross, a PE teacher at Congleton High School in Cheshire – where rugby is compulsory from the age of 11 – says the sport provides a challenge.  Mr Cross says children wear gum-shields and are taught how to maintain the proper posture in scrums to avoid injury, a technique known as “tower of power”.  “Contact rugby helps build character. They are putting their body on the line in a match. The risk factor is part of it,” he says.  “They enjoy the contact element. There is a ‘boy factor’ – it’s partly about developing masculinity. They would be more likely to be bored by touch rugby.  “I would say that some students need it. It provides a challenge, where challenge is being taken out of everyday life.”  Mr Cross says children wear gum-shields and are taught how to maintain the proper posture in scrums to avoid injury, a technique known as “tower of power”.  “Contact rugby helps build character. They are putting their body on the line in a match. The risk factor is part of it,” he says.  “They enjoy the contact element. There is a ‘boy factor’ – it’s partly about developing masculinity. They would be more likely to be bored by touch rugby.  “I would say that some students need it. It provides a challenge, where challenge is being taken out of everyday life.”  The RFU and the Welsh Rugby Union both said they took player safety “extremely seriously” but that rugby was a “fantastic sport for children” which offered many benefits for society.

The Scottish Rugby Union said it was “committed to player welfare at every level of the game” but pointed out that every sport carried “an element of risk”.

Southern hemisphere

South African schools allow tackling, as do schools in Australia – although there has been a recent push to make children wear protective headgear, but this is not compulsory.  In New Zealand, tackling is permitted, but in some schools it is banned in lunchtime games that are not being supervised.  Former England rugby player Matt Perry said: “I took a risk when I started rugby at seven and I’m afraid at school level if that tackle is taken out we’ve lost one of the great games and one of the great cultural games.”  Former England international Brian Moore dismissed the evidence in the letter as “flawed” and “partial”.  Obesity would kill more children than rugby, he said.  “If you want to ban things, you’ve got to do it on the right basis.”

The Association for Physical Education said contact versions of the game should be introduced and managed only by “suitably experienced staff” following recognised guidelines.  “Parents should be aware of what sports are taught in the schools they choose to send their children to – if rugby is taught, then parents send their children to the school in the knowledge that they are likely to be asked to play rugby at some level,” it added.

A spokesman for the Department for Education in England said: “Team sports, such as rugby, play an important role in developing character.  “We expect schools to be aware of the risks associated with sporting activities and to provide a safe environment for pupils.”

2.3.2016 BBC News

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hip

Rise in hip replacements for under 60s

The number of hip replacement operations on people aged under 60 has risen 76% in the last decade, NHS figures for England reveal.  In 2004-05 there were 10,145 hip replacements for people aged 59 and below, with 17,883 in 2014-15.  The Royal College of Surgeons says this is partly because doctors are now more confident that replacement joints will be more durable than in the past.  Patients are also said to be less willing to wait.

As a proportion of all hip replacements carried out, the rise among under 60s is small, but the Royal College of Surgeons says it is still noteworthy.  Demand for new hips across all ages has risen – there were 89,919 of the operations in 2004-05 and 122,154 in 2014-15.

Stephen Cannon, vice-president of the RCS, says as hip replacement techniques and prosthetics have improved, so have the numbers of younger patients undergoing this type of surgery.  “It’s no longer seen as a last resort.  “As surgeons, we now have more confidence about the wear rate of these prosthetics which allows us to be less restrictive on an age basis.”

‘Less arduous’

He said surgeons used to advise patients with hip pain to wait until they were 60 or 65 to have a replacement because the old-fashioned replacements had a shelf-life of about 15 years, meaning the operation might need redoing once in a lifetime – when the patient had turned 80.

“If you look at newer prosthetics, you could do the first operation at 55 and it is going to last for 20 years or more, so you would still only need one revision in a lifetime.”  He said another factor might be patient demand.  “Certainly, in my experience, patients do not get fobbed off. They don’t want to wait for an operation. They say, ‘I can’t play a round of golf or tennis and I want to.'”  Mr Cannon said concerns over the safety of a the metal-on-metal hip replacement in 2010 did not appear to have affected demand.  He said hip operations had become less arduous. Patients can be back on their feet with crutches on the same day or the day after surgery, and out of hospital within three days post-op. “They’re off crutches altogether by six weeks.”

‘Perfect storm’

Most hip replacements are done if the joint becomes damaged from arthritis or an injury. Many of the conditions treated with a hip replacement are age-related so hip replacements are usually carried out in older adults.  Mr Cannon says it’s not clear if conditions such as osteoarthritis are becoming more common and affecting people at younger ages, but it is worth exploring.  And with an ageing population, he says demand for hip operations could soon outstrip supply.  “The ageing population is a perfect storm. We are not there quite yet, but we might be in 10 years from now. It’s a continuing trend.”

A spokesman for the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man said: “The increase in numbers of under-60s undergoing primary hip surgery is entirely in line with the overall increase in provision of the operation.  “The orthopaedic sector must continue to work to get the first time surgery as right for the patient as possible – especially where younger patients are concerned as they are most likely to need at least one revision surgery in their lifetime.  “It is, of course, heartening and very encouraging that hip and knee implants are lasting ten years or more, with risk of revision lower than 5%.  “Joint replacement surgery offers significant benefits – getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility.”

BBC News 3.3.2016

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feet

How to Keep Your Feet From Aching

Your feet do a lot for you every day. They need some TLC in return.  Stay ahead of foot pain with these 10 simple tips.

1. Insist on Comfort

Sure, you want your shoes to look great. But they also need to fit you just right. You’ll feel better in them and your feel will be happier when they do.  When you’re shoe shopping and fall for a gorgeous but crazy-making pair, walk away, no matter how much you like the style. Don’t count on them “breaking in.”

2. Take the Wet Footprint Test

This simple test will help you pick the best shoes for you.  Get your foot a little bit wet. Stand on a paper bag and then step off. Look at the image your foot left behind. If you see half of your arch, you have a normal foot or a neutral arch. If you see almost your entire foot, you have a flat foot. If you see just a thin line connecting the ball of your foot to your heel, you have high arches.  Remember your type when you choose your shoes.

3. Choose the Proper Shoe for High Arches

Shoes with laces, buckles, or straps are best for this type of foot. Look for extra cushioning and a soft platform. Shoes with good arch support and a slightly raised heel can help keep your feet in fine form.

4. For Flat Feet Get the Right Insert

See a foot doctor to set you up with custom inserts for your shoes. They can be pricey, but they may really help. “They’re like eyeglasses for your feet,” Reid says.

5. There’s a Shoe for That, So Wear It

Do you run or play a specific sport three or more times a week? Treat your feet to a shoe made just for that activity.  Good running shoes, for example, can help prevent heel pain, stress fractures, and other foot problems that runners sometimes get. Replace your sports shoes when they start to wear down.

6. Kick the High Heel Habit

“A 5-inch spike heel isn’t going to do anybody any good,” Bowman says. “It forces all the weight to the front of the foot and will cause pain.” High heels also put you on the fast track to bunions, corns, and other problems.  If you love heels, try a shorter one. A two-inch heel is better than a four-inch heel. Don’t wear them every day, and don’t wear them when you will be on your feet for a long time. Choose chunky heels instead of skinny ones if you have flat feet.

7. Forgo Flip-Flops

Flip-flops are a good choice to protect your feet in locker room showers, pool areas, and the hot sand at the beach.  But they can cause big problems, like heel pain, tendinitis, and stress fractures, especially if you have flat feet.  Don’t wear flip-flops on a long-distance walk, for sports, or for yard work. They don’t give you enough shock absorption, arch support, or protection.  Does the thong between your toes cause irritation? That can lead to blisters and infections. When they wear out, replace them.

8. Ease the Stress

Extra weight can lead to muscle fatigue as well as heel, arch, and muscle pain.  Extra pounds can change your foot structure. You can develop spurs — bumps that grow on your foot bones — which can be painful. And they can make your feet and ankles swell.

9. Slip on a Shoe

Don’t go barefoot. It puts a strain on your foot and can lead to plantar warts and athlete’s foot. “If you’re walking in bare feet, you’re exposed to the elements. You can cut the skin on your feet,” Reid says.

10. Don’t Cut Corners

Do you know the best way to trim your toenails?  Cut them straight across. If you clip them in the corners, that will lead to an ingrown nail, which becomes extremely painful over time.  Like for any other part of your body, see your doctor if you have pain or notice anything unusual. With that kind of care, your feet will flourish.

WebMD Feature June 27, 2015

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iStock_000014874795_Double

10 Solutions for Sore Knees

If you slip on the sidewalk, wipe out while playing with your kids, or wrench your knee all of a sudden, you know you need rest, ice, and a trip to your doctor. But what should you do about ongoing knee pain that just won’t quit? Maybe it’s a hangover from an old sports injury. Or perhaps it’s arthritis or another condition. Whatever the cause, these 10 tips will help you feel better and get back on your feet.
1. Do This Stretch DailyMany people with knee pain have trouble straightening their knee, says Ann Wendel, PT, a physical therapist in Virginia and spokesperson for the American Physical Therapy Association.Doing hamstring stretches helps your legs move better. To do them:

  • Lie on your back.
  • Wrap a sheet, towel, or strap around your foot to help you hold your knee straight. Keep the stretch gentle. It should not hurt.
  • Raise your leg and hold for about 30 seconds.
  • Repeat with the other leg.

2. Go Shoe Shopping

If your soles have worn thin, it’s time for a new pair of shoes. Shoes should provide enough protection so you can move without pain shooting up your leg to your knee. David Johnson MD an orthopaedic surgeon in Bristol said that some people do well, he says, with cushioned insoles or orthotics or from a change the alignment of their leg.

Love your stilettos? Save them for special occasions. High heels are bad news when you wear them too often. They pitch your body forward and make it harder to keep your knees aligned.

3. Consider Acupuncture

Acupuncture is all about unblocking qi, the Chinese medical word for life force. It uses very fine needles on certain points of the body. Western scientists don’t know exactly how it works. But a large study from Germany found that people with knee osteoarthritis had less pain and stiffness after 15 sessions of acupuncture than others who didn’t add it to their knee care.

4. Plank for Posture

Strengthen your core with exercises such as planks and Pilates to  help improve your posture. When you slouch, your body mass shifts forward. That’s bad for your knees, so make posture a priority.  The idea is to make your core — especially your abs and back — strong.  Keep them engaged and you’ll stand taller.

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3D Printed Bone Nottingham

3D-printed bone structure allows tissue regeneration

3D printing can now help human bone that has undergone major tissue damage to regenerate, according to research presented on January 19, 2016, at the “Printing for the Future” conference, which took place at the Institute of Physics in London, UK.  Rapid Prototyping (RP) technology, the forerunner to 3D printing has been around since the 1980s, but it has only relatively recently become visible in the mainstream.  Designers have used 3D-printing techniques to create a variety of items, from jewelry to individualized football boots and even a grandfather clock. One group is currently working on making an airplane wing.

The medical world has high hopes for 3D printing. Medical News Today has already reported on the use of 3D printing technology to manufacture part of the sternum that surgeons successfully implanted into a cancer patient.  Patients who undergo cancer treatment or who experience a major fracture face losing a large volume of bone tissue. Synthetic bone substitutes can be used to replace the lost material, but making these tough enough for the job can be a challenge.

Temporary bridge will help patients after cancer treatment and fractures

Manolis Papastavrou, of Nottingham Trent University’s Design for Health and Wellbeing Research Group, in Nottingham, UK, is controlling the microstructure of a 3D-printed bone scaffold.  The structure provides a temporary bridge that allows the regeneration of natural tissue. It can be made to match the individual’s exact size and shape requirements, based on medical imaging data. Being porous means that blood flow and cell growth can occur.  The scaffold consists of the same minerals that feature in natural bone. It can dissolve as the patient recovers and new tissues replace it.

Researchers studied how the growth of crystals at sub-zero temperatures could be used together with 3D-printing techniques to structure a material at different orders of magnitude. They aimed to mimic structures that exist in biological materials.  The team believes that combining 3D printing with freezing will enable a faster, more economical production of medical devices.  Mr. Papastavrou, a PhD candidate, explains that the structure of a material, from the molecular up to the macro level, affects the toughness. Porosity would normally weaken a material, but the current technology is able to overcome that.

Future applications: implants and drug release control

Prof. Breedon, of Nottingham University, who helped oversee the research, calls it “a real step forward,” because it demonstrates how 3D printing can improve biomaterials without needing to achieve high resolution.  Manipulating the growth of crystals in a 3D-printed material makes it possible to improve the microstructures of bone scaffolds. This will make them stronger and may help people to recover more quickly after a major illness or injury.  The researchers told Medical News Today that no clinical studies have yet taken place, as the team is still working on improving the mechanical properties of scaffolds.

In terms of where the technology is at the moment, they told us:

“The material used (beta-tricalcium phosphate) has been proven to exhibit the appropriate biological properties. The process is still under development, the next step being the infiltration of this highly porous structure with a polymer to create a strong bio-composite. The research demonstrates the concept of combining 3D printing with other conventional scaffold fabrication techniques (freezing in this case) to obtain very fine micro-structural features. We believe it will take another 5-10 years for this technology to be used in a clinical setting.”

The researchers also said that the technology could be used in controlled drug release. The ability to tailor the level of micro-porosity makes it a good candidate for this function. “By controlling the freezing rate in different areas of a printed part,” they said, “it is possible to obtain porosity gradients, with gradually smaller pores towards its outer surface.”  Mr. Papastavrou adds that metal orthopedic implants could be replaced with bone scaffolds in materials that can be broken down by the body. Surgeons also recently used 3D models to enhance the safety of surgery in which they transplanted a father’s kidney into his daughter.

NMT 7 February 2016

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Michelangelo

Michelangelo battled through painful arthritis to design St Peter’s Basilica

Pictures of Michelangelo in later life show that the artist’s hands were severely damaged through excessive hammering and chiseling.

The Renaissance artist and architect continued to sculpt, paint and event drew up the plans for St Peter’s Basilica in Rome while suffering the effects of chronic osteoarthritis which left his fingers twisted into bony protrusions, a new study suggests.

Italian scientists believe that extensive hammering and chiselling carried out by Michelangelo when creating masterpieces, like David, was responsible for leave his hands deformed in later life.  Yet it was his refusal to give up work until just days before his death which kept his fingers flexible, according Dr Davide Lazzeri, a specialist in plastic reconstructive and aesthetic surgery at the Villa Salaria Clinic, Rome.

Dr Lazzeri studied paintings of Micaelangelo throughout his life, noticing how his hands degenerated as he grew older, until it was clear from their claw-like posture, that he was suffering from arthritis. However letters reveal that he was still seen ‘hammering’ six days before his death.  “The diagnosis of osteoarthritis offers one plausible explanation for Michelangelo’s loss of dexterity in old age and emphasises his triumph over infirmity as he persisted in his work until his last days,” said the academic.

“Indeed, the continuous and intense work could have helped Michelangelo to keep the use of his hands for as long as possible.”

Michelangelo Buonarroti was born in 1474 in the town of Caprese.  He apprenticed under the Renaissance master, Ghirlandaio, then studied in the court of Lorenzo il Magnifico.  He came to Rome, where he sculpted his first ‘Pieta’ for a French cardinal, before returning to Florence to work on his ‘David’.  Despite his misgivings, he was persuaded by Pope Julius II to go back to Rome to start work on the pontiff’s’ own monumental tomb, which was destined for the choir of the old St Peter’s.  The Pope then changed his mind, insisting that the young sculptor should instead paint the ceiling of the Sistine Chapel. Despite complaining that he was ‘no painter’, Michaelangelo spent four years covering the ceiling in frescoes, standing on 60ft high scaffolding with paint dripping into his eyes, finishing it in 1512.  The project was interrupted by another spell in Florence, before he was able to return to Rome once more, dragged back at the age of 60 by Pope Paul III.  There he painted the Last Judgment (1534-41), on the wall behind the altar of the Sistine Chapel.

Worn out by the commission, he painted his own miserable-looking face on the wrinkled human skin held by St Bartholomew, one of the main figures in the painting.  But unwilling to give up working, he went on to paint the Conversion of Saint Paul and the Crucifixion of Saint Peter for the Catican.

In 1546, Michelangelo was asked to take over as architect of St Peter’s Basilica in Rome, a project which had been floundering for 50 years. The dome, which was not completed until after his death has been called ‘the greatest creation of the Renaissance.’  In December 2007, a red chalk sketch for the dome of St Peter’s Basilica, possibly the last made by Michelangelo before his death, was discovered in the Vatican archives. He died in Rome in 1564 at the age of 89, still working.

Three paintings of Michelangelo between the ages of 60 and 65 and show that the small joints of his left hand were affected by non-inflammatory degenerative changes that can be interpreted as osteoarthritis. In earlier portraits of the artist his hands appear with no signs of deformity.

Dr Lazzeri, a specialist in plastic reconstructive and aesthetic surgery at the Villa Salaria Clinic, Rome, said: “It is clear from the literature that Michelangelo was afflicted by an illness involving his joints. In the past this has been attributed to gout but our analysis shows this can be dismissed.”  There are no signs of inflammation in the artist’s hands and no evidence of any tophi, the small lumps of uric acid crystals that can form under the skin of people with gout. According to letters written by Michelangelo his hand symptoms appeared later in life and in 1552, in a letter to his nephew, he wrote that writing gave him great discomfort. Despite this he continued to create one masterpiece after another and was seen hammering up to six days before his death in 1564, three weeks before his 89th birthday. By then Michelangelo was unable to write anymore and only signed his letters.

The research was published in the Journal of the Royal Society of Medicine.

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Arthritic wrist

Copper Bracelets: Do Copper Bracelets Help With Arthritis?

Many people say copper wristbands help ease the aches and pains of stiff and sore joints.  It is certainly true that people do say this – even scientific research provides evidence that people taking part in trials sometimes say bracelets help with their pain.  It is also true, however, that online shops and forums use marketing pitches to remind us of this fact that people do sometimes say that copper bracelets help – and people say it for good reason.  But why do people say copper worn around the wrist is beneficial, and how does the evidence stack up?

Do copper bracelets have a beneficial effect, or not – especially for the arthritis pain that people often use them for?

Part of the problem in trying to answer the efficacy question is that copper bracelets almost certainly do no harm, and as they are not drugs or medical devices, there is no regulation of the health claims that are made for them.  Also, to find out if they provide any benefit, there has been only limited research into the use of copper bracelets.  This article will examine the research that has been done into any pain-relieving power – and then explain why copper wristbands are bought for health reasons.

What is the evidence behind the use of copper bracelets?

For the question of what evidence there is for the health effects of copper bracelets, the scientists give a short answer.

There is:

  1. No good evidence that they reduce pain or inflammation
  2. Fairly good evidence that they do not have any clinical effect.

These conclusions come from the best data out there so far: a widely available scientific comparison of different copper and magnetic bracelets used by people with rheumatoid arthritis, published in 2013.

This study was designed in such a way that, while it was not a large study, there were enough people taking part and wearing different kinds of bracelets that, should there have been even a minimal clinical improvement of 20% in pain ratings, the study would have found it. There was not.

The trial adds to a previous disappointment about the benefits of wearing metals in this way. A previous study looked at magnetic bracelets. It was the single randomised, placebo-controlled trial on the use of magnet therapy for rheumatoid arthritis that had been conducted before the new experiment on different kinds of bracelet.  Dr. Stewart Richmond, who also led the 2013 study from the Department of Health Sciences at the University of York in the UK, wrote in the published paper for magnetic bracelets:

“The results of this trial, which compared strong versus weak magnets strapped to the knee, showed that there was no statistical difference in pain outcomes between experimental and control groups.”

And about the latest findings from comparing copper-only, magnetic and placebo bracelets, Dr. Richmond writes:

“It’s a shame that these devices don’t seem to have any genuine benefit. They’re so simple and generally safe to use.”

But he goes on to say that “people who suffer with rheumatoid arthritis may be better off saving their money, or spending it on other complementary interventions, such as dietary fish oils for example, which have far better evidence for effectiveness.”

Using copper bracelets for pain relief

When we see the sales descriptions for copper bracelets, sold within a wider industry for magnetic wristbands estimated to be worth hundreds of millions of dollars, we find that the information is often:

  • Impressive – “worn for healing by mankind for centuries” or “made from the finest pure copper”
  • Accurate – “copper is essential for our bodies” or “the metal has a natural ability to conduct heat.”

But what is the relevance of these two types of information when it comes to any effect against disease? What is the relevance to the human body at all, when copper is worn as a bracelet?  Reputable sellers try not to tie such information to any direct claims for health, and that is because, however impressive or accurate this type of information is, it is not proof of any effect and provides no real promise.  Even when reasonable product statements testify that “many people wear these for health benefits,” or many people say “these work for their condition,” these statements are not necessarily proof of a health benefit.

MNT  

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elderly 3

New understanding of bones could lead to stronger materials, osteoporosis treatment

Researchers at Cornell University have discovered that bone does something better than most man-made materials: it bounces back after it breaks. In an article published in the Proceedings of the National Academy of Sciences this week Cornell scientists report that cancellous bone the spongy foam-like type of bone found near joints and in the vertebrae that is involved in most osteoporosis related fractures displays unique material properties that allow it to recover shape after it breaks.

When most things break, they fall apart and lose their mechanical function. To help make car and aircraft parts last longer, engineers apply surface treatments that harden the surfaces to prevent cracks from starting.

“Cancellous bone does the opposite, it has softer surfaces with a more brittle interior,” says Christopher Hernandez, Associate Professor of Mechanical and Aerospace Engineering and Biomedical Engineering and principal investigator on the project. The combination of softer surfaces and brittle interior allows cancellous bone to direct cracks to locations where they are less detrimental, allowing the structure to recover its shape — bounce back — after it breaks.

“That’s totally not what we expected from an engineering standpoint,” says Ashley Torres, a graduate student in biomedical engineering who was one of two individuals to lead the study. “But it allows the material able to continue to function after failure.”

The discovery provides a compelling answer to the long-standing question as to why bones have foam-like regions. “We used to think that we had cancellous bone for the same reasons that we use foams in engineering, to absorb energy or make the structure more lightweight, but it turns out that cancellous bone does something different, the way cancellous bone breaks actually makes it heal better,” says Hernandez.

“In the future, this could help in the design of new materials that can take advantage of this ‘function after failure,'” says Jonathan Matheny the other graduate student leading the project. Material heterogeneity in structures, the group proposes, could help mitigate the effects of small structural flaws that are inevitable in manufacturing. Additionally, Matheny said these findings have implications for medicine, “to help us identify people at risk for an osteoporosis-related fracture and prescribe drug treatment.”

MNT 1 March 2016

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New study of patients receiving physical therapy following total knee replacement raises new concerns over referral for profit

A new study concludes that patients who undergo total knee replacement (TKR) surgery and are referred to a physical therapist (PT) not affiliated with their surgeon’s practice have fewer visits and more individualized, one-on-one care. Conversely, the research showed that those who received physiotherapy services from a clinic owned by their physician had twice as many visits and were provided a less-intensive approach.

The study, e-published ahead of print in the scientific journal Health Services Research, examined whether the course of physical therapy treatments received by patients who undergo TKR surgery differs depending on whether the orthopedic surgeon (OS) has a financial stake in physical therapy services, often called physician self-referral. The authors reviewed 3,771 TKR episodes. Of those, 709 (18.8%) met criteria as self-referring. Of the remaining 3,062 episodes deemed non-self-referring (NSR), 2,215 (72.3%) were cases in which the OS who performed the TKR did not have an ownership interest in physical therapy services. For the remaining 847 NSR episodes, the OS had an ownership interest in physical therapy services, but the patient received services elsewhere.

Key findings included:

  • The duration of episodes of care provided by a physician-owned physical therapy practice were a week longer.
  • TKR patients who were treated in a clinic owned by their OS received an average of 8.3 more (or twice as many) PT visits than those who were treated in a clinic in which their OS had no financial stake.
  • When there is no financial incentive for the OS owner, the episodes of care were virtually identical to those received in a non-physician-owned clinic, making clear the link between financial profit and course of care.
  • Patients who received care in a non-physician-owned clinic tended to receive more one-on-one care than those who were self-referred to their physician’s own physical therapy services. Patients who were self-referred for treatment received less intensive interventions and more group care, an approach that requires more visits and potentially extends recovery time.

“When there is referral-for-profit, and from this data as related to group therapy and an extended number of visits, it stands to reason there is increased risk that the patient’s individual needs are of secondary importance to revenue. This has long been the concern here at the American Physical Therapy Association (APTA), and it is why we have fought so hard, alongside our partners in the Alliance for Integrity in Medicare Coalition, against physician-owned physical therapy services (POPTS),” said APTA President Sharon Dunn, PT, PhD, OCS. “This study provides further evidence that when the bottom line takes precedence in health care the patient loses. A patient’s welfare and recovery should always be the primary focus of treatment.”

Beyond the clinical implications, authors believe their study adds more weight to the argument against the in-office ancillary services (IOAS) exception to the Stark laws – federal legislation that prohibits most self-referral practices in Medicare. IOAS allows physicians to self-refer for several “common sense” or same-day treatments; unfortunately, it also creates loopholes for services that are rarely provided on the same day, including physical therapy, anatomic pathology, advanced imaging, and radiation therapy. Authors write that most research on these exceptions has reached the same conclusion as their own study: “that self-referral results in increased use of services and higher health care expenditures.”

The study was funded by the Foundation for Physical Therapy and was authored by Jean M. Mitchell, PhD, James D. Reschovsky, PhD, and Elizabeth Anne Reicherter, PT, DPT, PhD. Reicherter, who is currently employed by APTA, was with the Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, when the study was conducted.

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