Search Results (139)

Background: The incidence of anterior cruciate ligament ruptures in football has experienced a marked increase in recent years, affecting both professional and amateur players. This injury is characterised by being highly disabling, causing the player to withdraw from the field of play for prolonged periods and there is no clear consensus on how to carry out the different phases of rehabilitation, which poses a major challenge for health professionals. Case presentation: This study followed a semi-professional player who suffered an anterior cruciate ligament tear following two forced valgus actions without direct contact in the same match. Outcome and follow-up: The patient underwent surgery using an autologous hamstring graft. He followed a progressive rehabilitation programme consisting of one preoperative phase and six phases after the operation. After a 12-month follow-up, with exercises aimed at perfecting step-by-step basic and specific physical skills, the player showed a complete functional recovery, achieving the desired parameters. Conclusions: This case highlights the importance of structured rehabilitation adapted to the specific needs of the football player through an approach with coherent progressions, which considers the muscle chains that determine the movements performed on the football pitch. Full article

Aortic aneurysm is a vascular disease with a complex pathogenesis which is usually asymptomatic but can lead to high mortality with sudden rupture. This review comprehensively examines the molecular mechanisms of aortic aneurysms in the context of extracellular matrix destruction, smooth muscle cell apoptosis, chronic inflammation, oxidative stress, genetic mutations, and epigenetic regulations. In addition, the potential of molecular biomarkers in diagnosis and prognosis and targeted treatment strategies are evaluated. Animal models and translational findings form the basis for establishing a bridge between preclinical and clinical applications. This study aims to provide insight into the integration of molecular findings into clinical practice in light of the current literature and to guide future research. Full article

Abdominal aortic aneurysm (AAA) is the most common aortic disease occurring below the renal arteries, caused by multiple etiologies. Currently, no effective drug treatment exists, and the specific pathogenesis remains unclear. Due to its insidious onset and diagnostic challenges, AAA often culminates in aortic rupture, which has a high mortality rate. During AAA development, vascular smooth muscle cells (VSMCs) undergo significant pathological alterations, including contractile dysfunction, phenotypic modulation, cellular degradation, and heightened inflammatory and oxidative stress responses. In particular, emerging evidence implicates vascular smooth muscle cell (VSMC) metabolic dysregulation and mitochondrial dysfunction as key contributors to AAA progression. In this review, we systematically summarize the current understanding of VSMC biology, including their developmental origins, structural characteristics, and functional roles in aortic wall homeostasis, along with the regulatory networks governing the VSMC phenotype and functional maintenance. This review highlights the urgent need for further investigation into the aortic wall VSMC pathophysiology to identify novel therapeutic targets for AAA. These insights may pave the way for innovative treatment strategies in aortic disease management. Full article

Background/Objectives: Abdominal aortic aneurysm (AAA) repair is a prophylactic intervention aimed at preventing rupture. As the population ages, surgical decision-making becomes increasingly complex, especially in older and frailer patients. Imaging biomarkers, such as psoas muscle area (PMA) and density (PMD), have been proposed as surrogates for frailty and potential predictors of surgical outcomes. However, their clinical utility remains uncertain. Methods: In this retrospective, single-center study, we evaluated 199 patients who underwent elective AAA repair between 2015 and 2019. Preoperative computed tomography angiography (CTA) was used to measure PMA and PMD at the level of the third lumbar vertebra. Lean psoas muscle area (LPMA) was calculated as the product of PMA and PMD. Sarcopenia was defined as the lowest tertile of each measurement. Outcomes were assessed using Fisher’s exact test, Kaplan–Meier survival analysis, and logistic regression. Results: No significant associations were found between PMA, PMD, or LPMA and early or late postoperative complications or mortality. Conclusions: Psoas muscle indices, measured on routine CTA scans, do not reliably predict postoperative outcomes in AAA patients. These findings suggest that further studies integrating broader clinical and functional assessments are needed to improve risk stratification and inform preoperative decision-making in this patient population. Full article

This longitudinal study investigated the incidence and characteristics of injuries among U9, U11, and U13 male football players in an academy setting over a six-season period, from 2016/17 to 2021/22. A total of 374 injuries were analyzed, with a particular focus on muscle injuries, including Delayed Onset Muscle Soreness (DOMS), muscle ruptures, and contusions. The study revealed that the highest injury incidence occurred in the U13 group, with quadriceps injuries being most prevalent in both the U13 and U11 groups. The study found that muscle injuries accounted for a significant proportion of all injuries, particularly in the U13 group, where muscle injuries increased over time. Intrinsic factors such as physical development during puberty and extrinsic factors like training intensity and psychological pressures may contribute to the higher injury rates in older age groups. Additionally, seasonal fluctuations in injury rates were observed, with a notable decline during the COVID-19 lockdowns in 2019/20 and 2020/21, followed by an increase post-lockdown due to deconditioning. The study highlights the vulnerability of young athletes to muscle injuries, particularly during growth spurts, and calls for further research into training methods and injury prevention strategies to mitigate these risks. Full article

Acute coronary syndrome (ACS) refers to a spectrum of conditions characterized by a sudden decrease in blood flow to the heart. This includes unstable angina, the mildest form, as well as non-ST- and ST-segment elevation myocardial infarction. The primary cause of ACS is typically the rupture or erosion of an atherosclerotic plaque in a coronary artery, resulting in the formation of a blood clot that can, partially or completely, block the blood flow to the heart muscle. The ongoing discovery and comprehension of emerging biomarkers for atherosclerosis could enhance our capacity to predict future events, particularly when integrated alongside traditional risk factors in assessing overall risk profiles. With advancements in proteomic technologies, large-scale approaches have been increasingly instrumental in unraveling pathways implicated in atherosclerotic degeneration and identifying novel circulating markers, which may serve as early diagnostic indicators or targets for innovative therapies. Over recent decades, numerous matrices including plasma, urine, microparticles, lipoproteins, atherosclerotic plaque extracts and secretomes, as well as thrombi, have been examined to address these questions. Furthermore, proteomics has been applied to various experimental models of atherosclerosis to deepen our understanding of the mechanisms underlying atherogenesis. This review offers a critical overview of the past two decades of untargeted omics research focused on identifying circulating and tissue biomarkers relevant to ACS. Full article

Objectives: Although considered a safe procedure, functional endoscopic sinus surgery (FESS) can cause various significant ophthalmic complications, i.e., serious extraocular muscle (EOM) damage. The aim of this study is to review the surgical management outcomes of patients with mechanical strabismus and diplopia as a complication of FESS, who referred to ophthalmological department in Norbert Barlicki University Teaching Hospital No. 1 over the 5-year period from 2018 to 2023. Methods: The records of seven consecutive patients with diplopia following endoscopic sinus surgery were retrospectively reviewed. Demographics, ophthalmological and orthoptic examination, the results of orbital imaging, type of FESS, type of strabismic surgery, and the timing of the first intervention were analysed. Results: The time from FESS to referral for strabismic intervention varied from one day to two months. Two patients, who were operated upon immediately after the FESS procedure, underwent direct reunion of the proximal and distal parts of the ruptured medial rectus muscle. One patient required maxillofacial intervention in order to improve prominent enophthalmos. The remaining five demonstrated severe adhesion formation around at least one of the EOMs and orbital walls. Only patients who were operated upon within a short period after complicated FESS achieved orthotropia and lack of diplopia in the primary position with a single surgery. Conclusions: Early recognition of the orbital complications subsequent to FESS and prompt referral are essential for achieving a satisfactory surgical result. Appropriate treatment should be based on the mechanism, location, type, and severity of muscle damage. Full article

Thoracic aortic aneurysms (TAAs) pose a significant health burden due to their asymptomatic progression, often culminating in life-threatening aortic rupture, and due to the lack of effective pharmacological treatments. Risk factors include elevated hemodynamic stress on the ascending aorta, frequently associated with hypertension and hereditary genetic mutations. Among the hereditary causes, Marfan syndrome is the most prevalent, characterized as a connective tissue disorder driven by FBN1 mutations that lead to life-threatening thoracic aortic ruptures. Similarly, mutations affecting the TGF-β pathway underlie Loeys–Dietz syndrome, while mutations in genes encoding extracellular or contractile apparatus proteins, such as ACTA2, are linked to non-syndromic familial TAA. Despite differences in genetic origin, these hereditary conditions share central pathophysiological features, including aortic medial degeneration, smooth muscle cell dysfunction, and extracellular remodeling, which collectively weaken the aortic wall. Recent evidence highlights mitochondrial dysfunction as a crucial contributor to aneurysm formation in Marfan syndrome. Disruption of the extracellular matrix–mitochondrial homeostasis axis exacerbates aortic wall remodeling, further promoting aneurysm development. Beyond its structural role in maintaining vascular integrity, the ECM plays a pivotal role in supporting mitochondrial function. This intricate relationship between extracellular matrix integrity and mitochondrial homeostasis reveals a novel dimension of TAA pathophysiology, extending beyond established paradigms of extracellular matrix remodeling and smooth muscle cell dysfunction. This review summarizes mitochondrial dysfunction as a potential unifying mechanism in hereditary TAA and explores how understanding mitochondrial dysfunction, in conjunction with established mechanisms of TAA pathogenesis, opens new avenues for developing targeted treatments to address these life-threatening conditions. Mitochondrial boosters could represent a new clinical opportunity for patients with hereditary TAA. Full article

Background/Objectives: Optimal activation of the quadriceps femoris, particularly the vastus medialis, while minimizing excessive activation of the vastus lateralis, is crucial for treating knee injuries like ACL ruptures and patellofemoral pain syndrome. Restoring proper muscle balance may enhance rehabilitation outcomes, but effective strategies for modulating muscle activity remain unclear. High-velocity low-amplitude hip manipulation has shown potential to influence neuromuscular function, yet its impact on quadriceps activation during knee extension has not been well studied. Therefore, the main aim of this study is to examine the effects of a single session of high-velocity low-amplitude hip manipulation on quadriceps femoris muscle activation and maximum voluntary contraction during knee extension. Methods: This study utilizes a randomized controlled design. Thirty physically active men and women (mean age: 21.9 ± 1.7 years) were randomly assigned to either an experimental group (n = 15; receiving hip joint manipulation) or a control group (n = 15; undergoing a sham intervention). Participants in the intervention group received a treatment involving hip manipulation and short-duration traction. Muscle activity of the rectus femoris, vastus lateralis, and vastus medialis was assessed using surface electromyography before and after the intervention, while muscle performance was measured by evaluating isometric knee extension strength in the lower limb. The isometric strength test was conducted in a seated position with the knee flexed at 60 degrees in Biodex System 4. Results: This study finds that the experimental group had significantly higher vastus lateralis mean amplitude (p = 0.020; effect size = 0.186) and vastus medialis mean amplitude (p < 0.001; effect size = 0.577) of electromyography root mean square electromyography compared to the control group. The experimental group also showed greater vastus medialis max amplitude (p < 0.001; effect size = 0.435). No significant differences were noted for rectus femoris mean amplitude (p = 0.078; effect size = 0.110), vastus lateralis max amplitude (p = 0.363; effect size = 0.031), rectus femoris max amplitude (p = 0.069; effect size = 0.117), or median frequency of the raw electromyography signal across muscle groups. Conclusions: In conclusion, high-velocity low-amplitude hip manipulation significantly enhances vastus medialis activation, highlighting its potential to improve quadriceps balance. These findings support the incorporation of hip manipulation into rehabilitation protocols. Full article

Background: Fibroblast activation protein (FAP) is a cell surface glycoprotein expressed by myofibroblastic cells in areas of active tissue remodeling, such as wound healing, fibrosis, and certain chronic inflammatory lesions. As FAP is uniquely present in chronic inflammatory lesions and has an important role in extracellular matrix (ECM) turnover, it appears to have all the characteristics necessary for involvement in atherosclerosis and atherosclerotic plaque rupture and has become a potential target in the treatment of myocardial infarction. Methods: To further understand the role of FAP, its expression in atherosclerotic plaques was examined in a genetically modified mouse model of accelerated atherosclerosis (Apobec1 −/− Ldlr −/− double-knockout mice). The immunohistochemical Fap staining of atherosclerotic plaques in a mouse model of atherosclerosis was correlated with quantification of Fap mRNA obtained from the atherosclerotic plaques of the aortic arch. Fap distribution was characterized in mouse atherosclerotic plaques relative to other markers of activated smooth muscle cells, such as alpha smooth muscle actin and myosin heavy chain (Acta2 and Myh2), ECM turnover (Ki-67, procollagen III and Mmp-9), and inflammation in atherosclerosis (Cd-44, Il-12 and Tgf beta) using immunohistochemistry (IH) and RT-PCR analysis. Results: The mouse model of accelerated atherosclerosis showed an increasing presence of Fap with the progression of atherosclerosis and a high expression level in advanced atherosclerotic lesions compared with other markers of ECM turnover and inflammation in atherosclerosis. Conclusions: FAP exhibits a distinct pattern of expression in a mouse model of atherosclerosis as compared to other markers of activated vascular smooth muscle cells, ECM degeneration, and inflammatory cytokines. Full article

Injuries to the soleus muscle are often unrecognized, which increases the risk of complete tearing. Consequently, it results in the need for a long break in sports. This is mainly because the soleus muscle is complex, and the clinical signs of injury are difficult to capture, which can mimic Achilles tendinopathy and tennis player’s calves. This muscle has a complex connective tissue structure with three intramuscular tendons, which makes it challenging to interpret pathological muscle conditions. Injuries to the soleus muscle can be acute or chronic and are usually considered to be a minor discomfort by both the patient and the sports medicine physician, leading to a relatively quick return to sports activity with a high risk of re-injury. This narrative literature review aims to explore the diagnostic challenges and treatment failures associated with soleus muscle injuries, highlighting the critical lack of standardized protocols and a comprehensive understanding of the nuances of these injuries, which requires the collection of qualitative data from clinical case studies, quantitative data from imaging studies and rehabilitation outcomes, and expert opinion to formulate evidence-based guidelines to improve patient management. Calf muscle pain symptoms should not be ignored because the injury may become chronic, and the lack of treatment adequate to the actual cause of the pain increases the risk of the injury deepening, including complete rupture. High-resolution ultrasonography and magnetic resonance imaging are recommended methods for differentially diagnosing soleus muscle injury in conjunction with physical examination to make a precise and reliable diagnosis. A soleus muscle injury case report and a comprehensive proposal for conservative treatment supplement our literature review. Full article

Background/Objectives: Secure large-bore cannula insertion is critical for effective extracorporeal membrane oxygenation (ECMO), as inadequate fixation can lead to complications such as infection, dislodgment, and life-threatening events. With inconsistent guidelines for ECMO line management, this study compares the effectiveness of traditional suture fixation to an adhesive securement method in the prevention of ECMO cannula dislodgment using an in vitro model. Methods: Porcine skin and muscle tissue sections were prepared and mounted in a custom holder. A 21F venous ECMO cannula was inserted using a modified Seldinger technique. Three fixation methods were randomly compared: (1) three silk sutures, and (2a) one silk suture with a CathGrip adhesive anchoring device. In addition, a sub-analysis was performed using (2b) the Hollister adhesive anchoring device. A uniaxial testing machine simulated 50 mm cannula dislodgment, measuring tensile forces at 12.5, 25, and 50 mm dislodgment points. Results: A total of 26 ECMO cannula fixations using sutures, 26 with adhesive CathGrip, six with a Hollister device, and three controls were tested across six porcine samples. Sutures demonstrated greater variability in force at maximum dislocation, with 27% rupturing at 50 mm. In contrast, CathGrip provided greater flexibility without tearing. The adhesive exhibited higher stiffness (2.38 N/mm vs. 2.09 N/mm, p < 0.001) and dislodgment energy (0.034 J vs. 0.032 J, p = 0.002) in the 0–5 mm range, while sutures showed greater stiffness in the 5–50 mm range (1.42 N/mm vs. 1.18 N/mm, p < 0.001). At larger displacements (25 mm and 50 mm) and in total energy absorption, no statistically significant differences were observed (p = 0.57). In a sub-analysis, the six fixations using the Hollister device exhibited higher variability and significantly lower dislodgment forces at 25 mm (p = 0.033) and 50 mm (p = 0.004) compared to the CathGrip device. Conclusions: This study suggests that adhesive anchoring methods, such as CathGrip, may provide comparable or potentially superior fixation strength to sutures for ECMO cannula stabilization under controlled conditions. However, further research, including clinical trials, is necessary to confirm these findings, evaluate long-term performance, and explore the implications for dislodgment risk and infection prevention in clinical practice. Full article

Background: Achilles tendon rupture rehabilitation protocols often emphasize two key factors, namely plantar flexion and load restriction during the early recovery stages. However, we hypothesize that variations in walking speed also play a significant role in affecting the load on the Achilles tendon. This study aims to explore the combined impact of plantar flexion angle and walking speed on the surface electromyography (EMG) activity of the calf muscles. Methods: Surface EMG measurements on 24 healthy volunteers assessed the activity of the calf muscles (gastrocnemius lateralis, gastrocnemius medialis, and soleus). Participants walked on a treadmill using two designs of ankle foot orthoses set at three different angles of the ankle joint (mainly 0°, 15°, or 30° plantar flexion), as well as barefoot and in sports shoes. The tests were performed at full loads of 1, 2 and 4 km/h or with additional measurements at 1 and 2 km/h with a partial load of 20 kg. The walking speed of 4 km/h in sports shoes was used as reference, corresponding to the maximum load on the calf muscles during walking. Results: Both orthoses demonstrated a significant reduction in EMG activity by more than half even at a 0° setting and 1 km/h compared to walking barefoot or in sports shoes. However, as walking speed increased to 2 km/h and especially to 4 km/h, EMG activity significantly increased, approaching the level of walking with sports shoes at 1 km/h. The results indicated that even minor changes in walking speed had a significant impact on muscle activity, underscoring the importance of this parameter. Conclusions: This study suggests that walking speed should be considered a crucial factor in rehabilitation protocols for Achilles tendon ruptures, alongside plantar flexion and load restrictions, to optimize recovery outcomes. Full article

There has been rapid growth in women’s football worldwide; however, research on injury prevention strategies and physiological considerations specific to female athletes remains insufficient. Women’s football has experienced an increase in injury prevalence, despite being underrepresented in sports literature, with less than 25% of research focused on this demographic. The incidence of injuries, particularly among young elite female footballers, is notably high, impacting long-term health outcomes such as osteoarthritis and contributing to shorter playing careers. Certain injuries, such as anterior cruciate ligament (ACL) ruptures, occur at significantly higher rates in women compared to men, underscoring sex-specific risk factors that must be addressed in injury prevention programs (IPPs). This narrative review aims to evaluate the effectiveness of IPPs tailored for female football players and to address their heightened susceptibility to injuries compared to males. Research studies and review articles were identified using a literature search of the PubMed, SportDiscus, and Google Scholar databases from 1990 to December 2024. Biological factors, including hormonal influences—such as increased ACL laxity during the menstrual cycle—and musculoskeletal differences, such as muscle strength imbalances, reduced joint stability, and hip weakness, significantly contribute to this increased risk. Despite the existence of injury prevention protocols like FIFA 11+, their consistent application and adaptation to meet the unique needs of female footballers remain limited. In addition to physical injuries, mental health is a critical concern. Female football players exhibit higher rates of depression and anxiety compared to their male counterparts, influenced by factors such as injury-related stress and menstrual cycle variations. In conclusion, the growing participation of women in football highlights the urgent need for research and implementation of injury prevention strategies specifically tailored to female players. Full article

Clinical symptoms of monocled cobra (Naja kaouthia) envenoming include the paralysis of extraocular muscles, local tissue necrosis and death through respiratory failure. These neurotoxic outcomes are mainly due to the inhibitory action of postsynaptic neurotoxins to nicotinic acetylcholine receptors. However, injuries involving respiratory muscles have rarely been investigated. In this study, we determined the effect of N. kaouthia envenoming on morphological changes in the rat diaphragm. The efficacy of cobra monovalent antivenom in neutralising the histopathological effects of N. kaouthia venom was also evaluated. The intramuscular (i.m.) administration of N. kaouthia venom (2 mg/kg) caused skeletal muscle fibre atrophy and ruptures of myofibrils shown via a light microscope study. Transmission electron microscopy (TEM) revealed the zig-zagging of the Z-band, mitochondrial damages and degeneration of the synaptic fold of the neuromuscular junction following experimental cobra envenoming for 4 h. Intravenous administration of cobra antivenom at manufacturer-recommended doses diminished histopathological changes in the diaphragm following the administration of cobra venom. The expression of NF-kB and MuRF1 in the experimentally N. kaouthia-envenomed diaphragm indicated inflammation and tissue atrophy in the immunofluorescence analysis, respectively. In this study, we found that there were respiratory muscle injuries following N. kaouthia envenoming. The early administration of monovalent N. kaouthia antivenom is capable of neutralising neurotoxic outcomes following cobra envenoming. Full article