IntroductionMotor evoked potentials (MEPs) are currently considered as a more useful method for neurophysi-ological intraoperative monitoring than somatosensory evoked potentials in cases of surgery applied to patients with adolescent idiopathic scoliosis. The non-invasive approach is preferred to modify MEP recordings, criticizing, in many cases, the fundamentalism for neurophysiological monitoring based only on needle recordings. The aim of the review is to provide our own experience and prac-tical guidelines with reference to neuromonitoring innovations.Material and MethodsRecordings of MEPs with surface electrodes instead of needle electrodes including nerve instead of muscle combinations during neurophysiological monitoring associated with surgical interventions to the spine have become more relevant for pediatric purposes, avoiding the anesthesiology-related influences. Observations on 280 patients with Lenke A–C types of spine curvature are presented before and after the surgical correction.ResultsThe MEPs recorded from nerves do not undergo fluctuations at different stages of scoliosis correc-tions and the anesthesia effect more than MEPs recorded from muscles. The use of non-invasive surface electrodes during neuromonitoring for MEP recordings shortens the total time of the surgical procedure without diminishing the precision of the neural transmission evaluation. The quality of MEP recordings during intraoperative neuromonitoring from muscles can be significantly influ-enced by the depth of anesthesia or administration of muscle relaxants but not those recorded from nerves.ConclusionsThe proposed definition of “real-time” neuromonitoring comprises the immediate warning from a neurophysiologist about the changes in a patient’s neurological status during scoliosis surgery (es-pecially during pedicle screws’ implantation, corrective rods’ implantation, correction, distraction and derotation of the spine curvature) exactly during the successive steps of corrective procedures. This is possible due to the simultaneous observation of MEP recordings and a camera image of the surgical field. This procedure clearly increases safety and limits financial claims resulting from possible complications.

Analysis of health care workers’ stress levels during the COVID-19 virus pandemic, and whether there is a relationship between health care workers’ stress levels and mental health in the context of coping with stress. One hundred and seventy professionally active health care workers took part in the study: doctors (n=41), nurses (n=114) and paramedics (n = 15). On average, study subjects were 37 years old and had 14 years of work experience. The following were used in this questionnaire-based study: General Health Questionnaire (GHQ–28), Perceived Stress Scale (PSS-10), Mini-COPE – Coping Inventory. The research group experienced high levels of stress. Nurses experienced the most acute stress. Increasing stress levels are accompanied by an intensification of psychopathological symptoms (insomnia and depression). Older individuals and those with more years worked at work experienced less psychopathological symptoms. Non-adaptive stress coping methods (e.g. use of psychoactive substances) resulted in deteriorating mental health within the research group. Habitual use of non-adaptive strategies may bring relief in the short term in the form of reduced negative consequences of stress transactions and facilitate mobilisation or just sufficient performance at work. However, in the longer term, it may lead to deteriorating health. The obtained data shows that positive reinterpretation, age and length of work track record constitute protective factors against deteriorating health.

The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level.

Objective: The cross-sectional study aimed to assess the stress outcomes in health care staff working during the Covid-19 pandemic and to explore the role of coping in the relationship between stress outcomes and mental health dimensions with Preacher & Hayes's mediation analysis. Subjects and methods: 170 participants including physicians (n=41; 24.1%), nurses (n=114, 67.1%) and paramedics (n = 15, 8.8%) with a mean age of 37.69 ± 12,23 years and an average seniority of 14.40 ±12.32 years. were administered The Toronto Alexithymia Scale– 20 (TAS – 20), Cohen's Perceived Stress Scale (PSS-10), the Emotional Processing Scale (EPS) and Positive and Negative Affect Schedule (PANAS). The data were analyzed by estimation of simple correlation coefficients and a Preacher and Hayes's mediation procedure. Results: Participants reported elevated levels of stress (7-8 sten on the sten scale developed for the PSS-10 questionnaire). Statistically significant differences in the stress levels between nurses, paramedics and physicians could not determined. In contrast, significant association between mental health outcomes and occupational category could not be found. Coping mediated the relationship between coping strategies and mental health outcomes. A positive and significant relationship was observed between stress, dysfunctional coping strategies and mental health. Conclusion: Our observations support the assumption about a controlling role of coping in the relationship between work-related stress and mental health outcomes in the medical staff working amid pandemic.

The role of anti-HLA antibodies in transplant rejection is well-known but the injury associated with non-HLA antibodies is now widely discussed. The aim of our study was to investigate a role of non-HLA antibodies in hand allografts rejection. The study was performed on six patients after hand transplantation. The control group consisted of: 12 kidney transplant recipients and 12 healthy volunteers. The following non-HLA antibodies were tested: antibody against angiotensin II type 1 receptor (AT1R-Ab), antibody against endothelin-1 type-A-receptor (ETAR-Ab), antibody against protease-activated receptor 1 (PAR-1-Ab) and anti-VEGF-A antibody (VEGF-A-Ab). Chosen proinflammatory cytokines (Il-1, IL-6, IFNγ) were used to evaluate the post-transplant humoral response. Laboratory markers of endothelial activation (VEGF, sICAM, vWF) were used to assess potential vasculopathy. The patient with the highest number of acute rejections had both positive non-HLA antibodies: AT1R-Ab and ETAR-Ab. The same patient had the highest VEGF-A-Ab and very high PAR1-Ab. All patients after hand transplantation had high levels of laboratory markers of endothelial activation. The existence of non-HLA antibodies together with multiple acute rejections observed in patient after hand transplantation should stimulate to look for potential role of non-HLA antibodies in humoral injury in vascular composite allotransplantation.

Stroke is one of the leading causes of disability, including loss of hand manipulative skills. It constitutes a major limitation in independence and the ability to perform everyday tasks. Among the numerous accessible physiotherapeutic methods, it is becoming more common to apply Virtual Reality "VR”. The aim of this study was to establish whether immersive VR was worth considering as a form of physical therapy and the advisability of applying it in restoring post-stroke hand function impairment. A proprietary application Virtual Mirror Hand 1.0 was used in the research and its effectiveness in therapy was compared to classical mirror therapy. A total of 20 survivors after ischaemic stroke with comparable functional status were divided into a study group (n = 10) and control group (n = 10). Diagnostic tools included 36-Item Short Form Survey “SF-36” and the Fugl-Meyer Assessment Upper Extremity “FMA-UE”. Collected metrics showed a normal distribution and the differences in mean values were tested by the student’s t-test. In both, the study and control groups’ changes were recorded. A statistically significant outcome for FMA-UE and SF-36 measured by the student’s t-test for dependent or independent samples (p > 0.05) were obtained in both groups. Importantly, proven by conducted studies, an advantage of VR proprietary application was subjective sensations amelioration in pain and sensory impressions. Applying Virtual Mirror Hand 1.0 treatment to patients after a stroke appears to be a good solution and definitely provides the opportunity to consider VR applications as an integral part of the neurorehabilitation process. These results give a basis to plan further larger-scale observation attempts. Moreover, the development of the Virtual Mirror Hand 1.0 as an innovative application in physiotherapy may become equivalent to classical mirror therapy in improving the quality and effectiveness of the treatment used for post-stroke patients.

The COVID-19 pandemic has had a significant impact on the operation of medical facilities. In this period, they have seen increased absence of medical staff from work, a decrease in the number of hospitalizations and in the value of healthcare services provided. We assess the impact of this pandemic on the operation of a non-COVID-19 orthopedic and rehabilitation hospital using International Classification of Functioning, Disability and Health (ICF) categories. The authors analyzed these parameters in relation to the operation of a non-COVID-19 orthopedic, rehabilitation and rheumatological hospital in Q1 2020 compared to Q1 2019. For the analysis, the categories and qualifiers of the ICF were used, allowing for a simple and easily readable data analysis. In March 2020, in comparison to March 2019, the average working time of medical workers (p < 0.001) and the number of hospitalizations (p < 0.034) decreased significantly. In April 2020, compared to April 2019, the average working time of medical workers (<0.001) and the number of hospitalizations (0.002) also decreased significantly. In addition, in April 2020, the percentage value of the contracted services provided decreased significantly (p = 0.017), which was not observed in March of that year. The COVID-19 pandemic has affected the operation of a non-COVID-19 hospital, causing an increase in staff absences from work, a decrease in the number of hospitalizations and a decrease in the value of the revenue generated from health services provided. The ICF is a useful tool for the evaluation of a hospital’s healthcare services.

Objective: The study aimed to describe properties and to prove diagnostic usefulness of motor evoked potentials (MEPs) recordings from muscles versus nerves of lower extremities when induced at lumbar levels with magnetic field. Methods: Methodologically similar MEPs recordings from muscles and nerves of lower extremities were performed once in healthy volunteers ( N = 43) and patients with disc-root conflicts at lumbar spine levels ( N = 43, proven in MRI studies). Simultaneous electroneurographic (ENG) recordings following stimulation of peroneal nerves verified neural impulses transmission in motor fibers peripherally and at L5 ventral roots. Results: ENG studies in patients proven only moderate axonal type of peroneal nerves injury. The mean values of MEPs amplitudes recorded from nerves were significantly different from those recorded in anatomically related muscles, both in controls (1179.6 ± 451.2 vs 1718.3 ± 481.3) and patients (495.6 ± 275.9 vs 1218.2 ± 465.5) ( p = 0.0009–0.0000012); they are about 30% and 51% smaller, respectively. In both groups of subjects, latencies of MEPs recorded from nerves were shorter at about 3.0 ms and characterized by a slightly longer duration (3.0–5.0 ms) than those recorded from muscles. Results revealed positive correlations between decrease of amplitudes in sEMG and MEPs recordings from lower extremities muscles indicating consequences of pathology in neural transmission from spinal centers. Conclusions: Results of this study point to clear-cut characteristics of MEPs induced oververtebrally with the magnetic field in parameters recorded in healthy subjects and patients with consequences of chronic L4-L5 low back pain, which can be easily implemented in clinical practice. Non-invasive method of MEPs recorded from nerves can be helpful for diagnosing of patients with visible atrophic changes in muscles and simultaneous symptoms of only slight pathology in transmission of nerve impulses peripherally.