SAAMP 2.0: an algorithm to predict genotype-phenotype correlation of lysosomal storage diseases

ABSTRACT

Lysosomal storage diseases (LSDs) are a group of genetic disorders, resulting from deficiencies of lysosomal enzyme. Genotype-phenotype correlation is essential for timely and proper treatment allocation. Recently, by integrating prediction outcomes of 7 bioinformatics tools, we developed a SAAMP algorithm to predict the impact of individual amino acid substitution. To optimize this approach, we evaluated the performance of these bioinformatics tools in a broad array of genes. PolyPhen and PROVEAN had the best performances, while SNP&GOs, PANTHER and I-Mutant had the worst performances. Therefore, SAAMP 2.0 was developed by excluding 3 tools with worst performance, yielding a sensitivity of 94% and a specificity of 90%. To generalize the guideline to proteins without known structures, we built the 3D model of iduronate-2-sulfatase by homology modeling. Further, we investigated the phenotype severity of known disease-causing mutations of the GLB1 gene, which lead to two LSDs (GM1 gangliosidosis; Morquio disease type B). Based on previous literature and structural analysis, we associated these mutations with disease subtypes and proposed a theory to explain the complicated genotype-phenotype correlation. Collectively, an updated guideline for phenotype prediction with SAAMP 2.0 was proposed, which will provide essential information for early diagnosis and proper treatment allocation, and may be generalized to many monogenic diseases.

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Reply to “Is it significant? Is it relevant?”

We thank Drs. Manca and Deriu for their insightful comments (Manca and Deriu, 2018). We agree that the scientific and clinical relevance of a study is not necessarily reflected by the statistical significance of a specific test. A statistical cut-off, using a pre-defined significance threshold, should not be equated with the presence or absence of a scientifically or clinically relevant finding. Judging the scientific or clinical relevance requires more than simply referring to statistical significance.

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Bariatric surgery prior to elective posterior lumbar fusion is associated with reduced medical complications and infection

Background context: Severely obese patients with operative spinal pathology present a challenge to the spine surgeon, given the increased complication risk.Purpose: Determine the impact of bariatric surgery on perioperative complications of posterior lumbar fusion.Study Design: Retrospective cohort study.Patient Sample: Patients undergoing posterior lumbar fusion surgery in the State Inpatient Databases (SID) of New York, Florida, North Carolina, Nebraska, Utah, and California.Outcomes: Thirty-day medical complications, surgical complications (nerve injury, infection, revision), death, readmission, and hospital length of stay (LOS).

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The impact of the difference in O-C2 angle in the development of dysphagia after occipitocervical fusion: a simulation study in normal volunteers combined with a case-control study

Dysphagia has been recognized as one of the most serious complications after occipitocervical fusion (OCF) and the difference between postoperative and preoperative O-C2 angle (dO-C2A) was proposed to be an indicator in predicting and preventing dysphagia. Therefore, in order to prevent postoperative dysphagia, previous studies recommend surgeons should correct the O-C2 angle (O-C2A) during surgery if the occipitocervical alignment was in an excessively flexed position. However, until now, there was no explicit indicator of the condition in which surgeons should adjust the patient's O-C2A during surgery.

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Do findings identified on magnetic resonance imaging predict future neck pain? a systematic review

Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear.

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How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? findings from the RAND auc study

Degenerative Lumbar Scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance.

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Vertebral body replacement using patient-specific 3D-printed polymer implants in cervical spondylotic myelopathy: an encouraging preliminary report

Resulting from recent studies that suggest a benefit of implant design on the achievement of fusion and stability in cervical spinal disease management, manufacturing development has increased over the past years. This paper attempts to describe how the development of patient-specific implants, which are used during the procedures of anterior cervical corpectomy and vertebral body replacement (VBR) impact the outcomes of cervical spondylotic myelopathy (CSM) management.

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Radionuclide transport in the “sediments – water – plants” system of the water bodies at the Semipalatinsk test site

Publication date: Available online 1 February 2018
Source:Journal of Environmental Radioactivity
Author(s): A.K. Aidarkhanova, S.N. Lukashenko, N.V. Larionova, V.V. Polevik
This paper provides research data on levels and character of radionuclide contamination distribution in the «sediments– water – plants » system of objects of the Semipalatinsk test site (STS). As the research objects there were chosen water bodies of man-made origin which located at the territory of "Experimental Field", "Balapan", "Telkem" and "Sary-Uzen" testing sites. For research the sampling of bottom sediments, water, lakeside and water plants was taken. Collected samples were used to determine concentration of anthropogenic radionuclides ⁹⁰Sr, ^239+240Pu, ²⁴¹Am, ¹³⁷Cs. The distribution coefficient (Kd) was calculated as the ratio of the content of radionuclides in the sediments to the content in water, and the concentration ratio (FV) was calculated as the ratio of radionuclide content in plants to the content in sediments or soil.



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Acidified seawater increases accumulation of cobalt but not cesium in manila clam Ruditapes philippinarum

Publication date: Available online 1 February 2018
Source:Journal of Environmental Radioactivity
Author(s): Narin Sezer, Hasan Oğuz Kocaoğlan, Önder Kılıç, Thomas Lacoue-Labarthe, Murat Belivermiş
The pH of seawater around the world is expected to continue its decline in the near future in response to ocean acidification that is driven by heightened atmospheric CO2 emissions. Concomitantly, economically-important molluscs that live in coastal waters including estuaries and embayments, may be exposed to a wide assortment of contaminants, including trace metals and radionuclides. Seawater acidification may alter both the chemical speciation of select elements as well as the physiology of organisms, and may thus pose at risk to many shellfish species, including the manila clam Ruditapes philippinarum. The bioconcentration efficiency of two common radionuclides associated with the nuclear fuel cycle, ¹³⁴Cs and ⁵⁷Co, were investigated by exposing live clams to dissolved ¹³⁴Cs and ⁵⁷Co at control (pH = 8.1) and two lowered pH (pH = 7.8 and 7.5) levels using controlled aquaria. The uptake and depuration kinetics of the two radionuclides in the whole-body clam were followed for 21 and 35 days, respectively. At steady-state equilibrium, the concentration factor (CFss) for ⁵⁷Co increased as the pH decreased (i.e. 130 ± 5, 194 ± 6, and 258 ± 10 at pH levels 8.1, 7.8 and 7.5, respectively), whereas the ¹³⁴Cs uptake was not influenced by a change in pH conditions. During depuration, the lowest depuration rate constant of ⁵⁷Co by the manila clam was observed at the intermediate pH of 7.8. An increase in the accumulation of ⁵⁷Co at the intermediate pH value was thought to be caused mainly by the aragonitic shell of the clam, as well as the low salinity and alkalinity of seawater used in the experiment. Considering that accumulation consists of uptake and depuration, among the three pH conditions moderately acidified seawater enhanced most the accumulation of ⁵⁷Co. Accumulation of ¹³⁴Cs was not strongly influenced by a reduced pH condition, as represented by an analogous uptake constant rate and CFss in each treatment. Such results suggest that future seawater pH values that are projected to be lower in the next decades, may pose a risk for calcium-bearing organisms such as shellfish.



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Ramie (Boehmeria nivea)'s uranium bioconcentration and tolerance attributes

Publication date: Available online 1 February 2018
Source:Journal of Environmental Radioactivity
Author(s): Wei-hong Wang, Xue-gang Luo, Lai Liu, Yan Zhang, Hao-zhou Zhao
The authors sampled and analyzed 15 species of dominant wild plants in Huanan uranium tailings pond in China, whose tailings' uranium contents were 3.21–120.52 μg/g. Among the 15 species of wild plants, ramie (Boehmeria nivea) had the strongest uranium bioconcentration and transfer capacities. In order to study the uranium bioconcentration and tolerance attributes of ramie in detail, and provide a reference for the screening remediation plants to phytoremedy on a large scale in uranium tailings pond, a ramie cultivar Xiangzhu No. 7 pot experiment was carried out. We found that both wild ramie and Xiangzhu No. 7 could bioconcentrate uranium, but there were two differences. One was wild ramie's shoots bioconcentrated uranium up to 20 μg/g (which can be regarded as the critical content value of the shoot of uranium hyperaccumulator) even the soil uranium content was as low as 5.874 μg/g while Xiangzhu No. 7's shoots could reach 20 μg/g only when the uranium treatment concentrations were 275 μg/g or more; the other was that all the transfer factors of 3 wild samples were >1, and the transfer factors of 27 out of 28 pot experiment samples were <1. Probably wild ramie was a uranium hyperaccumulator. Xiangzhu No. 7 satisfied the needs of uranium hyperaccumulator on accumulation capability, tolerance capability, bioconcentration factor, but not transfer capability, so Xiangzhu No. 7 was not a uranium hyperaccumulator.We analyzed the possible reasons why there were differences in the uranium bioconcentration and transfer attributes between wild ramie and Xiangzhu No. 7., and proposed the direction for further research.In our opinion, both the plants which bioconcentrate contaminants in the shoots and roots can act as phytoextractors. Although Xiangzhu No. 7's biomass and accumulation of uranium were concentrated on the roots, the roots were small in volume and easy to harvest. And Xiangzhu No. 7's cultivating skills and protection measures had been developed very well. Xiangzhu No. 7's whole bioconcentration factors and the roots' bioconcentration factors, which were 1.200–1.834 and 1.460–2.341, respectively, increased with the increases of uranium contents of pot soil when the soil's uranium contents are 25–175 μg/g, so it can act as a potential phytoextractor when Huanan uranium tailings pond is phytoremediated.



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Pink1 attenuates propofol-induced apoptosis and oxidative stress in developing neurons

Abstract

Background

The underlying mechanisms of propofol-induced neurotoxicity in developing neurons are still not completely understood. We examined the role of PTEN-induced kinase 1 (Pink1), an antioxidant protein, in propofol-induced apoptosis in developing neurons.

Materials and methods

Primary hippocampal neurons isolated from neonatal Sprague–Dawley rats were exposed to propofol 20 μM for 2, 4, 6 and 12 h. Subsequently, neurons underwent overexpression and knockdown of Pink1, followed by propofol exposure (20 μM, 6 h). Neuron apoptosis was detected by terminal transferase deoxyuridine triphosphate-biotin nick-end labeling (TUNEL). Reactive oxygen species (ROS) production in neurons was detected by using a 2,7-dichlorodihydro-fluorescein diacetate probe and target protein or mRNA levels were analyzed by Western blotting or real-time polymerase chain reaction.

Results

Propofol treatment time-dependently increased the number of TUNEL-positive neurons and the expression levels of cleaved caspase-3 and B-cell lymphoma 2 (BcL-2) associated X protein, but decreased expression levels of BcL-2. Furthermore, propofol treatment time-dependently reduced the expression levels of Pink1 mRNA and protein. ROS production and the markers of oxidative stress, 2,4-dinitrophenol and 4-hydroxynonenal, were increased by propofol treatment. However, these propofol-induced changes were significantly restored by Pink1 overexpression.

Conclusions

Pink1 plays an important role in neuronal apoptosis induced by propofol. Our results may provide some new insights in propofol-induced neurotoxicity in developing neurons.

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Quick reference tidal volume cards reduce the incidence of large tidal volumes during surgery

Abstract

Ventilation with large tidal volumes (V _T), greater than 10 ml/kg of predicted body weight (PBW), is associated with worse outcomes in critically ill and surgical patients. We hypothesized that the availability of quick reference cards with proposed V _T ranges specific to gender and different heights would reduce the intraoperative use of large V _T during prolonged abdominal surgery. We compared retrospectively the incidence of median V _T used during prolonged (≥4-h-long) abdominal surgery before ("before") and after ("after") the quick reference V _T cards were made available in all anesthesia machines in operating rooms of a single academic US medical center. We evaluated the effect of the intervention on the primary outcome while adjusting for previously identified risk factors of large V _T use: female gender, obesity (body mass index, BMI > 30), and short height (< 165 cm). The frequency of V _T > 10 ml/kg PBW was 15.1% in the before group and 4.3% in the after group (p < 0.001). The frequency of large V _T used during abdominal surgery was significantly decreased after the intervention even after adjusting for female gender, obesity or short height [adjOR 0.11 (95% CI 0.04–0.30)]. Our quick reference V _T cards significantly reduced the frequency of large V _T use during abdominal surgery.

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HANP on renal damage during cardiac surgery

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Central noradrenergic activity affects analgesic effect of Neuropeptide S

Abstract

Background

Neuropeptide S (NPS) is an endogenous neuropeptide controlling anxiolysis, wakefulness, and analgesia. NPS containing neurons exist near to the locus coeruleus (LC) involved in the descending anti-nociceptive system. NPS interacts with central noradrenergic neurons; thus brain noradrenergic signaling may be involved in NPS-induced analgesia. We tested NPS analgesia in noradrenergic neuron-lesioned rats using a selective LC noradrenergic neurotoxin, N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4).

Methods

A total 66 male Sprague–Dawley rats weighing 350–450 g were used. Analgesic effects of NPS were evaluated using hot-plate and tail-flick test with or without DSP-4. The animal allocated into 3 groups; hot-plate with NPS alone intracerebroventricular (icv) (0.0, 1.0, 3.3, and 10.0 nmol), tail-flick NPS alone icv (0.0 and 10.0 nmol), and hot-plate with NPS and DSP-4 (0 or 50 mg/kg ip). In hot-plate with NPS and DSP-4 group, noradrenaline content in the cerebral cortex, pons, hypothalamus, were measured.

Results

NPS 10 nmol icv prolonged hot plate (%MPE) but not tail flick latency at 30 and 40 min after administration. DSP-4 50 mg/kg decreased noradrenaline content in the all 3 regions. The NA depletion inhibited NPS analgesic effect in the hot plate test but not tail flick test. There was a significant correlation between hot plate latency (percentage of maximum possible effect: %MPE) with NPS 10 nmol and NA content in the cerebral cortex (p = 0.017, r ² = 0.346) which noradrenergic innervation arisen mainly from the LC. No other regions had the correlation.

Conclusions

NPS analgesia interacts with LC noradrenergic neuronal activity.

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Effect of dexmedetomidine for attenuation of propofol injection pain in electroconvulsive therapy: a randomized controlled study

Abstract

Purpose

Current analgesic strategies for propofol injection pain may cause adverse reactions during electroconvulsive therapy (ECT), such as shortening seizure duration. This study investigated whether dexmedetomidine could attenuate propofol injection pain in ECT.

Methods

Participants were randomly allocated to receive 0.2 μg/kg dexmedetomidine (Dex-0.2 group), 0.5 μg/kg dexmedetomidine (Dex-0.5 group) or saline (control group) prior to ECT. The composite pain scale and objective Surgical Pleth Index (SPI) were used to measure the intensity of injection pain, and the percentage of patients with pain score > 2 was the primary outcome.

Results

Of 137 patients recruited, 46 were assigned to each of the Dex-0.2 or Dex-0.5 groups, while 45 were in the control group. The percentage of pain score > 2 was reduced from 68.9% (31/45) in the control group to 34.8% (16/46) in the Dex-0.2 group (P < 0.001) and 15.2% (7/46) in the Dex-0.5 group (P < 0.001). The pain score and SPI at 5 s after propofol injection were greater in the control group than in the Dex-0.2 [pain scores 3 (2–4) vs. 1 (1–3), P < 0.001, SPI 76.6 ± 10.0 vs. 58.0 ± 11.0, P < 0.001] and Dex-0.5 groups [pain scores 3 (2–4) vs. 1 (0–1), P < 0.001, SPI 76.6 ± 10.0 vs. 51.2 ± 12.3, P < 0.001]. There were no significant differences in seizure duration between the three groups. No patients developed bradycardia and hypotension.

Conclusions

Pretreatment with dexmedetomidine was able to reduce the propofol injection pain in ECT without interfering with the seizure duration and causing adverse effects such as bradycardia and hypotension. In addition, close monitoring of hemodynamic variables and preparation of a treatment plan and drugs for bradycardia are essential.

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Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy

Abstract

Purpose

Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy.

Methods

Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3–7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6.

Results

The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001).

Conclusions

We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result.

ClinicalTrials.gov ID

NCT02484222.

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Perioperative respiratory complications: current evidence and strategy discussed in 2017 JA symposium

Abstract

Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea. We hope that this special article regarding this year's JA symposium may be useful for JA readers to manage clinical anesthesia on a daily basis.

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Development of a Social Functioning Assessment Using Computerized Adaptive Testing for Patients With Stroke

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Shih-Chieh Lee, Yi-Jing Huang, Gong-Hong Lin, Yeh-Tai Chou, Chia-Yeh Chou, Ching-Lin Hsieh
ObjectiveTo develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.DesignThis study contained 2 phases. First, a unidimensional item bank was formed using social-related items with sufficient item fit (ie, infit and outfit mean square [MNSQ]). The social-related items were selected from 3 commonly used patient-reported quality-of-life measures. Items with differential item functioning (DIF) of sex were deleted. Second, we performed simulations to determine the best set of stopping rules with both high reliability and efficiency. The participants' responses to the items were extracted from a previous study.SettingRehabilitation wards and departments of rehabilitation/neurology of 5 general hospitals.ParticipantsPatients (N=263) with stroke (47.1% were inpatients).InterventionsNot applicable.Main Outcome MeasureSocial-CAT.ResultsThe unidimensionality of the 24 selected items was supported (infit and outfit MNSQs =0.8–1.2). One item had DIF of sex and was deleted. The item bank was composed of the remaining 23 items. With the best set of stopping rules (person reliability ≥.90 or limited reliability increased ≤.001), the Social-CAT used on average 10 items to achieve sufficient reliability (average person reliability =.88; 81.0% of the patients with reliability ≥.90).ConclusionsThe Social-CAT appears to be a unidimensional measure with acceptable reliability and efficiency, and it could be useful for both clinicians and patients in time-pressed clinical settings.



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Differences in Physical Performance Measures among Patients with Unilateral Lower-Limb Amputations Classified as Functional Level K3 versus K4

Publication date: Available online 1 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jaclyn Megan Sions, Emma Haldane Beisheim, Tara Jo Manal, Sarah Carolyn Smith, John Robert Horne, Frank Bernard Sarlo
ObjectiveTo determine if differences in physical function, assessed via self-report questionnaires and physical performance tests, exist between individuals with lower-limb loss using a prosthetic device classified as a K3 versus a K4 functional level.DesignCross-sectional study.SettingUniversity of Delaware Physical Therapy Amputee Clinic.ParticipantsParticipants (n=55) were included if they were aged ≥18 years with a unilateral transfemoral or transtibial amputation, classified as K3 or K4 functional level, completed all relevant outcome measures, and currently were using a prosthesis.InterventionsNot applicable.Main Outcome MeasuresLocomotor Capabilities Index (LCI), Prosthetic Evaluation Questionnaire-Mobility Section (PEQ-MS), Timed Up and Go (TUG), 10-Meter Walk Test (10MWT), Amputee Mobility Predictor (AMPPRO), and 6 Minute Walk Test (6MWT). K-level was determined by group consensus based on a standardized clinical evaluation.ResultsAfter controlling for covariates, patients classified as K3 had slower TUG times (p=.002) and self-selected and fast gait speeds (p<.001), lower AMPPRO scores (p<.001), and walked shorter distances during the 6MWT (p=.003) when compared to patients classified as K4. No significant between-group differences for the LCI or PEQ-MS were found.ConclusionsClinicians involved in prosthetic prescription may consider including the TUG, 10MWT, AMPPRO, and 6MWT during their clinical evaluations to help differentiate between individuals of higher functional mobility. The LCI and PEQ-MS may be less useful in classifying individuals as K3 versus K4 due to a ceiling effect.



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Masthead

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2





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Editorial Board

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2, Supplement





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Editorial Board

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2





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Table of Contents

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2, Supplement





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The Authors Respond

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Meng-Ting Lin, Ming-Yen Hsiao, Yu-Kang Tu, Tyng-Guey Wang




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Table of Contents

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2





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Masthead

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2, Supplement





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Community Reintegration, Participation, and Employment Issues in Veterans and Service Members With Traumatic Brain Injury

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2, Supplement
Author(s): Christina Dillahunt-Aspillaga, Gail Powell-Cope
Traumatic brain injury (TBI) has been called the signature injury of the post-9/11 wars in Iraq, Afghanistan, and neighboring countries. Although similarities exist between veterans and service members with TBI, levels of severity and different constellations of coexisting comorbid conditions affect them differently. These conditions affect physical, cognitive, and emotional function, which in turn can complicate community reintegration (CR), or the ability to return to family, vocational, and community life. This special supplement of the Archives of Physical Medicine and Rehabilitation consists of articles written by accomplished teams from multiple disciplines, including anthropology, neuropsychology, nursing, occupational therapy, psychology, and rehabilitation sciences. Each article brings a different perspective to bear on what CR means for veterans and service members from examination of predictors and perceptions of veterans and service members and others to measurement studies. Collectively, this group of articles represents current thinking about CR and lays the groundwork for testing interventions to improve CR outcomes for veterans and service members (eg, employment, living situation, family life).



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Editors' Selections From This Issue: Volume 99 / Number 2 / February 2018

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2





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Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Flavia Coroian, Claire Jourdan, Karima Bakhti, Claire Palayer, Audrey Jaussent, Marie-Christine Picot, Denis Mottet, Marc Julia, Huey-Yune Bonnin, Isabelle Laffont
ObjectiveTo assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization.DesignRandomized blinded assessor controlled trial.SettingPhysical Medicine and Rehabilitation departments of 2 university hospitals.ParticipantsPatients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo).InterventionsA 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group).Main Outcome MeasuresThe primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo).ResultsRecruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2.ConclusionsIn a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.



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Comments on “Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study”

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Greg Atkinson, Alan M. Batterham, Philip Williamson




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Safety of Active Rehabilitation for Persistent Symptoms After Pediatric Sport-Related Concussion: A Randomized Controlled Trial

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Catherine Chan, Grant L. Iverson, Jacqueline Purtzki, Kathy Wong, Vivian Kwan, Isabelle Gagnon, Noah D. Silverberg
ObjectivesTo examine the safety and tolerability of an active rehabilitation program for adolescents who are slow to recover from a sport-related concussion, and secondarily to estimate the treatment effect for this intervention.DesignSingle-site, parallel, open-label, randomized controlled trial comparing treatment as usual (TAU) to TAU plus active rehabilitation.SettingOutpatient concussion clinic.ParticipantsAdolescents (N=19) aged 12 to 18 years with postconcussion symptoms lasting ≥1 month after a sports-related concussion.InterventionsTAU consisted of symptom management and return-to-play advice, return-to-school facilitation, and physiatry consultation. The active rehabilitation program involved in-clinic subsymptom threshold aerobic training, coordination exercises, and visualization and imagery techniques with a physiotherapist (mean, 3.4 sessions) as well as a home exercise program, over 6 weeks.Main Outcome MeasuresA blinded assessor systematically monitored for predetermined adverse events in weekly telephone calls over the 6-week intervention period. The treating physiotherapist also recorded in-clinic symptom exacerbations during aerobic training. The Post-Concussion Symptom Scale was the primary efficacy outcome.ResultsNineteen participants were randomized, and none dropped out of the study. Of the 12 adverse events detected (6 in each group), 10 were symptom exacerbations from 1 weekly telephone assessment to the next, and 2 were emergency department visits. Four adverse events were referred to an external safety committee and deemed unrelated to the study procedures. In-clinic symptom exacerbations occurred in 30% (9/30) of aerobic training sessions, but resolved within 24 hours in all instances. In linear mixed modeling, active rehabilitation was associated with a greater reduction on the Post-Concussion Symptom Scale than TAU only.ConclusionsThe results support the safety, tolerability, and potential efficacy of active rehabilitation for adolescents with persistent postconcussion symptoms.



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MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Courtney Frengopoulos, Michael W. Payne, Ricardo Viana, Susan W. Hunter
ObjectiveTo investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation.DesignRetrospective chart audit.SettingRehabilitation hospital.ParticipantsConsecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology.InterventionsNot applicable.Main Outcome MeasuresCognitive status was assessed using the MoCA. The L Test of Functional Mobility (L Test) and the 2-minute walk test were used to estimate functional mobility and walking endurance.ResultsIn multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest.ConclusionsIndividuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test.



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Efficacy of Activities of Daily Living Retraining During Posttraumatic Amnesia: A Randomized Controlled Trial

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Jessica Trevena-Peters, Adam McKay, Gershon Spitz, Rachel Suda, Belinda Renison, Jennie Ponsford
ObjectiveTo assess the efficacy of activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) compared with ADL retraining commencing after emergence from PTA.DesignRandomized controlled trial.SettingInpatient rehabilitation center.ParticipantsParticipants with severe TBI (N=104), admitted to rehabilitation and remaining in PTA for >7 days, were randomized to receive either treatment as usual (TAU) with daily ADL retraining (treatment), or TAU alone (physiotherapy and/or necessary speech therapy) during PTA.InterventionsADL retraining was manualized, followed errorless and procedural learning principles, and included individualized goals. Both groups received occupational therapy as usual after PTA.Main Outcome MeasuresPrimary outcome was the FIM completed at admission, PTA emergence, discharge, and 2-month follow-up. Secondary outcomes included length of rehabilitation inpatient stay, PTA duration, Agitated Behavior Scale scores, and Community Integration Questionnaire (CIQ) scores at follow-up. Groups did not significantly differ in baseline characteristics.ResultsOn the primary outcome, FIM total change, random effects regression revealed a significant interaction of group and time (P<.01). The treatment group had greater improvement in FIM scores from baseline to PTA emergence, which was maintained at discharge, but not at follow-up. Twenty-seven percent more of the treatment group reliably changed on FIM scores at PTA emergence. Group differences in length of stay, PTA duration, agitation, and CIQ scores were not significant; however, TAU trended toward longer length of stay and PTA duration.ConclusionsIndividuals in PTA can benefit from skill retraining.



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Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: An Updated Review of the Literature From 2007 to 2016

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Yael Goverover, Nancy D. Chiaravalloti, Amanda R. O'Brien, John DeLuca
ObjectiveTo update the clinical recommendations for cognitive rehabilitation of people with multiple sclerosis (MS), based on a systematic review of the literature from 2007 through 2016.Data SourcesSearches of MEDLINE, PsycINFO, and CINAHL were conducted with a combination of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, processing speed, and working memory. One hundred twenty-nine articles were identified and underwent initial screening.Study SelectionFifty-nine articles were selected for inclusion after initial screening. Nineteen studies were excluded after further detailed review. Forty studies were fully reviewed and evaluated.Data ExtractionArticles were assigned to 1 of 6 categories: attention, learning and memory, processing speed and working memory, executive functioning, metacognition, or nonspecified/combined cognitive domains. Articles were abstracted and levels of evidence were decided using specific criteria.Data SynthesisThe current review yielded 6 class I studies, 10 class II studies, and 24 class III studies. One intervention in the area of verbal learning and memory received support for a practice standard, 2 computer programs received support as practice guidelines (in the area of attention and multicognitive domains), and several studies provided support for 5 practice options in the domains of attention and learning and memory.ConclusionsSubstantial progress has been made since our previous review regarding the identification of effective treatments for cognitive impairments in persons with MS. However, much work remains to be done to optimize rehabilitation potential by applying the most methodologically rigorous research designs to provide class I evidence in support of a given treatment strategy.



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Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2
Author(s): Chih-Kai Hong, Wei-Ren Su




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Information/Education Pages (I/EPs)

Publication date: February 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 2





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Measurement Characteristics and Clinical Utility of the Awareness Questionnaire in Individuals With Traumatic Brain Injury

Publication date: Available online 1 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Edeth Engel, Allison Peipert, Linda Ehrlich-Jones




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De novo variants in CDK13 associated with syndromic ID/DD; molecular and clinical delineation of 15 individuals and a further review

Abstract

De novo variants in the gene encoding cyclin-dependent kinase 13 (CDK13) have been associated with congenital heart defects and intellectual disability (ID). Here, we present the clinical assessment of fifteen individuals and report novel de novo missense variants within the kinase domain of CDK13. Furthermore, we describe two nonsense variants and a recurrent frame-shift variant. We demonstrate the synthesis of two aberrant CDK13 transcripts in lymphoblastoid cells from an individual with a splice-site variant. Clinical characteristics of the individuals include mild to severe ID, developmental delay, behavioural problems, (neonatal) hypotonia and a variety of facial dysmorphism. Congenital heart defects were present in two individuals of the current cohort, but in at least 42% of all known individuals. An overview of all published cases is provided and does not demonstrate an obvious genotype-phenotype correlation, although two individuals harbouring a stop codons at the end of the kinase domain might have a milder phenotype. Overall there seems not to be a clinically recognizable facial appearance. The variability in the phenotypes impedes an à vue diagnosis of this syndrome and therefore genome-wide or gene-panel driven genetic testing is needed. Based on this overview we provide suggestions for clinical work-up and management of this recently described ID syndrome.

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Worldwide distribution of common IDUA pathogenic variants

Abstract

Mucopolysaccharidosis type I (MPS I) is a rare disorder caused by deleterious sequence variants in the α-L-iduronidase (IDUA) gene. More than 200 pathogenic variants have been described so far, but their frequencies have not yet been analysed on a worldwide scale. To address this, we analysed the genotypes of MPS I patients from thirty-five published studies papers. The most common pathogenic variant observed was p.Trp402Ter. With frequencies of up to 63%, it was the major allele in most European countries, America and Australia. The variant p.Gln70Ter was also frequent; it was found mainly in northern and eastern Europe. The most frequent variant in North African countries was p.Pro533Arg; in Morocco, it represented more than 90% of mutant alleles. Variants observed in East Asians were not found in Western populations, including c.1190-1G>A, p.Ala79Val, p.Leu346Arg and c.613_617dupTGCTC. Conversely, p.Trp402Ter and p.Pro533Arg were not found in patients from East Asia. In conclusion, the most common pathogenic IDUA variant in MPS I patients are p.Trp402Ter, p.Gln70Ter and p.Pro533Arg. Knowledge about the genetic background of MPS I for each population is essential when developing new genotype-targeted therapies, as well as to enable faster genetic analysis and improve patient management.

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Lack of clear and univocal genotype-phenotype correlation in Familial Mediterranean Fever patients: A systematic review

Abstract

Familial Mediterranean fever (FMF) is the most common autosomal recessive autoinflammatory disease. To date, following the isolation of more than 280 MEFV sequence variants, the genotype–phenotype correlation in FMF patients has been intensively investigated, however, an univocal and clear consensus has not been yet reached. Thus, the aim of this systematic review was to analyse the available literature findings in order to provide to scientific community an indirect estimation of the impact of genetic factors on the phenotypic variability of FMF. This systematic review has been conducted according to the PRISMA guidelines. The p.M694V mutation was reported to have a relatively severe clinical course, similarly, patients homozygous for M694I and M680I, or carrying a combination of both at codons 694 and 680, have a severe disease. Also, patients homozygous for M694V and V726A variants experienced more severe clinical picture. Conversely, heterozygous p.V726A and p.E148Q genotypes have been correlated with a milder disease course. At present, doubts remain on the potential pathogenic role of E148Q variant. The heterogenity in clinical FMF manifestations reflects the changes occuring in repertoire of mutations. We believe that clinical criteria and gene tests, enhancing each other, could better support the diagnosis of FMF.

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Intrinsic EEG and task-related changes in EEG affect Go/NoGo task performance

Publication date: Available online 2 February 2018
Source:International Journal of Psychophysiology
Author(s): Diana Karamacoska, Robert J. Barry, Genevieve Z. Steiner, Elle P. Coleman, Emily J. Wilson
Substantial research into the brain dynamics underlying cognitive functioning during tasks links the brain's EEG activity to the stimulus-evoked ERP activity. This study focused on examining how the resting state intrinsic EEG, and the change from rest to the task, affect these stimulus-response processes. Forty young adults (aged 20.3 ± 2.3 years) had EEG recorded during eyes-closed (EC) and eyes-open (EO) resting states, and then during an auditory Go/NoGo task. Amplitude in the delta to beta bands was analyzed for the overall resting state EEG, the reactive change from EC to EO, and for the change from EO to the task (termed task-related change here). The relationships between these EEG measures and Go/NoGo behavioral outcomes and ERPs were assessed. Greater resting state delta and theta amplitudes were linked to Go N1-1 enhancements, but only resting state delta correlated with the NoGo N1-1. These relationships replicate previous data and highlight the functional relevance of low frequency intrinsic activity in attentional processes. However, delta increases from EO to the task predicted poorer Go response accuracy and variability, and enhanced Go Slow Wave (SW) positivity. This increase in delta, and smaller alpha-1 increments, were associated with longer mean RTs. Theta increases predicted larger Go N1-1 amplitudes, but lower NoGo accuracy rates, while beta-1 increments were predictive of NoGo SW negativity. These novel effects suggest that task-related EEG changes impact decision-making and cognitive control processes, and subsequent behavioral performance.



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Resting heart rate variability is associated with ex-Gaussian metrics of intra-individual reaction time variability

Publication date: Available online 2 February 2018
Source:International Journal of Psychophysiology
Author(s): Derek P. Spangler, DeWayne P. Williams, Lassiter Speller, Justin R. Brooks, Julian F. Thayer
The relationships between vagally mediated heart rate variability (vmHRV) and the cognitive mechanisms underlying performance can be elucidated with ex-Gaussian modeling—an approach that quantifies two different forms of intra-individual variability (IIV) in reaction times (RT). To this end, the current study examined relations of resting vmHRV to whole-distribution and ex-Gaussian IIV. Subjects (N = 83) completed a 5-minute baseline while vmHRV (root mean square of successive differences; RMSSD) was measured. Ex-Gaussian (sigma, tau) and whole-distribution (standard deviation) estimates of IIV were derived from reaction times on a Stroop task. Resting vmHRV was found to be inversely related to tau (exponential IIV) but not to sigma (Gaussian IIV) or the whole-distribution standard deviation of RTs. Findings suggest that individuals with high vmHRV can better prevent attentional lapses but not difficulties with motor control. These findings inform the differential relationships of cardiac vagal control to the cognitive processes underlying human performance.



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Associations between oxytocin receptor gene (OXTR) methylation, plasma oxytocin, and attachment across adulthood

Publication date: Available online 2 February 2018
Source:International Journal of Psychophysiology
Author(s): Natalie C. Ebner, Tian Lin, Melis Muradoglu, Devon H. Weir, Gabriela M. Plasencia, Travis S. Lillard, Hossein Pournajafi-Nazarloo, Ronald A. Cohen, C. Sue Carter, Jessica J. Connelly
The neuropeptide oxytocin (OT) has been implicated in a wide range of affiliative processes. OT exerts its functions via OT receptors, which are encoded by the oxytocin receptor gene (OXTR). Epigenetic modification of OXTR through the process of DNA methylation has been associated with individual differences in behavioral phenotypes. Specifically, lower levels of OXTR methylation have been linked to better social and affective functioning. However, research on epigenetic mechanisms of OXTR is scarce in non-clinical populations, and even less is known about epigenetic variability across adulthood. The present study assessed methylation levels at OXTR CpG site −934 and plasma OT levels in 22 young (20–31 years, M = 23.6) and 34 older (63–80 years, M = 71.4) participants. Lower levels of OXTR methylation and higher plasma OT levels were associated with less self-reported attachment anxiety in young but not older participants, with largely independent contributions of OXTR methylation and plasma OT levels. In contrast, in the overall sample, lower levels of OXTR methylation were associated with higher self-reported attachment avoidance. Age analysis suggested that these results were largely driven by young adults. Plasma OT levels were unrelated to attachment avoidance. Taken together, these findings support the emerging notion in the literature that epigenetic properties of OXTR, in addition to endogenous OT levels, are related to adult attachment. Further, the age effects observed in the associations between OXTR methylation, plasma OT, and adult attachment emphasize the importance of adopting a developmental perspective when studying properties of the OT system and their relation to affiliative processes. Findings contribute to growing evidence suggesting that epigenetic modification of genes regulating OT pathways and endogenous OT levels are associated with the way people form and maintain intimate social relationships.



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Editorial Board

Publication date: February 2018
Source:International Journal of Psychophysiology, Volume 124





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Nocebo and pseudo-neglect: Paradoxical effects detected with eye-tracking

Publication date: Available online 2 February 2018
Source:International Journal of Psychophysiology
Author(s): Carina Höfler, Andreas Gremsl, Anne Schienle
The knowledge about effects of placebos and nocebos on specific visual attention processes is still very limited. In the present eye-tracking study, it was analyzed if a nocebo (sham transcranial magnetic stimulation) is able to elicit left-sided attentional deficits (pseudo-neglect). Fifty-two healthy participants performed a search task on the computer, once with and once without the nocebo. Indicators of left-biased search behavior (e.g. fixation count, reaction times for left vs. right-sided target detection) and affective state (e.g., valence, arousal) were assessed. The sample was divided into two groups (nocebo responder, non-responder) based on the experienced effectiveness of the nocebo. The nocebo treatment was associated with a positive and calm affective state. Contrary to the verbal suggestion, the nocebo increased the number of fixations and the dwell time on the left side of the computer screen. Moreover, the nocebo decreased the detection time for targets on the left side. These paradoxical nocebo effects were restricted to nocebo responders. Possible implications of nocebo-related compensatory behaviors for neuropsychological therapy are discussed.



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A history of sport-related concussion is associated with sustained deficits in conflict and error monitoring

Publication date: Available online 1 February 2018
Source:International Journal of Psychophysiology
Author(s): Ryan L. Olson, Christopher J. Brush, Peter J. Ehmann, Jennifer F. Buckman, Brandon L. Alderman
Previous research has demonstrated long-term deficits in neurocognitive function in individuals with a history of sport-related concussion. The purpose of this study was to examine the relationship between a history of concussion and behavioral and event-related potential (ERP) indices of pre- and post-response conflict and error monitoring. A secondary aim was to determine whether years of high risk sport participation were related to impairments in these cognitive control processes. Forty-seven former athletes (age = 20.8 ± 2.2 years) with (n = 25; 5 females) and without (n = 22; 9 females) a history of concussion completed a modified flanker task while behavioral performance, N2, error-related negativity (ERN), and error positivity (Pe) components were assessed. An increase in post-response error-related (ERN) brain activity and a nonsignificant trend of increased pre-response conflict (N2) was observed in individuals with a prior sport-related concussion relative to non-concussed controls; however, no behavioral performance differences were found between groups. No significant associations were found between ERP and behavioral measures and the number of years of high-risk sport participation; however, time since last head injury was associated with shorter N2 latency. Together, these findings suggest a persistent impairment in cognitive control and error-related processing in individuals with a history of concussion. These findings are interpreted within the framework of the compensatory error-monitoring hypothesis.



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Comment on: Volume for Muscle Hypertrophy and Health Outcomes: The Most Effective Variable in Resistance Training

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Author’s Reply to Souza et al: Comment on: “Volume for Muscle Hypertrophy and Health Outcomes: The Most Effective Variable in Resistance Training”

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Health-Promoting Behavior and Influencing Factors in Young North Korean Refugees (NKRs) Living in South Korea

Abstract

The number of young North Korean refugees (NKRs) entering South Korea to escape famine and poverty and improve their quality of life is drastically increasing. The aims of this study were to identify and compare health promoting lifestyle behaviors (HPLBs) of young NKRs, compared to South Koreans, and to investigate influencing factors related to HPLBs in young NKRs. Data were obtained from 150 NKRs residing in South Korea and 161 South Koreans. Respondents provided their psychological status (depression, stress, and life satisfaction) and HPLBs. The NKRs reported lower interpersonal relations scores and higher spiritual growth scores compared to the control group. Attendance in religious services, stress, and life satisfaction were significantly associated with HPLBs in young NKRs. Health education and/or promotion programs focusing interpersonal relations and spiritual growth may be beneficial. In addition, regular psychological health screening is proposed as part of health-checkup programs, potentially improving adjustment to South Korean society.

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The Effects of Postprandial Exercise on Glucose Control in Individuals with Type 2 Diabetes: A Systematic Review

Abstract

Background

Regulation of postprandial hyperglycemia is a major concern for individuals with type 2 diabetes. Exercise can reduce postprandial hyperglycemia by increasing contraction-mediated glucose uptake. However, there is no consensus with which to develop guidelines for optimal postprandial exercise timing and prescription.

Objective

The current systematic review was conducted to consolidate the literature surrounding the effects of postprandial exercise on glucose regulation in individuals with type 2 diabetes.

Methods

Electronic databases were searched on 17 February 2017. Inclusion criteria were: (1) trial was a randomized crossover trial; (2) subjects were diagnosed with type 2 diabetes; (3) a standardized meal was given; (4) exercise was initiated within three hours of the meal; (5) subjects were not treated with insulin.

Results

Twelve studies met the inclusion criteria, involving 135 participants (108 males, 20 females, seven unknown). The included studies varied greatly in their timing, duration, intensity, modality, and glucose measures. Postprandial aerobic exercise (11 studies) decreased short-term glucose area under the curve by 3.4–26.6% and 24-h prevalence of hyperglycemia by 11.9–65%. Resistance exercise (two studies) decreased the short-term glucose area under the curve by 30% and 24-h prevalence of hyperglycemia by 35%.

Conclusion

Postprandial exercise may be an effective way to improve glucose control in individuals with type 2 diabetes. The most consistent benefits were seen in long-duration (≥ 45 min), moderate-intensity aerobic exercise. Resistance training also appears to be an effective modality. We recommend that individuals with type 2 diabetes focus on increasing energy expenditure after the largest meal of the day. More research is needed in this area to confirm the results of this systematic review and to provide clinicians with specific exercise recommendations.

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Clinical diagnosis of temporomandibular joint arthritis

Abstract

Background

Evidence-based clinical diagnostic criteria for temporomandibular joint (TMJ) arthritis are not available.

Objective

To establish (i) criteria for clinical diagnosis of TMJ arthritis and (ii) clinical variables useful to determine inflammatory activity in TMJ arthritis using synovial fluid levels of inflammatory mediators as the reference standard.

Methods

A calibrated examiner assessed TMJ pain, function, noise and occlusal changes in 219 TMJs (141 patients, 15 healthy individuals). TMJ synovial fluid samples were obtained with a push-pull technique using the hydroxycobalamin method and analyzed for TNF, TNFsRII, IL-1β, IL-1ra, IL-1sRII, IL-6 and serotonin. If any inflammatory mediator concentration exceeded normal, the TMJ was considered as arthritic.

Results

In the patient group, 71% of the joints were arthritic. Of those, 93% were painful. 66% of the non-arthritic TMJs were painful to some degree.

Intensity of TMJ resting pain and TMJ maximum opening pain, number of jaw movements causing TMJ pain and laterotrusive movement to the contralateral side significantly explained presence of arthritis (AUC 0.72, p<0.001). Based on these findings, criteria for possible, probable and definite TMJ arthritis were determined.

Arthritic TMJs with high inflammatory activity showed higher pain intensity on maximum mouth opening (p<0.001) and higher number of painful mandibular movements (p=0.004) than TMJs with low inflammatory activity.

Conclusion

The combination TMJ pain on maximum mouth opening and Contralateral laterotrusion <8mm appears to have diagnostic value for TMJ arthritis. Among arthritic TMJs, higher TMJ pain intensity on maximum mouth opening and number of mandibular movements causing TMJ pain indicates higher inflammatory activity.

This article is protected by copyright. All rights reserved.

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Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain

Background and Objectives This study is a meta-analysis of randomized controlled trials comparing the efficacy of transcutaneous electrical nerve stimulation (TENS) to a control and to other nerve stimulation therapies (NSTs) for the treatment of chronic back pain. Methods Citations were identified in MEDLINE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov through June 2014 using the following keywords: nerve stimulation therapy, transcutaneous electrical nerve stimulation, back pain, chronic pain. Control treatments included sham, placebo, or medication only. Other NSTs included electroacupuncture, percutaneous electrical nerve stimulation, and percutaneous neuromodulation therapy. Results Twelve randomized controlled trials including 700 patients were included in the analysis. The efficacy of TENS was similar to that of control treatment for providing pain relief (standardized difference in means [SDM] = −0.20; 95% confidence interval [CI], −0.58 to 0.18; P = 0.293). Other types of NSTs were more effective than TENS in providing pain relief (SDM = 0.86; 95% CI, 0.15–1.57; P = 0.017). Transcutaneous electrical nerve stimulation was more effective than control treatment in improving functional disability only in patients with follow-up of less than 6 weeks (SDM = −1.24; 95% CI, −1.83 to −0.65; P

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Commonality of Risk Factors for Mothers’ Poor Oral Health and General Health: Baseline Analysis of a Population-Based Birth Cohort Study

Abstract

Objective The association between and commonality of risk factors for poor self-rated oral health (SROH) and general health (SRGH) among new mothers has not been reported. The purpose of this paper is to assess the commonality of risk factors for poor SROH and SRGH, and self-reported obesity and dental pain, among a population-based sample of new mothers in Australia. It also investigated health conditions affecting new mothers' general health. Methods Data collected at baseline of a population-based birth cohort was used. Mothers of newborns in Adelaide were approached to participate. Mothers completed a questionnaire collecting data on socioeconomic status (SES), health behaviours, dental pain, SROH, self-reported height and weight and SRGH. Analysis was conducted sequentially from bivariate to multivariable regression to estimate prevalence rate (PR) of reporting poor/fair SROH and SRGH. Results of the 1895 new mothers, some 21 and 6% rated their SROH and SRGH as poor/fair respectively. Dental pain was associated with low income and smoking status, while being obese was associated with low SES, low education and infrequent tooth brushing. SROH and SRGH was associated with low SES, smoking, and dental pain. SROH was also associated with SRGH [PR: 3.06 (2.42–3.88)]. Conclusion for practice There was a commonality of factors associated with self-rated oral health and general health. Strong associations between OH and GH were also observed. Given the importance of maternal health for future generations, there would be long-term societal benefit from addressing common risk factors for OH and GH in integrated programs.

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