Σάββατο, 12 Αυγούστου 2017

Liver transplantation for NASH cirrhosis is not performed at the expense of major post-operative morbidity

Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation (LT) and coexists with multiple comorbidities. Obese and cirrhotic patients experience more perioperative complications. Limited data exist about short-term complications after LT for NASH cirrhosis.

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Fibroblast Growth Factor 15 Deficiency Increases Susceptibility but does not Improves Repair to Acetaminophen-induced Liver Injury in Mice

The leading cause of acute liver failure (ALF) is hepatotoxicity from acetaminophen (APAP) overdose. However, limited options are available to treat this ALF so stimulating liver regeneration maybe a potential treatment. Our previous study has shown that fibroblast growth factor 15 (FGF15) plays a crucial role in liver regeneration, but the roles of FGF15 in liver injury and repair following APAP-overdose are unknown. In this study, treatment of FGF15 knockout (KO) male mice with APAP at 200, 250, or 300mg/kg significantly increased the degree of liver injury compared to wild type (WT) mice.

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Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission

Publication date: Available online 12 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Janet K. Freburger, Dongmei Li, Erin P. Fraher
ObjectivesTo determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home.DesignRetrospective cohort analysis of Medicare claims (2010-2013).SettingAcute care hospital and community.ParticipantsPatients hospitalized for stroke who were discharged home and survived the first 30 days (N=23,413; mean [SD] age of 77.6 [7.5] years).InterventionsPhysical and occupational therapist use in the home and/or outpatient setting in the first 30 days after discharge (any use, number of visits, days to first visit).Main Outcome MeasureHospital readmission 30-60 days after discharge. Covariates included demographic characteristics, proxy variables for functional status, hospitalization characteristics, comorbidities, and prior health care use. Multivariate logistic regression analyses were conducted to examine the relationship between therapist use and readmission.ResultsDuring the first 30 days after discharge, 31% of patients saw a therapist in the home, 11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative to patients who had no therapist contact, those who saw an outpatient therapist were less likely to be readmitted to the hospital (odds ratio 0.73 [059-0.90]). While the point estimates did not reach statistical significance, there was some suggestion that the greater the number of therapist visits in the home and the sooner the visits started, the lower the risk of hospital readmission.ConclusionAfter controlling for observable demographic, clinical, and health-related differences, we found that individuals who received outpatient therapy in the first 30 days after discharge home following stroke were less likely to be readmitted to the hospital in the subsequent 30 days, relative to those who received no therapy.



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Safety and Feasibility of Rehabilitation Interventions in Children Undergoing Hematopoietic Stem Cell Transplant with Thrombocytopenia

Publication date: Available online 12 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Katarzyna Ibanez, Noel Espiritu, Regine L. Souverain, Laura Stimler, Lauren Ward, Elyn R. Riedel, Rachel Lehrman, Farid Boulad, Michael Dean Stubblefield
ObjectiveTo analyze the relationship between platelet counts, the intensities of physical therapies (PT) and occupational therapies (OT) services received, and the frequency of bleeding complications in children undergoing hematopoietic stem cell transplants (HSCT) during a period of severe thrombocytopenia.DesignRetrospective review studySettingTertiary care hospitalParticipantsChildren (age <18) hospitalized for HSCT in 2010 and 2011 who received PT and OT services while markedly thrombocytopenic (platelets≤50K/mcL).InterventionsNoneMain Outcome MeasuresIntensities of PT and OT interventions, the patients' platelet counts on specific therapy days and any bleeding events (minor or major) that occurred during or briefly following rehabilitation interventions.ResultsSixty-two patients (accounting for sixty-three HSCTs) met the criteria for analysis. Fifty-six of these patients (fifty-seven HSCTs) underwent PT and/or OT while markedly thrombocytopenic. There was no correlation between the platelet count and the intensity of rehabilitation interventions. There were no major bleeding events. There was no association between minor bleeding and intensities of PT or OT interventions and no association between minor bleeding events and platelet counts. Only 5 minor bleeding events occurred during or following moderate or intensive therapy out of 346 PT and OT sessions (1.5%).ConclusionThe results of our study suggest that bleeding complications during or following mobilization and supervised exercise during PT and OT in children with severe thrombocytopenia undergoing HSCT are minor and relatively rare. These are encouraging results for both patients and rehabilitation specialists treating this population who is at high risk for developing immobility related complications.



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Transfer of tritium into laying hen's meat and eggs at prolonged intake with atmospheric air, water and grass meal

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Zh.А. Baigazinov, S.N. Lukashenko, S.S. Karatayev, А.V. Panitski, А.S. Mamyrbayeva, S.А. Baigazy, T.Ye. Kozhakhanov, L.F. Subbotina
Following a continuous intake of tritium (T) by laying hens' over a 55 day period, an increase of НТО concentration both in eggs and meat was observed over the first 2 weeks for intakes via inhalation and ingestion of water and grass meal. After this time, equilibrium of the T in these products occurred. It was found that when the intake of HTO is from water, air and grass meal, the ratio of its activity concentration in muscular tissue to that in eggs does not exceed 1, 4, and 6 respectively. The ratio of ОBТ concentration to that of НТО in the meat of hens (ОBТ/HTO) when intakes were from water, air and grass meal were 0.08, 0.09 and 0.7, respectively.



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The role of agonist and antagonist muscles in explaining isometric knee extension torque variation with hip joint angle

Abstract

Purpose

The biarticular rectus femoris (RF), operating on the ascending limb of the force–length curve, produces more force at longer lengths. However, experimental studies consistently report higher knee extension torque when supine (longer RF length) compared to seated (shorter RF length). Incomplete activation in the supine position has been proposed as the reason for this discrepancy, but differences in antagonistic co-activation could also be responsible due to altered hamstrings length. We examined the role of agonist and antagonist muscles in explaining the isometric knee extension torque variation with changes in hip joint angle.

Method

Maximum voluntary isometric knee extension torque (joint MVC) was recorded in seated and supine positions from nine healthy males (30.2 ± 7.7 years). Antagonistic torque was estimated using EMG and added to the respective joint MVC (corrected MVC). Submaximal tetanic stimulation quadriceps torque was also recorded.

Result

Joint MVC was not different between supine (245 ± 71.8 Nm) and seated (241 ± 69.8 Nm) positions and neither was corrected MVC (257 ± 77.7 and 267 ± 87.0 Nm, respectively). Antagonistic torque was higher when seated (26 ± 20.4 Nm) than when supine (12 ± 7.4 Nm). Tetanic torque was higher when supine (111 ± 31.9 Nm) than when seated (99 ± 27.5 Nm).

Conclusion

Antagonistic co-activation differences between hip positions do not account for the reduced MVC in the supine position. Rather, reduced voluntary knee extensor muscle activation in that position is the major reason for the lower MVC torque when RF is lengthened (hip extended). These findings can assist standardising muscle function assessment and improving musculoskeletal modelling applications.



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Gene-panel testing of breast and ovarian cancer patients identifies a recurrent RAD51C duplication

ABSTRACT

Gene-panel sequencing allows comprehensive analysis of multiple genes simultaneously and is now routinely used in clinical mutation testing of high-risk breast and ovarian cancer patients. However, only BRCA1 and BRCA2 are often analyzed also for large genomic changes. Here, we have analyzed 10 clinically relevant susceptibility genes in 95 breast or ovarian cancer patients with gene-panel sequencing including also CNV analysis for genomic changes. We identified 12 different pathogenic BRCA1, BRCA2, TP53, PTEN, CHEK2, or RAD51C mutations in 18/95 patients (19%). BRCA1/2 mutations were observed in 8 patients (8.4%) and CHEK2 protein-truncating mutations in 7 patients (7.4%). In addition, we identified a novel duplication encompassing most of the RAD51C gene. We further genotyped the duplication in breast or ovarian cancer families (n = 1149), in unselected breast (n = 1729) and ovarian cancer cohorts (n = 553), and in population controls (n = 1273). Seven additional duplication carries were observed among cases but none among controls. The duplication associated with ovarian cancer risk (3/590 of all ovarian cancer patients, 0.5%, p=0.032 compared to controls) and was found to represent a large fraction of all identified RAD51C mutations in the Finnish population. Our data emphasizes the importance of comprehensive mutation analysis including CNV detection in all the relevant genes.

Thumbnail image of graphical abstract

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Effects of vestibular rehabilitation on gait performance in poststroke patients: a pilot randomized controlled trial

imageThe effects of vestibular rehabilitation on poststroke patients are unknown. This study aimed to investigate whether or not vestibular rehabilitation would improve both the vestibulo–ocular reflex and gait performance of patients with poststroke hemiparesis. Twenty-eight patients with stroke were assigned randomly to either an experimental group (N=14) or a control group (N=14). The experimental group performed the conventional physical therapy for 40 min and vestibular rehabilitation for 20 min, as a 60 min session, during the first 3 weeks and then completed only the conventional intervention for 60 min for the following 3 weeks. The control group performed only the 60 min conventional physical therapy for 6 weeks. Both groups were measured using the gaze stabilization test, the 10 m walking test, the timed up and go test, and the dynamic gait index. Patients were assessed at baseline, and at 3 and 6 weeks. Although the control group showed no significant difference in any outcome measures, the experimental group showed an improvement in gaze stabilization test scoring, which increased significantly after 3 weeks compared with the baseline (P=0.030). The dynamic gait index was also significantly increased after 3 and 6 weeks compared with the baseline (P=0.049 and 0.024, respectively). This study indicated that vestibular rehabilitation might improve poststroke patients' vestibulo–ocular reflex. Moreover, patients might show improved gait performance at least up to 3 weeks after the vestibular intervention by the sensory reweight to coordinate vestibular input.

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Psychometric properties of the Oswestry Disability Index

imageThe aim of this study was to investigate the psychometric properties of the Oswestry Disability Index (ODI) in a large cross-sectional cohort of individuals with chronic low back pain by defining its internal consistency, construct structure and validity, and its ability to differentiate between different degrees of functional limitation. A total of 837 consecutive outpatient patients with low back pain were studied. The internal consistency of ODI was assessed by Cronbach's α, construct structure by exploratory factor analysis, construct validity by confirmatory factor analysis, and discrimination was determined by item response theory analysis. The ODI showed good internal consistency (α=0.85). Explanatory factor analysis showed that ODI is a unidimensional test measuring functional level and nothing else. The confirmatory factor analysis showed that the standardized regression weights of all ODI items were relatively high, varying from 0.5 to 0.7. The item response theory analysis suggested that eight out of 10 ODI items have a close to perfect ability to measure functional limitations in accordance with the actual severity of disability experienced by the respondents. Discrimination of all the items was high to perfect (1.08–2.01). The test characteristic and test information curves showed that the discriminative ability of the ODI is superior at higher levels of disability. The present data showed that the ODI is an internally consistent, unidimensional scale with overall excellent construct validity and ability to discriminate the severity of functional disability. The analysis suggests that the ODI may better distinguish between the relative degrees of function at above-average disability levels.

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Functional effects of treadmill-based gait training at faster speeds in stroke survivors: a prospective, single-group study

imageTo examine the functional effects of walking retraining at faster than self-selected speed (SSS). Ten individuals with chronic stroke participated in a 4-week training over a treadmill at walking speeds 40% faster than SSS, three times per week, 30 min/session. Outcome measures assessed before, after, and 2 months after the end of intervention were the Timed Up and Go, the 6-Minute Walk, the 10-Meter Walk test, the Modified Ashworth Scale, SSS, and fastest comfortable speed. After 4 weeks of training, all outcome measures showed clinically meaningful and statistically significant improvements (P

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Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up

imageThe aim of this study was to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) on the phantom limb pain (PLP) of patients with amputations within a 24-month follow-up. This study was a randomized-controlled trial. A total of 60 patients with amputations were selected by a purposive sampling and patients were divided randomly into two experimental and control groups. Samples were assigned through randomized allocation. EMDR therapy was administered individually to the experimental group participants in 12 one-hour sessions over a 1-month period In each session, the patient completed the Subjective Units of Distress Scale and a pain-rating scale before and after the intervention. Follow-up measures were obtained 24 months later for the experimental group. The participants in the control group were measured on the two scales at an initial session and again after 1- and 24-month follow-up. The mean PLP decreased in the experimental group between the first and last sessions and remained so at a 24-month follow-up. No decrease occurred for the control group over the 1- and 24-month period. The differences were statistically significant (P

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Crouch gait can be an effective form of forced-use/no constraint exercise for the paretic lower limb in stroke

imageIn hemiplegic gait the paretic lower limb provides less muscle power and shows a briefer stance compared with the unaffected limb. Yet, a longer stance and a higher power can be obtained from the paretic lower limb if gait speed is increased. This supports the existence of a 'learned non-use' phenomenon, similar to that underlying some asymmetric impairments of the motion of the eyes and of the upper limbs. Crouch gait (CG) (bent-hip bent-knee, about 30° minimum knee flexion) might be an effective form of 'forced-use' treatment of the paretic lower limb. It is not known whether it also stimulates a more symmetric muscle power output. Gait analysis on a force treadmill was carried out in 12 healthy adults and seven hemiplegic patients (1–127 months after stroke, median: 1.6). Speed was imposed at 0.3 m/s. Step length and single and double stance times, sagittal joint rotations, peak positive power, and work in extension of the hip, knee, and ankle (plantar flexion), and surface electromyography (sEMG) area from extensor muscles during the generation of power were measured on either side during both erect and crouch walking. Significance was set at P less than 0.05; corrections for multiplicity were applied. Patients, compared with healthy controls, adopted in both gait modalities and on both sides a shorter step length (61–84%) as well as a shorter stance (76–90%) and swing (63–83%) time. As a rule, they also provided a higher muscular work (median: 137%, range: 77–250%) paralleled by a greater sEMG area (median: 174%, range: 75–185%). In erect gait, the generation of peak extensor power across hip, knee, and ankle joints was in general lower (83–90%) from the paretic limb and higher (98–165%) from the unaffected limb compared with control values. In CG, peak power generation across the three lower limb joints was invariably higher in hemiparetic patients: 107–177% from the paretic limb and 114–231% from the unaffected limb. When gait shifted from erect to crouch, only for hemiplegic patients, at the hip, the paretic/unaffected ratio increased significantly. For peak power, work, sEMG area, and joint rotation, the paretic/unaffected ratio increased from 55 to 85%, 56 to 72%, 68 to 91%, and 67 to 93%, respectively. CG appears to be an effective form of forced-use exercise eliciting more power and work from the paretic lower limb muscles sustained by a greater neural drive. It also seems effective in forcing a more symmetric power and work from the hip extensor muscles, but neither from the knee nor the ankle.

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Improved oxygen uptake efficiency slope in acute myocardial infarction patients after early phase I cardiac rehabilitation

imageA predischarge submaximal exercise test is often recommended after acute myocardial infarction (AMI) as part of phase I cardiac rehabilitation. In this study, a submaximal exercise parameter, oxygen uptake efficiency slope (OUES), was used to monitor the benefit of early mobilization within 48 h after AMI. An early mobilization protocol within 48 h after AMI has been initiated since 1 September 2012 in our center. Patients with onset time of AMI within 1 year before and 1 year after initiation of the early mobilization protocol were recruited for comparisons. Sixty patients were analyzed on the basis of this criterion, and were subjected to predischarge submaximal exercise tests. The OUES calculated with 100% exercise duration (OUES100) and calculated with the first 50% of exercise duration (OUES50) were obtained and analyzed. Both OUES100 and OUES50 of the AMI patients with early mobilization were significantly higher than those without early mobilization (P=0.025 and 0.007, respectively). The OUES100 and OUES50 were also highly correlated (r=0.891, P

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Effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation: a meta-analysis of randomized-controlled trials

imageExercise training has become part of the standard care for patients with cardiovascular disease. We investigated the effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation (AF). We searched for randomized-controlled trials of supervised exercise training versus care without exercise training (the control) in patients with permanent or nonpermanent AF published up to November 2016. Standard mean differences (SMD) or mean differences (MD), and 95% confidence intervals (CIs) were calculated using random-effect models. We identified 259 trials, and after an assessment of relevance, five trials with a combined total of 379 participants were analyzed. In AF patients, exercise training significantly improved exercise capacity and left ventricular ejection fraction compared with the control (SMD: 0.91, 95% CI: 0.70 to 1.12; MD: 4.8%, 95% CIs: 1.56 to 8.03, respectively). Compared with the control, exercise training also significantly reduced BMI (MD: −0.47 kg/m2, 95% CIs: −0.89 to −0.06) and significantly improved scores in the 'general health' and 'vitality' sections of the 36-item Short Form Health Status Survey (SMD: 0.71, 95% CIs: 0.30 to 1.12; SMD: 0.81, 95% CIs: 0.40 to 1.23, respectively). Exercise training improved exercise capacity, left ventricular ejection fraction, and some the 36-item Short Form Health Status Survey scores, and reduced BMI in AF patients.

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Acceptance in chronic neck pain: associations with disability and fear avoidance beliefs

imageChronic neck pain can result in significant levels of disability. Physiotherapy treatments often aim to modify cognitive factors and this approach benefits some, but not all, patients. Research from other pain conditions suggests that acceptance may be related to disability; however, it is unclear whether these associations exist in patients with neck pain. Moreover, it is unclear to what extent other cognitive factors are related to acceptance. Feasibly, if these factors are related, existing treatments may already be indirectly modifying acceptance. The aim of this study was therefore to establish the associations between acceptance and disability, and between acceptance and other cognitive factors. Cross-sectional data were collected from 149 patients and regression analyses were carried out. In the first analysis, disability was the dependent variable and the proportion of variance explained by two acceptance subscales (activities engagement and pain willingness) was calculated. In the second analyses, the acceptance subscales were the dependent variables. Measures of pain-related fear, catastrophizing and pain vigilance and awareness were entered as explanatory variables and the proportion of variance explained was calculated. In the first analysis, acceptance explained 18% of variance in disability (P

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Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients

imageTo study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman's correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79–0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

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Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study

imageThe aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants' ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA.

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Fatigue and physical fitness of mildly disabled persons with multiple sclerosis: a cross-sectional study

imageFatigue is frequent and disabling in persons with multiple sclerosis (pwMS) with mild neurological disability. These patients also have impaired physical fitness. Whether mildly disabled pwMS are deconditioned, and this deconditioning is linked to fatigue, remains unknown. Our aim is to determine the physical fitness of mildly disabled patients with multiple sclerosis and study its relationship with perceived fatigue and to link perceived fatigue with other parameters. Twenty patients (14 women; mean age: 45.5 years) with mild disability (Expanded Disability Status Scale 0–4) underwent a 2-min walking test, Timed Up-and-Go test, aerobic capacity testing, and isometric knee extension testing to assess strength and neuromuscular fatigability. They completed questionnaires assessing perceived fatigue, psychological status, and physical activity. Correlation coefficients and multivariate regression were used to analyze the relationships among variables. Seventeen (85%) patients reported a high level of fatigue. Thirteen (65%) patients had subnormal aerobic capacity. Fatigue was weakly to moderately associated with aerobic capacity, mobility, walking capacity, depression, and neuromuscular fatigability. An association of disease duration, aerobic capacity, and the neuromuscular fatigability index explained 65.1% of fatigue. A high proportion of pwMS with mild neurological disability are fatigued and deconditioned. Perceived fatigue is linked to aerobic capacity, neuromuscular fatigability, depression, mobility, and walking capacity. Focusing on these parameters could help in the management of fatigue.

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Rasch validation and comparison of Slovenian, Croatian, and Italian versions of the Mini-BESTest in patients with subacute stroke

imageWe aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get Up & Go; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability–item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.

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The concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis

imageThis study aims to investigate the concurrent validity and intrarater reliability of the Microsoft Kinect to measure thoracic kyphosis against the Flexicurve. Thirty-three healthy individuals (age: 31±11.0 years, men: 17, height: 170.2±8.2 cm, weight: 64.2±12.0 kg) participated, with 29 re-examined for intrarater reliability 1–7 days later. Thoracic kyphosis was measured using the Flexicurve and the Microsoft Kinect consecutively in both standing and sitting positions. Both the kyphosis index and angle were calculated. The Microsoft Kinect showed excellent concurrent validity (intraclass correlation coefficient=0.76–0.82) and reliability (intraclass correlation coefficient=0.81–0.98) for measuring thoracic kyphosis (angle and index) in both standing and sitting postures. This study is the first to show that the Microsoft Kinect has excellent validity and intrarater reliability to measure thoracic kyphosis, which is promising for its use in the clinical setting.

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Aerobic interval training reduces vascular resistances during submaximal exercise in obese metabolic syndrome individuals

Abstract

Purpose

The aim of this study was to determine the effects of high-intensity aerobic interval training (AIT) on exercise hemodynamics in metabolic syndrome (MetS) volunteers.

Methods

Thirty-eight, MetS participants were randomly assigned to a training (TRAIN) or to a non-training control (CONT) group. TRAIN consisted of stationary interval cycling alternating bouts at 70–90% of maximal heart rate during 45 min day−1 for 6 months.

Results

CONT maintained baseline physical activity and no changes in cardiovascular function or MetS factors were detected. In contrast, TRAIN increased cardiorespiratory fitness (14% in VO2PEAK; 95% CI 9–18%) and improved metabolic syndrome (−42% in Z score; 95% CI 83–1%). After TRAIN, the workload that elicited a VO2 of 1500 ml min−1 increased 15% (95% CI 5–25%; P < 0.001). After TRAIN when subjects pedaled at an identical submaximal rate of oxygen consumption, cardiac output increased by 8% (95% CI 4–11%; P < 0.01) and stroke volume by 10% (95% CI, 6–14%; P < 0.005) being above the CONT group values at that time point. TRAIN reduced submaximal exercise heart rate (109 ± 15–106 ± 13 beats min−1; P < 0.05), diastolic blood pressure (83 ± 8–75 ± 8 mmHg; P < 0.001) and systemic vascular resistances (P < 0.01) below CONT values. Double product was reduced only after TRAIN (18.2 ± 3.2–17.4 ± 2.4 bt min−1 mmHg 10−3; P < 0.05).

Conclusions

The data suggest that intense aerobic interval training improves hemodynamics during submaximal exercise in MetS patients. Specifically, it reduces diastolic blood pressure, systemic vascular resistances, and the double product. The reduction in double product, suggests decreased myocardial oxygen demands which could prevent the occurrence of adverse cardiovascular events during exercise in this population.

Clinicaltrials.gov identifier

NCT03019796.



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The role of satellite cells in activity-induced adaptations: breathing new life into the debate

Abstract

Satellite cells are myogenic stem cells responsible for muscle regeneration throughout the lifespan.

This article is protected by copyright. All rights reserved



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Reply from Mike Tipton, Joseph Costello and Julian Paton

Abstract

We would like to thank Andrea Nicolò, Michele Girardi and Massimo Sacchetti for their letter to the editor of The Journal of Physiology concerning our recent review (Tipton et al. 2017).

This article is protected by copyright. All rights reserved



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Adenosine and dopamine oppositely modulate a hyperpolarization activated current Ih in chemosensory neurons of the rat carotid body in co-culture

Abstract

Adenosine and dopamine (DA) act as neurotransmitters or neuromodulators at the carotid body (CB) chemosensory synapse, however, their mechanisms of action are not fully understood. Using a functional co-culture model of rat CB chemoreceptor (type I) cell clusters and juxtaposed afferent petrosal neurons (PNs), we tested the hypothesis that adenosine and DA act postsynaptically to modulate a hyperpolarization-activated, cyclic nucleotide-gated (HCN) cation current (Ih). In whole-cell recordings from hypoxia-responsive PNs, cAMP mimetics enhanced Ih whereas the HCN blocker ZD7288 (2 μm) reversibly inhibited Ih. Adenosine caused a potentiation of Ih (EC50 ∼ 35 nm) that was sensitive to the A2a blocker SCH58261 (5 nm), and an ∼16 mV depolarizing shift in V1/2 for voltage dependence of Ih activation. By contrast, DA (10 μm) caused an inhibition of Ih that was sensitive to the D2 blocker sulpiride (1–10 μm), and an ∼11 mV hyperpolarizing shift in V1/2. Sulpiride potentiated Ih in neurons adjacent to, but not distant from, type I cell clusters. DA also decreased PN action potential frequency whereas adenosine had the opposite effect. During simultaneous paired recordings, SCH58261 inhibited both the presynaptic hypoxia-induced receptor potential in type I cells and the postsynaptic PN response. By contrast, SCH58261 inhibited only the postsynaptic PN response induced by isohydric hypercapnia. Confocal immunofluorescence confirmed the localization HCN4 subunits in tyrosine hydroxylase-positive chemoafferent neurons in tissue sections of rat petrosal ganglia. These data suggest that adenosine and dopamine, acting through A2a and D2 receptors respectively, regulate PN excitability via their opposing actions on Ih.

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Changes in pulmonary vascular responsiveness to hypoxia

Abstract

We read with interest the recent article by Luks et al. (2017), which reports the relationship between arterial oxygen saturation and an echocardiographic index of pulmonary artery pressure (tricuspid transvalvular pressure gradient, TVPG) in healthy volunteers at sea level and after undertaking a two-week trek to Everest base camp.

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The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery.

Background: Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia. Methods: Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 [mu]g of fentanyl, and 100 [mu]g of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups. Results: No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68). Conclusions: In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Psoas Versus Femoral Blocks: A Registry Analysis of Risks and Benefits.

Background and Objectives: Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections. Methods: We extracted 22,434 surgical cases from the German Network for Regional Anesthesia registry (2007-2014) and grouped cases as psoas (n = 7593) and femoral (n = 14,841) blocks. Insertion-related complications (including single-shot blocks and catheter) and infectious complications (including only catheter) in each group were compared with [chi]2 tests. The groups were compared with multivariable logistic models, adjusted for potential confounding factors. Results: After adjustment for potential confounding factors, psoas blocks were associated with more complications than femoral blocks including vascular puncture 6.3% versus 1.1%, with an adjusted odds ratio (aOR) of 3.6 (95% confidence interval [CI], 2.9-4.6; P

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Liver transplantation for NASH cirrhosis is not performed at the expense of major post-operative morbidity

Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation (LT) and coexists with multiple comorbidities. Obese and cirrhotic patients experience more perioperative complications. Limited data exist about short-term complications after LT for NASH cirrhosis.

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Fibroblast Growth Factor 15 Deficiency Increases Susceptibility but does not Improves Repair to Acetaminophen-induced Liver Injury in Mice

The leading cause of acute liver failure (ALF) is hepatotoxicity from acetaminophen (APAP) overdose. However, limited options are available to treat this ALF so stimulating liver regeneration maybe a potential treatment. Our previous study has shown that fibroblast growth factor 15 (FGF15) plays a crucial role in liver regeneration, but the roles of FGF15 in liver injury and repair following APAP-overdose are unknown. In this study, treatment of FGF15 knockout (KO) male mice with APAP at 200, 250, or 300mg/kg significantly increased the degree of liver injury compared to wild type (WT) mice.

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Activity Demands During Multi-Directional Team Sports: A Systematic Review

Abstract

Background

Late-stage rehabilitation programs often incorporate 'sport-specific' demands, but may not optimally simulate the in-game volume or intensity of such activities as sprinting, cutting, jumping, and lateral movement.

Objective

The aim of this review was to characterize, quantify, and compare straight-line running and multi-directional demands during sport competition.

Data Sources

A systematic review of PubMed, CINAHL, SPORTDiscus, and Cochrane Central Register of Controlled Trials databases was conducted.

Study Eligibility Criteria

Studies that reported time-motion analysis data on straight-line running, accelerations/decelerations, activity changes, jumping, cutting, or lateral movement over the course of an entire competition in a multi-directional sport (soccer, basketball, lacrosse, handball, field hockey, futsal, volleyball) were included.

Study Appraisal and Synthesis Methods

Data was organized based on sport, age level, and sex and descriptive statistics of the frequency, intensity, time, and volume of the characteristics of running and multi-directional demands were extracted from each study.

Results

Eighty-one studies were included in the review (n = 47 soccer, n = 11 basketball, n = 9 handball, n = 7 field hockey, n = 3 futsal, n = 4 volleyball). Variability of sport demand data was found across sports, sexes, and age levels. Specifically, soccer and field hockey demanded the most volume of running, while basketball required the highest ratio of high-intensity running to sprinting. Athletes change activity between 500 and 3000 times over the course of a competition, or once every 2–4 s. Studies of soccer reported the most frequent cutting (up to 800 per game), while studies of basketball reported the highest frequency of lateral movement (up to 450 per game). Basketball (42–56 per game), handball (up to 90 per game), and volleyball (up to 35 per game) were found to require the most jumping.

Limitations

These data may provide an incomplete view of an athlete's straight-line running load, considering that only competition and not practice data was provided.

Conclusions

Considerable variability exists in the demands of straight-line running and multi-directional demands across sports, competition levels, and sexes, indicating the need for sports medicine clinicians to design future rehabilitation programs with improved specificity (including the type of activity and dosage) to these demands.



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