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European Spine Journal : Official... Jun 2024The purpose of the present study was to investigate the association between quantitatively assessed trunk extensor strength and gait-induced back pain (GIBP) in patients...
PURPOSE
The purpose of the present study was to investigate the association between quantitatively assessed trunk extensor strength and gait-induced back pain (GIBP) in patients with adult spinal deformity (ASD).
METHODS
Ninety-five patients with ASD aged ≥ 50 years who were admitted to our hospital between April 2018 and March 2023 were included in the study. GIBP was evaluated through a 6-minute walking test (6MWT), with GIBP being defined as the occurrence of back pain during the evaluation and inability to complete the test. The patients were divided into three groups: difficulty completing the 6MWT (Group 1), ability to complete the 6MWT with breaks (Group 2), and ability to complete the 6MWT without taking a break (Group 3). The main independent variable was trunk extensor strength, which was measured using a hand-held dynamometer. Ordered logistic regression analysis was conducted to assess the association between GIBP and trunk extensor strength while adjusting for basic characteristics and radiographic parameters as covariates.
RESULTS
The numbers of patients with ASD included in each group were; 27 in Group 1 (28.4%), 31 in Group 2 (32.6%), and 37 in Group 3 (39.0%). An ordered logistic regression analysis adjusted for basic characteristics and radiographic parameters, trunk extensor strength was significantly associated with GIBP (odds ratios, 1.128; 95% confidence intervals, 1.025-1.242).
CONCLUSIONS
The results of the present study strongly indicate that trunk extensor strength is a valuable factor associated with GIBP in patients with ASD.
PubMed: 38844588
DOI: 10.1007/s00586-024-08348-w -
Neurological Sciences : Official... Jun 2024To systematically review and conduct a meta-analysis to evaluate the safety and efficacy of the unilateral focused ultrasound (FUS) pallidotomy on motor complications in... (Review)
Review
To systematically review and conduct a meta-analysis to evaluate the safety and efficacy of the unilateral focused ultrasound (FUS) pallidotomy on motor complications in Parkinson's disease (PD) patients. A comprehensive search strategy was implemented through August 15, 2023, and updated on February 13, 2024, across six databases, identifying studies relevant to unilateral focused ultrasound pallidotomy and PD. Eligibility criteria included observational studies, clinical trials, and case series reporting on the impact of the intervention on motor complications in PD patients. The screening and data extraction were done by two independent reviewers. Risk of bias assessment utilized appropriate tools for different study designs. Statistical analysis involved narrative synthesis and meta-analysis. Subgroup analyses and leave-one-out analyses were performed. Five studies were included in our study, involving 112 PD patients undergoing FUS pallidotomy. UPDRS-II analysis revealed a significant improvement from baseline (mean difference (MD): -3.205, 95% CI: -4.501, -1.909, P < 0.001). UPDRS-III overall change was significant (MD: -10.177, 95% CI: [-12.748, -7.606], P < 0.001). UPDRS-IV showed a significant change from baseline (MD: -5.069, 95% CI: [-5.915, -4.224], P < 0.001). UDysRS demonstrated a significant overall improvement (MD: -18.895, 95% CI: [-26.973, -10.818], P < 0.001). The effect of FUS pallidotomy on motor complications in PD patients was effective, with a significant decrease in the UPDRS and UDysRS, reflecting improvement. The incidence of adverse events (headaches, pin-site pain, difficulty walking, and sonication-related head pain) of the FUS pallidotomy was not statistically significant, indicating its safety.
PubMed: 38842771
DOI: 10.1007/s10072-024-07617-2 -
JMIR Aging Jun 2024Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to... (Comparative Study)
Comparative Study Randomized Controlled Trial
Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study.
BACKGROUND
Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity.
OBJECTIVE
This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities.
METHODS
A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants' cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large).
RESULTS
Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity.
CONCLUSIONS
ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents.
Topics: Humans; Accelerometry; Male; Female; Cross-Sectional Studies; Walking; Aged, 80 and over; Cognition; Aged; Homes for the Aged
PubMed: 38842168
DOI: 10.2196/53020 -
Arthroscopy Techniques May 2024Checkrein deformity is rare and involves entrapment or fixed tethering of the flexor hallucis longus (FHL) in the posterior foot, just proximal to the flexor retinaculum...
Checkrein deformity is rare and involves entrapment or fixed tethering of the flexor hallucis longus (FHL) in the posterior foot, just proximal to the flexor retinaculum of the ankle, and causes the "constant length phenomenon" of FHL. The clinical presentation is a dynamic flexion deformity of the great toe characterized by flexion contracture of the interphalangeal joint with mild extension contracture of the metatarsophalangeal joint, causing difficulty in walking since in the stance phase of gait, the hallux is forced into plantar flexion and impinges onto the ground. Because the FHL tendon has some interconnection to the tendons of the flexor digitorum longus at the master knot of Henry, deformities of the second and third toes are sometimes seen. There is no standard surgical treatment for checkrein deformity. Surgical release of the FHL muscle or release/lengthening of the FHL tendon has been proposed. The purpose of this Technical Note is to report the endoscopic release of the FHL tendon at the posterior ankle for management of checkrein deformity of the great toe, second toe, and third toe.
PubMed: 38835445
DOI: 10.1016/j.eats.2024.102936 -
Frontiers in Oncology 2024Acute promyelocytic leukemia (APL) is rarely caused by the fusion gene. While APL patients with fusion commonly exhibit diverse hematologic symptoms, the presentation...
BACKGROUND
Acute promyelocytic leukemia (APL) is rarely caused by the fusion gene. While APL patients with fusion commonly exhibit diverse hematologic symptoms, the presentation of myeloid sarcoma (MS) as an initial manifestation is infrequent.
CASE PRESENTATION
A 61-year-old patient was referred to our hospital with 6-month history of low back pain and difficulty walking. Before this admission, spine magnetic resonance imaging (MRI) conducted at another hospital revealed multiple abnormal signals in the left iliac bone and vertebral bodies spanning the thoracic (T11-T12), lumbar (L1-L4), and sacral (S1/S3) regions. This led to a provisional diagnosis of bone tumors with an unknown cause. On admission, complete blood count (CBC) test and peripheral blood smear revealed a slightly increased counts of monocytes. Immunohistochemical staining of both spinal and bone marrow (BM) biopsy revealed positive expression for CD117, myeloperoxidase (MPO), and lysozyme. BM aspirate showed a significant elevation in the percentage of promyelocytes (21%), which were morphologically characterized by round nuclei and hypergranular cytoplasm. Multiparameter flow cytometry of BM aspirate revealed that blasts were positive for CD13, CD33, CD117, and MPO. Through the integrated application of chromosome analysis, fluorescence hybridization (FISH), reverse transcriptase polymerase chain reaction (RT-PCR), and Sanger sequencing, it was determined that the patient possessed a normal karyotype and a rare cryptic fusion gene, confirming the diagnosis of APL.
CONCLUSION
In the present study, we report the clinical features and outcome of a rare APL patient characterized by a cryptic fusion and spinal myeloid sarcoma (MS) as the initial presenting symptom. Our study not only offers valuable insights into the heterogeneity of APL clinical manifestations but also emphasizes the crucial need to promptly consider the potential link between APL and MS for ensuring a timely diagnosis and personalized treatments.
PubMed: 38835381
DOI: 10.3389/fonc.2024.1375737 -
Gait & Posture Jun 2024Older adults have difficulty maintaining side-to-side balance while navigating daily environments. Losing balance in such circumstances can lead to falls. We need to...
BACKGROUND
Older adults have difficulty maintaining side-to-side balance while navigating daily environments. Losing balance in such circumstances can lead to falls. We need to better understand how older adults adapt lateral balance to navigate environment-imposed task constraints.
RESEARCH QUESTION
How do older adults adjust mediolateral balance while walking along continually-narrowing paths, and what are the stability implications of these adjustments?
METHODS
Eighteen older (71.6±6.0 years) and twenty younger (21.7±2.6 years) healthy adults traversed 25 m-long paths that gradually narrowed from 45 cm to 5 cm. Participants switched onto an adjacent path when they chose. We quantified participants' lateral center-of-mass dynamics and lateral Margins of Stability (MoS) as paths narrowed. We quantified lateral Probability of Instability (PoI) as the probability that participants would take a laterally unstable (MoS<0) step as they walked. We also extracted these outcomes where participants switched paths.
RESULTS
As paths narrowed, all participants exhibited progressively smaller average MoS and increasingly larger PoI. However, their MoS variability was largest at both the narrowest and widest path sections. Older adults exhibited consistently both larger average and more variable MoS across path widths. Taken into account together, these resulted in either comparable or somewhat larger PoI as paths narrowed. Older adults left the narrowing paths sooner, on average, than younger. As they did so, older adults exhibited significantly larger average and more variable MoS, but somewhat smaller PoI than younger.
SIGNIFICANCE
Our results directly challenge the predominant interpretation that larger average MoS indicate "greater stability", which we argue is inconsistent with the principles underlying its derivation. In contrast, analyzing step-to-step gait dynamics, together with estimating PoI allows one to properly quantify instability risk. Furthermore, the adaptive strategies uncovered using these methods suggest potential targets for future interventions to reduce falls in older adults.
PubMed: 38833762
DOI: 10.1016/j.gaitpost.2024.05.028 -
Journal of the American Medical... Jun 2024To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests...
OBJECTIVES
To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests for community-dwelling older adults.
DESIGN
A prospective cohort study was performed, tracking health outcomes for a year.
SETTING AND PARTICIPANTS
The 3-m gait speed test at usual and fast pace was administered to community-dwelling older adults over Zoom.
METHOD
To examine acceptability, participants completed questionnaires regarding telehealth usability and experience. Virtual gait speed tests were administered at baseline and 24 to 72 hours later to evaluate reliability. Self-report mobility measures were used to examine convergent and known-groups validity. Participants' health outcomes were tracked for a year to evaluate predictive validity.
RESULTS
Sixty participants completed the baseline assessment and 52 completed the second assessment. Participants reported an overall positive experience with the test. Intraclass correlation coefficients for reliability ranged from 0.79 to 0.90. For convergent validity, correlations >0.30 were found predominantly for usual gait speed with self-report mobility measures. Both the usual- and fast-gait speed were able to discriminate between difficulty walking and gait aid use. Usual gait speed was able to predict specialist and family doctor visits and fast gait speed was able to predict rehabilitation specialist visits over 1 year.
CONCLUSIONS AND IMPLICATIONS
Our findings demonstrate support for the acceptability, reliability, and validity of virtually administered gait speed tests for community-dwelling older adults. Although future studies are needed to examine the validity of virtual gait speed tests in larger and more diverse samples to improve generalizability of results, clinicians and researchers can virtually administer 3-m gait speed tests with confidence that scores are trustworthy and reflect older adults' mobility.
PubMed: 38830594
DOI: 10.1016/j.jamda.2024.105048 -
International Journal of Surgery Case... Jul 2024Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal...
INTRODUCTION
Avulsion fractures of the calcaneal tuberosity with significant displacement can cause soft tissue complications in the heel. However, a treatment strategy for calcaneal tuberosity fractures with poor heel-skin condition is yet to be established. Here, we report a case involving avulsion fracture of the calcaneal tuberosity presenting with superficial skin necrosis that was treated with a plate lacking the anterior component and screws inserted percutaneously.
PRESENTATION OF CASE
A 74-year-old woman presented with progressive right heel pain following an injury to her heel sustained approximately six weeks previously. She had experienced difficulty walking due to heel pain and superficial necrosis was observed on the posterior surface of the heel. Radiography and computed tomography revealed an avulsion fracture of the calcaneal tuberosity with superior displacement. Open reduction was performed using a lateral L-shaped incision. After inserting two cancellous screws percutaneously into the calcaneal tuberosity, we fixed a plate lacking the anterior component to the lateral surface of the calcaneus. The superficial necrosis healed gradually post-operatively. Bone union was confirmed using radiography six months post-operatively.
DISCUSSION
We developed a novel surgical procedure to treat avulsion fractures of the calcaneal tuberosity with poor skin condition. The combination of a plate lacking the anterior component and the percutaneous insertion of canulated cancellous screws can reduce the risk of post-operative soft tissue complications while maintaining fixation of the fractured fragment.
CONCLUSION
Our findings provide a novel surgical method for the treatment of avulsion fractures of the calcaneal tuberosity with soft tissue complications.
PubMed: 38830333
DOI: 10.1016/j.ijscr.2024.109848 -
Sultan Qaboos University Medical Journal May 2024This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index...
OBJECTIVES
This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI).
METHODS
This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI.
RESULTS
A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI.
CONCLUSION
Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.
Topics: Humans; Male; Female; Adult; Retrospective Studies; Tunisia; Middle Aged; Severity of Illness Index; Spondylarthritis; Spondylitis, Ankylosing; Disease Progression
PubMed: 38828242
DOI: 10.18295/squmj.3.2024.023 -
Advanced Materials (Deerfield Beach,... Jun 2024Van der Waals (vdW) integration enables clean contacts for low-dimensional electronic devices. The limitation remains, however, that an additional tunneling contact...
Van der Waals (vdW) integration enables clean contacts for low-dimensional electronic devices. The limitation remains, however, that an additional tunneling contact resistance occurs, owing to the inherent vdW gap between the metal and the semiconductor. Here we demonstrate from theoretical calculations that stronger non-covalent hydrogen-bonding interactions facilitate electron tunneling and significantly reduce the contact resistance, thus promising to break the limitations of the vdW contact. π-Plane hydrogen-bonding contacts in surface-engineered MXene/carbon nanotube metal/semiconductor heterojunctions are realized, and an anomalous temperature-dependent tunneling resistance is observed. Low-dimensional flexible thin-film transistors integrated by hydrogen-bonding contacts exhibit both excellent flexibility and carrier mobility orders of magnitude higher than their counterparts with vdW contacts. Our strategy demonstrates a scalable solution for realizing high-performance and low-power flexible electronics beyond vdW contacts. This article is protected by copyright. All rights reserved.
PubMed: 38825781
DOI: 10.1002/adma.202404626