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Clinics (Sao Paulo, Brazil) May 2024An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as...
INTRODUCTION
An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as Computerized Dynamic Posturography (CDP) are not feasible for the clinical setting. Therefore, the present study's aim was to assess the correlation between the clinical Balance Evaluation Systems Test (BESTest) and CDP.
METHODS
20 male older adults with Parkinson's Disease (PD) were included in this study. Participants first executed the Sit-To-Stand (STS), Step/Quick turn (SQT), and Step Up and Over (SUO) tests on a Balance Master® force platform, followed by a clinical balance evaluation using the BESTest.
RESULTS
Four outcomes of the CDP were negatively correlated with one or more BESTest domains or total BESTest score: STS sway velocity was negatively correlated with the anticipatory postural adjustment (p = 0.02) and sensory orientation (p = 0.01) domains. SQT turn time was negatively correlated with biomechanical restriction (for turns to the left, p = 0.01, and right, p = 0.03, respectively), postural response (p = 0.01, p = 0.01), dynamic balance during gait (p = 0.007, p = 0.001), and total score (p = 0.02, p = 0.01). Step over time to the right in SUP was negatively correlated with the limits of the stability domain (p = 0.002) and total BESTest score (p = 0.020). SUO impact index was negatively correlated with the anticipatory postural adjustment domain (p = 0.01).
CONCLUSION
This study shows that several BESTest domains are significantly correlated with CDP outcomes, demonstrating that the BESTest can be used as a more clinically feasible alternative for computerized posturography, without loss of information.
PubMed: 38759438
DOI: 10.1016/j.clinsp.2024.100382 -
PloS One 2024The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload...
The effect of calcaneus and metatarsal head offloading insoles on healthy subjects' gait kinematics, kinetics, asymmetry, and the implications for plantar pressure management: A pilot study.
BACKGROUND
The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload high-risk ulcerative regions on the foot, by removing insole material, are the main contemporary conservative treatment to maintain mobility and reduce the likelihood of ulceration. However, their effect on the rest of the foot and relationship with key gait propulsive and balance kinematics and kinetics has not been well researched.
PURPOSE
The aim of this study is to investigate the effect of offloading insoles on gait kinematics, kinetics, and plantar pressure throughout the gait cycle.
METHODS
10 healthy subjects were recruited for this experiment to walk in 6 different insole conditions. Subjects walked at three speeds on a treadmill for 10 minutes while both plantar pressure and gait kinematics, kinetics were measured using an in-shoe pressure measurement insole and motion capture system/force plates. Average peak plantar pressure, pressure time integrals, gait kinematics and centre of force were analysed.
RESULTS
The average peak plantar pressure and pressure time integrals changed by -30% (-68% to 3%) and -36% (-75% to -1%) at the region of interest when applying offloading insoles, whereas the heel strike and toe-off velocity changed by 15% (-6% to 32%) and 12% (-2% to 19%) whilst walking at three speeds.
CONCLUSION
The study found that offloading insoles reduced plantar pressure in the region of interest with loading transferred to surrounding regions increasing the risk of higher pressure time integrals in these locations. Heel strike and toe-off velocities were increased under certain configurations of offloading insoles which may explain the higher plantar pressures and supporting the potential of integrating kinematic gait variables within a more optimal therapeutic approach. However, there was inter-individual variability in responses for all variables measured supporting individualised prescription.
Topics: Humans; Gait; Biomechanical Phenomena; Pilot Projects; Male; Pressure; Female; Adult; Foot Orthoses; Calcaneus; Healthy Volunteers; Shoes; Kinetics; Walking; Metatarsus; Foot
PubMed: 38758937
DOI: 10.1371/journal.pone.0303826 -
Alternative Therapies in Health and... May 2024Hepatobiliary disease requires surgical treatment and T-tube installment postoperatively, and discharged patients' usually still have a T tube. Little nursing care is...
CONTEXT
Hepatobiliary disease requires surgical treatment and T-tube installment postoperatively, and discharged patients' usually still have a T tube. Little nursing care is available in China for patients after discharge, resulting in postdischarge complications. Also, the incidence of nutritional risk in patients with hepatobiliary surgery is high.
OBJECTIVE
The study aimed to investigate the benefits of a precede-proceed model-dominant nursing combined with nutritional support for patients discharged after hepatobiliary surgery with a T tube, so as to improve their prognoses and promote their rehabilitation.
DESIGN
The research team conducted a prospective, single-center, randomized controlled trial.
SETTING
The study took place at Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine in Wuhan, Hubei, China.
PARTICIPANTS
Participants were 120 patients discharged after hepatobiliary surgery at the hospital between June 2020 and June 2022.
INTERVENTIONS
The research team randomly divided participants into two groups using the random number table method, each with 60 participants: (1) an intervention group, which received precede-proceed model-dominant nursing combined with nutrition support and (2) a control group, which received routine care.
OUTCOME MEASURES
At baseline and postintervention, the research team assessed: (1) nutritional status, (2) self-care agency, (3) compliance, (4) quality of life (QoL), (5) incidence of complications.
RESULTS
At baseline, no significant differences existed between the groups in nutritional status, self-care agency, QoL, or compliance (all P > .05). Postintervention compared to the control group, the intervention group's: (1) nutritional status, including albumin (P = .015), hemoglobin (P < .001), growth hormone (P < .001), BW (P = .047), BMI (P = .046), TST (P = .001), and MAMC (P = .016) were significantly higher and transferrin (P < .001) and NRS-2002 score (P < .001) were significantly lower; (2) self-care agency, including self-concept, self-responsibility, health knowledge, and self-nursing skills were significantly higher (all P < .001); (3) compliance scores, including observing the volume and color of bile correctly, clamping and opening the T tube properly, replacing the drainage bag correctly and in a timely manner, regularly disinfecting the skin around the drainage tube, keeping a balanced diet, adhering to medical regimens, exercising adequately were significantly higher (all P < .001); (4) QoL was significantly higher (P < .001); and (5) incidence of complications was significantly lower (P = .008).
CONCLUSIONS
Precede-proceed model-dominant nursing combined with nutrition support can significantly improve nutritional status, self-care agency, and QoL and can significantly decrease the incidence of complications for patients discharged after hepatobiliary surgery with a T tube and is worthy of promotion in clinics.
PubMed: 38758148
DOI: No ID Found -
International Journal of Particle... Mar 2024The breakpoint for a 360° radiotherapy gantry is typically positioned at 180°. This arbitrary setting has not been systematically evaluated for efficiency and may...
PURPOSE
The breakpoint for a 360° radiotherapy gantry is typically positioned at 180°. This arbitrary setting has not been systematically evaluated for efficiency and may cause redundant gantry rotation and extended setup times. Our study aimed to identify an optimal gantry breakpoint angle for a full-gantry proton therapy system, with the goal of minimizing gantry movement.
MATERIALS AND METHODS
We analyzed 70 months of clinically delivered proton therapy plans (9152 plans, 131 883 fractions), categorizing them by treatment site and mapping the fields from a partial-gantry to full-gantry orientation. For each delivered fraction, we computed the minimum total gantry rotation angle as a function of gantry breakpoint position, which was varied between 0° and 360° in 1° steps. This analysis was performed separately within the entire plan cohort and individual treatment sites, both with and without the capability of over-rotating 10° past the breakpoint from either direction (20° overlap). The optimal gantry breakpoint was identified as one which resulted in a low average gantry rotation per fraction.
RESULTS
Considering mechanical constraints, 130° was identified as a reasonable balance between increased gantry-rotation efficiency and practical treatment considerations. With a 20° overlap, this selection reduced the average gantry rotation by 41.4° per fraction when compared to the standard 180° breakpoint. Disease site subgroups showed the following reduction in average gantry rotation: gastrointestinal 192.2°, thoracic 56.3°, pediatric 44.9°, genitourinary 19.9°, central nervous system 10.7°, breast 2.8°, and head and neck 0.1°.
CONCLUSION
For a full-gantry system, a breakpoint of 130° generally outperforms the conventional 180° breakpoint. This reduction is particularly impactful for gastrointestinal, pediatric, and thoracic sites, which constitute a significant proportion of cases at our center. The adjusted breakpoint could potentially streamline patient delivery, alleviate mechanical wear, and enhance treatment precision by reducing the likelihood of patient movement during delivery.
PubMed: 38757073
DOI: 10.1016/j.ijpt.2024.03.001 -
Orthopaedic Journal of Sports Medicine May 2024Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.
BACKGROUND
Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.
PURPOSE
To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage survey during the 2-week postoperative period. In addition, patients completed a survey on postoperative day 21 inquiring about continued opioid use and medication disposal, if applicable. Opioid medication consumption was converted to morphine milligram equivalents (MMEs).
RESULTS
Of the 200 patients who were enrolled in the study, 176 patients had sufficient follow-up after undergoing 85 (48%) ACLR, 26 (14.8%) hip labral repair, 34 (19.3%) shoulder labral repair, 18 (10.2%) meniscectomy, and 13 (7.4%) meniscal repair procedures. Mean age was 26.1 years (SD, 7.38); surgeons prescribed a mean of 26.6 pills whereas patients reported consuming a mean of 15.5 pills. The mean MME consumption in the 14 days after each procedure was calculated: ACLR (95.7; 44% of prescription), hip labral repair (84.8; 37%), shoulder labral repair (57.2; 35%), meniscectomy (18.4; 27%), and meniscal repair (32.1; 42%). This corresponded to approximately 39% of the total opioid prescription being utilized across all procedures. Mean MME consumption was greatest on postoperative day 1 in hip, shoulder, and meniscal procedures and on postoperative day 2 in ACLR. Only 7.04% of patients reported continued opioid use in the third postoperative week. Patients had a mean of 11 unused pills or 77.7 MMEs remaining. Of the patients with remaining medication, 24.7% intended to keep their medication for future use.
CONCLUSION
The results of our study indicate that patients who undergo the aforementioned arthroscopic procedures consume <75 MMEs in the 2-week postoperative period, translating into a mean of 10 to 15 pills consumed. Approximately 60% of total opioids prescribed went unused, and one-fourth of patients intended to keep their remaining medication for future usage. We have provided general prescribing guidelines and recommend that surgeons carefully consider customizing their opioid prescriptions on the basis of procedure site to balance optimal postoperative analgesia with avoidance of dissemination of excess opioids.
PubMed: 38757068
DOI: 10.1177/23259671241249688 -
BJR Open Jan 2024The aim of this study was to evaluate the diagnostic performance of nonspecialist readers with and without the use of an artificial intelligence (AI) support tool to...
OBJECTIVES
The aim of this study was to evaluate the diagnostic performance of nonspecialist readers with and without the use of an artificial intelligence (AI) support tool to detect traumatic fractures on radiographs of the appendicular skeleton.
METHODS
The design was a retrospective, fully crossed multi-reader, multi-case study on a balanced dataset of patients (≥2 years of age) with an AI tool as a diagnostic intervention. Fifteen readers assessed 340 radiographic exams, with and without the AI tool in 2 different sessions and the time spent was automatically recorded. Reference standard was established by 3 consultant radiologists. Sensitivity, specificity, and false positives per patient were calculated.
RESULTS
Patient-wise sensitivity increased from 72% to 80% ( < .05) and patient-wise specificity increased from 81% to 85% ( < .05) in exams aided by the AI tool compared to the unaided exams. The increase in sensitivity resulted in a relative reduction of missed fractures of 29%. The average rate of false positives per patient decreased from 0.16 to 0.14, corresponding to a relative reduction of 21%. There was no significant difference in average reading time spent per exam. The largest gain in fracture detection performance, with AI support, across all readers, was on nonobvious fractures with a significant increase in sensitivity of 11 percentage points (pp) (60%-71%).
CONCLUSIONS
The diagnostic performance for detection of traumatic fractures on radiographs of the appendicular skeleton improved among nonspecialist readers tested AI fracture detection support tool showed an overall reader improvement in sensitivity and specificity when supported by an AI tool. Improvement was seen in both sensitivity and specificity without negatively affecting the interpretation time.
ADVANCES IN KNOWLEDGE
The division and analysis of obvious and nonobvious fractures are novel in AI reader comparison studies like this.
PubMed: 38757067
DOI: 10.1093/bjro/tzae011 -
Archives of Medical Science : AMS 2024Fluid resuscitation of patients with sepsis is crucial. This study explored the role of fluid balance in the early resuscitation of sepsis patients in the intensive care...
INTRODUCTION
Fluid resuscitation of patients with sepsis is crucial. This study explored the role of fluid balance in the early resuscitation of sepsis patients in the intensive care unit (ICU).
MATERIAL AND METHODS
A retrospective study of patients with sepsis using the Peking Union Medical College Hospital Intensive Care Medical Information System and Database from January 2014 to June 2020 was performed. Based on the survival status on day 28, the training cohort was divided into an alive group ( = 1,803) and a deceased group ( = 429). Univariate and multivariate analyses were used to identify risk factors, and the integrated learning XGBoost algorithm was used to construct a model for predicting outcomes. ROC and Kaplan-Meier survival curves were used to evaluate the effectiveness of the model. A verification cohort ( = 433) was used to verify the model.
RESULTS
Univariate analysis showed that fluid balance is an important covariate. Based on the scatterplot distribution, a significant difference in mortality was determined between groups stratified with a balance of 1000 ml. There were associations in the multivariate analysis between poor outcomes and sex, PO/FiO, serum creatinine, FiO, platelets, respiratory rate, SPO, temperature, and total fluid volume (1000 ml). Among these variables, total fluid balance (1000 ml) had an OR of 1.98 (CI: 1.41-2.77, < 0.001). Therefore, the model was built with these nine factors using XGBoost. Cross validation was used to verify generalizability. This model performed better than the SOFA and APACHE II models. The result was well verified in the verification cohort. A causal forest model suggested that patients with hypoxemia may suffer from positive fluid balance.
CONCLUSIONS
Sepsis fluid resuscitation in the ICU should be a targeted and goal-oriented treatment. A new prognostic prediction model was constructed and indicated that a 6-hour positive fluid balance after ICU initial admission is a risk factor for poor outcomes in sepsis patients. A 6-hour fluid balance above 1000 ml should be performed with caution.
PubMed: 38757044
DOI: 10.5114/aoms/172160 -
RSC Advances May 2024The pervasive application of pharmaceuticals in aquatic environments has acquired much focus owing to their nonbiodegradability and eco-toxicity, which might readily...
The pervasive application of pharmaceuticals in aquatic environments has acquired much focus owing to their nonbiodegradability and eco-toxicity, which might readily destroy the ecological balance. Developed chitosan-coated Fe-Cu CNS alginate-CMC beads (NBs) were utilized in this study to adsorb the quinolone antibiotic norfloxacin (NOR) from water for the first time. Under ideal conditions (: 20 mg L; sorbent conc.: 2000 mg L; sorbent dosage: 0.15 g; interaction time: 300 min; solution pH: 6.0), about 86% NOR removal was achieved through batch mode. The removal performance for NOR was examined concerning pH, ionic strength, and coexisting micropollutants. The greatest NOR removal was attained on NBs with the greatest Langmuir adsorption capacity of 355 mg g due to numerous mechanisms such as sorbent pore filling, electrostatic attraction, π-π attraction and hydrogen bonding. Studies using environmentally significant algae, such as sp., to analyze the residual toxicity of treated NOR solution revealed a significant reduction in their toxic effects. Current research has demonstrated that nanocomposite beads are an excellent wastewater treatment material with promising industrial applications due to their ease of synthesis, exceptional surface adsorption properties, stability, and environmentally friendly reaction.
PubMed: 38756850
DOI: 10.1039/d4ra01971g -
Chemical Science May 2024Birefringent crystals serve as the core elements of polarizing optical devices. However, the inherent challenge of balancing bandgap and birefringence poses a...
Birefringent crystals serve as the core elements of polarizing optical devices. However, the inherent challenge of balancing bandgap and birefringence poses a significant hurdle in designing crystals with excellent overall performance. In this study, we propose a novel approach, namely modification with perfluorinated groups, to achieve dual enhancement of the bandgap and birefringence of selenite materials. We have successfully synthesized the first selenite fluorosilicate, namely, Pb(SeO)(SiF). This compound exhibits a three-dimensional structure composed of two-dimensional lead selenite layers bridged by SiF octahedrons. Notably, by introducing a perfluorinated SiF group, the bandgap of the lead selenite compound has been expanded to 4.4 eV. Furthermore, Pb(SeO)(SiF) demonstrates a large birefringence (0.161 @ 546 nm), surpassing most of the selenite compounds with a bandgap larger than 4.2 eV. Theoretical calculations suggest that the large birefringence of Pb(SeO)(SiF) can be attributed to the synergistic effects of SeO, PbO and PbOF polyhedrons. Our research not only pioneers a new system for selenite materials, enriching the diversity of selenite structures, but also provides a design methodology for obtaining wide bandgap birefringent selenite.
PubMed: 38756790
DOI: 10.1039/d4sc01376j -
Frontiers in Immunology 2024Impaired metabolism is recognized as an important contributor to pathogenicity of T cells in (SLE). Over the last two decades, we have acquired significant knowledge... (Review)
Review
Impaired metabolism is recognized as an important contributor to pathogenicity of T cells in (SLE). Over the last two decades, we have acquired significant knowledge about the signaling and transcriptomic programs related to metabolic rewiring in healthy and SLE T cells. However, our understanding of metabolic network activity derives largely from studying metabolic pathways in isolation. Here, we argue that enzymatic activities are necessarily coupled through mass and energy balance constraints with in-built network-wide dependencies and compensation mechanisms. Therefore, metabolic rewiring of T cells in SLE must be understood in the context of the entire network, including changes in metabolic demands such as shifts in biomass composition and cytokine secretion rates as well as changes in uptake/excretion rates of multiple nutrients and waste products. As a way forward, we suggest cell physiology experiments and integration of orthogonal metabolic measurements through computational modeling towards a comprehensive understanding of T cell metabolism in lupus.
Topics: Lupus Erythematosus, Systemic; Humans; T-Lymphocytes; Metabolic Networks and Pathways; Energy Metabolism; Animals; Signal Transduction; Cytokines
PubMed: 38756769
DOI: 10.3389/fimmu.2024.1371708