Comparing postural strategy changes following adapted versus non-adapted responses in subjects with and without spinal stenosis

Musculoskeletal evaluation skills are needed to examine postural compensation techniques, but little is known about ground reaction forces (GRF) in standing posture. Even though a number of studies have evaluated GRF in patients with low back pain (LBP) during vertical perturbations, it would be important to consider compensation characteristics which might be associated with abnormal patterns of postural responses. The vertical excursions of the body center of mass (BCOM) were measured with delay time and normalized amplitude of GRF. Overall, there was no difference based on the vertical excursion of the BCOM (F = 0.12, p = 0.90), amplitude of the normalized GRF (F = 0.16, p = 0.74), or response time (F = 1.98, p = 0.17) between subjects with and without spinal stenosis.There was a gender difference based on the vertical excursion of the normalized BCOM (F = 5.92, p = 0.02) as well as the normalized amplitude of GRF (F = 4.17, p = 0.04). It was shown that male subjects implemented better adjustment strategies during adapted and non-adapted responses in order to improve body stability. In this way, manual therapists should be aware that gender differences exist in patients with spinal stenosis since the condition may change the individual's postural adjustment ability.     

ASB clinical biomechanics award winner 2016: Assessment of gaze stability within 24–48 hours post-concussion

BackgroundApproximately 90% of athletes with concussion experience a certain degree of visual system dysfunction immediately post-concussion. Of these abnormalities, gaze stability deficits are denoted as among the most common. Little research quantitatively explores these variables post-concussion. As such, the purpose of this study was to investigate and compare gaze stability between a control group of healthy non-injured athletes and a group of athletes with concussions 24–48 hours post-injury.MethodsTen collegiate NCAA Division I athletes with concussions and ten healthy control collegiate athletes completed two trials of a sport-like antisaccade postural control task, the Wii Fit Soccer Heading Game. During play all participants were instructed to minimize gaze deviations away from a central fixed area. Athletes with concussions were assessed within 24–48 post-concussion while healthy control data were collected during pre-season athletic screening. Raw ocular point of gaze coordinates were tracked with a monocular eye tracking device (240 Hz) and motion capture during the postural task to determine the instantaneous gaze coordinates. This data was exported and analyzed using a custom algorithm. Independent t-tests analyzed gaze resultant distance, prosaccade errors, mean vertical velocity, and mean horizontal velocity.FindingsAthletes with concussions had significantly greater gaze resultant distance (p = 0.006), prosaccade errors (p < 0.001), and horizontal velocity (p = 0.029) when compared to healthy controls.InterpretationThese data suggest that athletes with concussions had less control of gaze during play of the Wii Fit Soccer Heading Game. This could indicate a gaze stability deficit via potentially reduced cortical inhibition that is present within 24–48 hours post-concussion.     

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n = 20) to a neck pain group with poor scapular posture (n = 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p = 0.02) and less activity in the lower trapezius (LT) (p = 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p = 0.09; p = 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.     

Growth-differentiation factor-15 and tissue doppler ımaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors

ObjectivesAnthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines.Design and methodsThirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured.ResultsAlthough, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E′m wave, and E′m/A′m ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E′t wave, and E′t/A′t ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups.ConclusionsGrowth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS.     

Serum activated leukocyte cell adhesion molecule and intercellular adhesion molecule-1 in patients with gastric cancer: Can they be used as biomarkers?

Cellular adhesion molecules might be used as markers in diagnosis and prognosis in some types of malignant tumors. The purpose of this study was to determine the clinical significance of the serum levels of activated leukocyte cell adhesion molecule-1 (ALCAM) and intercellular adhesion molecule-1 (ICAM-1) in gastric cancer (GC) patients. Fifty-eight GC patients and 20 age- and sex-matched healthy controls were enrolled into this study. Pretreatment serum markers were determined by the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). The median age at diagnosis was 59.5 years (range 32–82 years). Tumor localizations of the majority of the patients were antrum (n = 42, 72.4%) and tumor histopathologies of the majority of the patients were diffuse (n = 43, 74.1%). The majority of the patients had stage IV disease (n = 41, 70.7%). Thirty six (62.1%) patients had lymph node involvement. The median follow-up time was 66 months (range 1–97.2 months). At the end of the observation period, 26 patients (44.8%) were dead. The median survival for all patients was 21.4 ± 5 months (%95 CI, 11.5–31.3). The 1-year survival rates were 66.2%.The baseline serum ALCAM levels of the patients were significantly higher than those of the controls (p = 0.001). There was no significant difference in the serum levels of ICAM-1 between the patients and controls (p = 0.232). No significant correlation was detected between the levels of the serum markers and other clinical parameters (p > 0.05). Tumor localization (p = 0.03), histopathology (p = 0.05), and response to chemotherapy (p = 0.003) had prognostic factors on survival. Neither serum ALCAM levels nor serum ICAM-1 levels were identified to have a prognostic role on overall survival (ICAM-1 p = 0.6, ALCAM p = 0.25). In conclusion, serum levels of ALCAM were found to have diagnostic value in GC patients.     

SIRT1 variants are associated with aging in a healthy Han Chinese population

BackgroundAging is influenced by diverse environmental and genetic risk factors. The SIRT1 (silent information regulator 1) gene has been shown to regulate lifespan and aging in previous studies. We determined whether variation in the SIRT1 gene is associated with aging in healthy Chinese population.MethodsThe study population comprised 482 healthy, unrelated Chinese subjects, of which 246 were aging individuals from 60 to 91 years old, and 236 younger individuals from 35 and 59 years old. All subjects were from Shenyang, China. Two single-nucleotide polymorphisms (SNP) were analyzed: rs3758391 near the 5′ end of the SIRT1 gene; and rs4746720, in the 3′ untranslated region.ResultsDifferences in allele and genotype frequency were seen between the groups, with rs3758391/C more common than rs3758391/T in the aging subjects (odds ratio = 1.453, p = 0.026), and with rs3758391/CC more common than rs3758391/CT and rs3758391/TT in the aging subjects (odds ratio = 3.042, p = 0.027). For the 3′ SNP, rs4746720/C was more common than rs4746720/T in the aging subjects (odds ratio = 1.347, p = 0.022), and rs4746720/CC was more common than rs4746720/CT and rs4746720/CT in the aging subjects (odds ratio = 1.461, p = 0.049). The haplotype frequency distribution was also different, with haplotype CC more common in the older group (odds ratio = 1.63, p = 0.01).ConclusionThese results suggest that SIRT1 gene polymorphisms may add a new factor on the multifactorial genetic contributions to aging.     

Immediate effects of Pilates based therapeutic exercise on postural control of young individuals with non-specific low back pain: A randomized controlled trial

ObjectivesLow back pain affects the person's ability to keep balance, especially in challenging conditions. The purpose of this study was to determine the immediate effects of Pilates exercises on postural sway and dynamic balance of young individuals with non-specific low back pain.DesignControlled laboratory design.Settings and main outcome measuresForty-six participants with non-specific low back pain were randomized to a Pilates (n = 23, 10 males; age: 21.8 ± 3.2 years) and a control group (n = 23, 9 males; age: 22.8 ± 3.6 years). Postural sway was assessed with a force platform and dynamic balance with the Star Excursion Balance Test, before and after the intervention or rest period. To assess postural sway, participants stood still on an unstable surface set on the force plate for 90s, with eyes closed.InterventionThe intervention lasted 20 min and consisted on four Pilates exercises: single leg stretch (level 1), pelvic press (level 1), swimming (level 1) and kneeling opposite arm and leg reach.ResultsAt baseline, no differences were found between groups. The Pilates group improved in all the postural sway values (area of CoP: 11.5 ± 3.4 to 9.7 ± 2.7 cm², p = 0.002 and CoP velocity: 2.8 ± 0.6 to 2.3 ± 0.5 cm/s, p < 0.001) and in the Star Excursion Balance Test. Control group only improved in CoP velocity, however, this improvement was significantly inferior compared to the Pilates group.ConclusionsPilates exercises immediately improved postural sway and dynamic balance in young adults with non-specific low back pain.     

Quantification of postural control deficits in patients with recent concussion: An inertial-sensor based approach

BackgroundThe aim of this study was to quantify postural control ability in a group with concussion compared with a healthy control group.MethodFifteen concussion patients (4 females, 11 males) and a group of fifteen age- and sex-matched controls were recruited. Participants were tested during the performance of the three stance variants (bilateral, tandem and unilateral) of the balance error scoring system standing on a force place, while wearing an inertial measurement unit placed at the posterior aspect of the sacrum.FindingsThe area of postural sway was computed using the force-plate and the ‘95% ellipsoid volume of sway’ was computed from the accelerometer data. Concussed patients exhibited increased sway area (1513 mm² [95% CI: 935 to 2091 mm²] vs 646 mm² [95% CI: 519 to 772 mm²]; p = 0.02) and sway volume (9.46 m³ s^− 6 [95% CI: 8.02 to 19.94 m³ s^− 6] vs 2.68 m³ s^− 6 [95% CI: 1.81 to 3.55 m³ s^− 6]; p = 0.01) in the bilateral stance position of the balance error scoring system. The sway volume metric also had excellent accuracy in identifying task ‘errors’ (tandem stance: 91% accuracy [95% CI: 85–96%], p < 0.001; unilateral stance: 91% accuracy [95% CI: 86–96%], p < 0.001).InterpretationIndividuals with concussion display increased postural sway during bilateral stance. The sway volume that was calculated from the accelerometer data not only differentiated a group with concussion from a healthy control group, but successfully identified when task errors had occurred. This may be of value in the development of a pitch-side assessment system for concussion.     

Military personnel with self-reported ankle injuries do not demonstrate deficits in dynamic postural stability or landing kinematics

BackgroundThe odds of sustaining non-contact musculoskeletal injuries are higher in Special Operations Forces operators than in infantry soldiers. The ankle is one of the most commonly injured joints, and once injured can put individuals at risk for reinjury. The purpose of this study was to determine if any differences in postural stability and landing kinematics exist between operators with a self-reported ankle injury in the past one year and uninjured controls.MethodsA total of 55 Special Operations Forces operators were included in this analysis. Comparisons were made between operators with a self-reported ankle injury within one-year of their test date (n = 11) and healthy matched controls (n = 44). Comparisons were also made between injured and uninjured limbs within the injured group. Dynamic postural stability and landing kinematics at the ankle, knee, and hip were assessed during a single-leg jump-landing task. Comparisons were made between groups with independent t-tests and within the injured group between limbs using paired t-tests.FindingsThere were no significant differences in dynamic postural stability index or landing kinematics between the injured and uninjured groups. Anterior-posterior stability index was significantly higher on the uninjured limb compared to the injured limb within the injured group (P = 0.02).InterpretationSingle ankle injuries sustained by operators may not lead to deficits in dynamic postural stability. Dynamic postural stability index and landing kinematics within one year after injury were either not affected by the injuries reported, or injured operators were trained back to baseline measures through rehabilitation and daily activity.     

Relation between riboflavin,flavin mononucleotide and flavin adenine dinucleotide concentrations in plasma and red cells in patients with critical illness

BackgroundThere is some evidence that the relationship between plasma and red cell vitamin B2 concentrations is perturbed in the critically ill patient. The aim of the present study was to examine the longitudinal interrelationships between riboflavin, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) in plasma and red cells in patients with critical illness.MethodsRiboflavin, FMN and FAD concentrations were measured, by HPLC, in plasma and red cells in healthy subjects (n = 119) and in critically ill patients (n = 125) on admission and on follow-up.ResultsOn admission, compared with the controls, critically ill patients had significantly higher plasma riboflavin and FMN concentrations (p < 0.001) and lower median plasma FAD concentrations (p < 0.001). In the red cell, FAD concentrations were significantly lower in critically ill patients (p < 0.001). In healthy subjects, plasma riboflavin was directly associated with both plasma FMN (r_s = 0.55, p < 0.001) and plasma FAD (r_s = 0.49, p < 0.001). Red cell riboflavin was directly associated with red cell FMN (r_s = 0.52, p < 0.001) but not red cell FAD. In the critically ill patients, plasma riboflavin was not significantly associated with either plasma FMN or FAD. Red cell riboflavin was directly associated with red cell FMN (r_s = 0.79, p < 0.001) and red cell FAD (r_s = 0.72, p < 0.001). Longitudinal measurements (n = 60) were similar.ConclusionsThe relationship between plasma riboflavin, FMN and FAD was significantly perturbed in critical illness. This effect was less pronounced in red cells. Therefore, red cell FAD concentrations are more likely to be a reliable measure of status in the critically ill patient.     

Sperm head defects and disturbances in spermatozoal chromatin and DNA integrities in idiopathic infertile subjects: Association with cigarette smoking

ObjectivesTo evaluate sperm chromatin and DNA integrities in idiopathic infertile men and determine the possible association(s) of cigarette smoking on oxidative stress markers, antioxidant capacity and semen quality.Subjects and methodsSemen samples from men referring to the andrology laboratory were categorized into 3 groups: fertile non-smokers (n = 16), infertile non-smokers (n = 36), and infertile smokers (n = 34). Semen analysis was performed according to WHO criteria. The percentage of sperm DNA fragmentation index (%DFI) and the percentage of sperm with abnormally high DNA stainability (HDS%; immature spermatozoa) were determined by SCSA using the metachromatic properties of acridine orange. Lipid peroxidation, superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) levels in seminal plasma and spermatozoa were measured by spectrophotometric assays.ResultsThe classical semen parameters were negatively correlated with lipid peroxidation in spermatozoa; motility and morphology were negatively correlated with %DFI (p < 0.05). HDS% was also negatively correlated with above markers except for morphology (r = ? 0.352, p = 0.081). DFI% and HDS% were significantly higher in the infertile smokers group than in infertile non-smokers (p = 0.032; p = 0.001 respectively). Cigarette smoking was significantly associated with DFI%, HDS%, TBARS and the fraction of “round-headed” sperm (r = 0.796, p = 0.0001; r = 0.371, p = 0.033; r = 0.606, r = 0.591, p = 0.001 respectively), and decreased SOD levels (r = ? 0.545).ConclusionDFI%, HDS% and round-head sperms are increased in idiopathic infertile men; this increase is associated with cigarette smoking. These defects may be attributed to increased oxidative stress and insufficient scavenging antioxidant enzymes in the seminal fluid of infertile patients.     

A PET [18F]altanserin study of 5-HT2A receptor binding in the human brain and responses to painful heat stimulation

There is a large body of evidence that serotonin [5-hydroxytryptamine (5-HT)] plays an important role in the transmission and regulation of pain. Here we used positron emission tomography (PET) to study the relationship between baseline 5-HT_2A binding in the brain and responses to noxious heat stimulation in a group of young healthy volunteers. Twenty-one healthy subjects underwent PET scanning with the 5-HT_2A antagonist, [¹⁸F]altanserin. In addition, participants underwent a battery of pain tests using noxious heat stimulation to assess pain threshold, pain tolerance and response to short-lasting phasic and long-lasting (7-minute) tonic painful stimulation. Significant positive correlations were found between tonic pain ratings and [¹⁸F]altanserin binding in orbitofrontal (r = 0.66; p = 0.005), medial inferior frontal (r = 0.60; p = 0.014), primary sensory–motor (r = 0.61; p = 0.012) and posterior cingulate (r = 0.63; p = 0.009) cortices. In contrast, measures of regional [¹⁸F]altanserin binding did not correlate with pain threshold, pain tolerance, or suprathreshold phasic pain responses. These data suggest that cortical 5-HT_2A receptor availability co-varies with responses to tonic pain. The correlation between [¹⁸F]altanserin binding in prefrontal cortex and tonic pain suggests a possible role of this brain region in the modulation and/or cognitive-evaluative appreciation of pain.     

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

ObjectiveCompare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.DesignRandomized controlled trial.SettingOne long-term care facility in Taiwan.Participants86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n = 30), or usual activity (n = 30).InterventionOne certified trainer provided the intervention group with 40 min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.Main outcome measuresQuality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF)ResultsParticipants in the Tai Chi group (M = 3.76, SD = 3.65) recorded significantly lower GDS-SF scores than participants in the control (M = 7.76, SD = 5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p = 0.03], general health [p = 0.04], and the associated domains: physical health [p = 0.00], psychological health [p = 0.02], social relations [p = 0.00], and environment [p = 0.00].ConclusionsThe findings highlight the importance of Tai Chi in improving QOL and depression in this population.     

Regional sex differences in grey matter volume are associated with sex hormones in the young adult human brain

Previous studies suggest organizing effects of sex hormones on brain structure during early life and puberty, yet little is known about the adult period. The aim of the present study was to elucidate the role of 17β-estradiol, progesterone, and testosterone on cortical sex differences in grey matter volume (GM) of the adult human brain. To assess sexual dimorphism, voxel-based morphometry (VBM) was applied on structural magnetic resonance images of 34 healthy, young adult humans (17 women, 17 men, 26.6 ± 5 years) using analyses of covariance. Subsequently, circulating levels of sex hormones were associated with regional GM using linear regression analyses. After adjustment for sex and total GM, significant associations of regional GM and 17β-estradiol were observed in the left inferior frontal gyrus (β = 0.39, p = 0.02). Regional GM was inversely associated with testosterone in the left inferior frontal gyrus (β = ?0.16, p = 0.04), and with progesterone in the right temporal pole (β = ?0.39, p = 0.008). Our findings indicate that even in young adulthood, sex hormones exert organizing effects on regional GM. This might help to shed further light on the underlying mechanisms of both functional diversities and congruence between female and male brains.     

Mutation -538 T/C in bone morphogenetic protein 4 do not increase the risk in sickle-cell disease with orthopedic complications but strongly associated with increased LDH and uric acid level in Indian patients from Chhattisgarh and Jharkhand states

BackgroundBone morphogenetic protein (BMP) are involved in the various orthopedic complications such as avascular necrosis, osteonecrosis and bone turnover, therefore genes coding for proteins, like BMP4, can be potential candidate for studying orthopedic disorders.MethodsA case–control study was conducted to examine the association between SNP T538C of BMP4 and orthopedic complications in sickling patients by employing PCR-RFLP.ResultsA total of 200 cases and 172 control groups were studied from Indian population. T538C SNP has not been implicated in disease and doesn't increase the risk (OR = 0.89, OR = 0.68). We observed no significant association between the T538C polymorphism and case group in the studied population. However, we observed significantly increased uric acid and LDH level in homowild (TT), heteromutant (TC) and homomutant (CC) in case group compared to control group ( all p = 0.0001) and (p = 0.0001, p = 0.0001, p = 0.015 and p = 0.0001, p = 0.0001, p = 0.0001 respectively) in the studied population.ConclusionsThe T/C polymorphism in BMP4 is not associated with case group and in view of present observation, we suggest that evaluation of LDH and uric acid level and its association with polymorphisms in the BMP4 may be considered to be reliable molecular and biochemical markers, and possess promising rational for diagnostic potential in clinical cases.     

Butyrylcholinesterase activity and mortality risk in hemodialysis patients: Comparison to hsCRP and albumin

ObjectiveTo test the prediction power of butyrylcholinesterase (BuChE) activity for mortality risk in hemodialysis patients during 12 months follow-up, and made comparison to hsCRP and albumin.Materials and methodsThe study enrolled 62 patients, aged 31–79 years. Serum BuChE, high-sensitivity C-reactive protein (hsCRP) and albumin were measured after 1, 3, 9 and 12 months of dialysis. The Kaplan–Meier survival curves were employed in mortality prediction.ResultsBuChE was positively associated with serum albumin (r = 0.318; p = 0.012) and inversely related to hsCRP (r = ? 0.358; p = 0.004). The highest mortality was in the lowest quartile of basal albumin (< 38.4 g/L; p = 0.027), hsCRP concentrations > 8 mg/L (p = 0.005), and BuChE activity in the lowest tercile of basal values (< 5.92 kU/L; p = 0.0041).ConclusionOur results suggest that low BuChE activity may be a nonspecific risk factor for mortality in patients who are on hemodialysis.     

An immediate effect of custom-made ankle foot orthoses on postural stability in older adults

BackgroundFoot and ankle problems are highly prevalent fall risks in the elderly. Ankle foot orthoses designed to stabilize the foot and ankles have been studied within specific patient groups, but their efficacy with a less restrictive elderly population is unknown. This study investigated if custom-made ankle foot orthoses improve postural stability in older adults.MethodsThirty ambulatory older adults averaged 73 (standard deviation = 6.5) years completed Romberg's balance (eyes-open/eyes-closed), functional reach, and Timed Up and Go tests while wearing validated kinematic sensors. Each test was completed in standardized shoes with and without bilateral orthoses. Additionally, barefoot trials were conducted for the Romberg's and functional reach tests.FindingsCompared to the barefoot and ‘shoes alone’ conditions, the orthoses reduced center of mass sway on average by 49.0% (P = 0.087) and 40.7% (P = 0.005) during eyes-open balance trials. The reduction was amplified during the eyes-closed trials with average reductions of 65.9% (P = 0.000) and 47.8% (P = 0.004), compared to barefoot and ‘shoes alone’ conditions. The orthoses did not limit functional reach distance nor timed-up and go completion times. However, the medial-lateral postural coordination while reaching was improved significantly with orthoses compared to barefoot (14.3%; P = 0.030) and ‘shoes alone’ (13.5%; P = 0.039) conditions.InterpretationAnkle foot orthoses reduced postural sway and improved lower extremity coordination in the elderly participants without limiting their ability to perform a standard activity of daily living. Additional studies are required to determine if these benefits are retained and subsequently translate into fewer falls.     

The effect of total hip and hip resurfacing arthroplasty on vertical ground reaction force and impulse symmetry during a sit-to-stand task

BackgroundThe aim of this study was to determine the influence of total hip arthroplasty and hip resurfacing arthroplasty on limb loading symmetry before, and after, hip reconstruction surgery during a sit-to-stand task.MethodsFourteen patients were recruited that were about to receive either a total hip prosthesis (n = 7) or a hip resurfacing prosthesis (n = 7), as well as matched controls. Patients performed a sit-to-stand movement before, 3 months after, and 12 months after surgery. Peak vertical ground reaction force and impulse were measured for each leg, from which ground reaction force and impulse symmetry ratios were calculated.FindingsBefore surgery, hip resurfacing patients showed a small asymmetry which was not different to normal for ground reaction force (0.88(0.28) vs. 1.00(0.11); p = 0.311) or impulse (0.87(0.29) vs. 0.99(0.09); p = 0.324) symmetry ratios. Total hip patients offloaded their affected hip by 30% in terms of impulse symmetry ratio (0.71(0.36) vs. 0.99(0.23); p = 0.018). At 3 months following surgery asymmetries were seen that were different to normal in both hip resurfacing patients for ground reaction force (0.77(0.16); p = 0.007), and total hip patients for ground reaction force (0.70(0.15); p = 0.018) and impulse (0.72(0.16); p = 0.011) symmetry ratios. By 12 months after surgery total hip patients regained a symmetrical loading pattern for both ground reaction force (0.95(0.06); p = 0.676) and impulse (1.00(0.06); p = 0.702) symmetry ratios. Hip resurfacing patients, however, performed the task by overloading their operated hip, with impulse symmetry ratio being larger than normal (1.16(0.16); p = 0.035).InterpretationPhysiotherapists should appreciate the need for early recovery of limb loading symmetry as well as subsequent differences in the responses observed with different prostheses.     

Effect of caregiver gender,age, and feedback prompts on chest compression rate and depth

BackgroundQuality of chest compressions (CC) is an important determinant of resuscitation outcome for cardiac arrest patients.PurposeTo characterize the quality of CC performed by hospital personnel, evaluate for predictors of CC performance, and determine the effects of audiovisual feedback on CC performance.MethodsSeven hundred and fifty four individuals participated in a CPR quality improvement challenge at 30 US hospitals. Participants performed 2 min of CC on a manikin with an accelerometer-based system for measuring both rate (CC/min) and depth (in.) of CC (AED Plus:ZOLL Medical). Real-time audiovisual feedback was disabled. A subset of participants performed a second trial of CC with the audiovisual feedback prompts activated.ResultsMean depth of CC was below AHA minimum guidelines (<1.5 in.) for 34% (1.30 ± 0.14 in.) and above maximum guidelines (>2.0 in.) for 12% of participants (2.20 ± 0.22 in.). Depth of CC was greater for male vs. female (p < 0.001) and younger vs. older (p = 0.009) but did not differ between ACLS, BCLS, and non-certified participants (p = 0.6). Predictors of CC depth included CC rate (r_part = ?0.34, p < 0.0001), gender (r_part = 0.13, p = 0.001), and age (r_part = ?0.09, p = 0.02).Mean depth of CC increased, mean rate decreased, and variance in CC depth and rate declined when feedback was used (p ≤ 0.0001 vs. without feedback). The percentage of CC performed within AHA guidelines (1.5–2 in.) improved from 15 to 78% with feedback.ConclusionsThe quality of CC performed by personnel at US hospitals as judged by their performance on a manikin is often suboptimal. Quality of CC can be improved with use of CPR feedback technologies.     

Hip fracture and anthropometric variations: Dominance among trochanteric soft tissue thickness,body height and body weight during sideways fall

BackgroundHip fracture depends on various anthropometric parameters such as trochanteric soft tissue thickness, body height and body weight. The objective was to evaluate the responses to the variations in anthropometric parameters during sideways fall, and to identify the most dominant parameter among them.MethodSeven finite element models were developed having anthropometric variations in trochanteric soft tissue thickness (5–26 mm), body height (1.70–1.88 m), and body weight (63–93.37 kg). These were simulated for sideways fall with ANSYS-LS-DYNA® code.FindingsSignificant effect of trochanteric soft tissue thickness variation was found on ‘normalized peak impact force with respect to the body weight’ (p = 0.004, r² = 0.808) and strain ratio (p = 0.083, r² = 0.829). But, variation in body height was found to be less significant on normalized peak impact force (p = 0.478, r² = 0.105) and strain ratio (p = 0.292, r² = 0.217). Same was true for the variation in body weight on normalized peak impact force (p = 0.075, r² = 0.456) and strain ratio (p = 0.857, r² = 0.007). The risk factor for fracture was also well correlated to the strain ratio for the inter-trochanteric zone (p < 0.0007, r² = 0.917) where the most fractures are clinically observed to happen.InterpretationsTrochanteric soft tissue thickness was found likely to be the most dominant parameter over body height and body weight, signifying that a slimmer elderly person, taller or shorter, with less trochanteric soft tissue thickness should be advised to take preventive measures against hip fracture under sideways fall.