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1.
Julio T. Chong Adam P. Klausner Albert Petrossian Michael D. Byrne Jewel R. Moore Lance L. Goetz David R. Gater B. Mayer Grob 《The journal of spinal cord medicine》2015,38(2):187-192
Objective
The objective of this study was to compare the safety, efficacy, quality-of-life impact, and costs of a single dose or a longer course of pre-procedural antibiotics prior to elective endoscopic urological procedures in individuals with spinal cord injury and disorders (SCI/D) and asymptomatic bacteriuria.Design
A prospective observational study.Setting
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.Participants
Sixty persons with SCI/D and asymptomatic bacteriuria scheduled to undergo elective endoscopic urological procedures.Interventions
A single pre-procedural dose of antibiotics vs. a 3–5-day course of pre-procedural antibiotics.Outcome measures
Objective and subjective measures of health, costs, and quality of life.Results
There were no significant differences in vital signs, leukocytosis, adverse events, and overall satisfaction in individuals who received short-course vs. long-course antibiotics. There was a significant decrease in antibiotic cost (33.1 ± 47.6 vs. 3.6 ± 6.1 US$, P = 0.01) for individuals in the short-course group. In addition, there was greater pre-procedural anxiety (18 vs. 0%, P < 0.05) for individuals who received long-course antibiotics.Conclusion
SCI/D individuals with asymptomatic bacteriuria may be able to safely undergo most endoscopic urological procedures with a single dose of pre-procedural antibiotics. However, further research is required and even appropriate pre-procedural antibiotics may not prevent severe infections. 相似文献2.
Leslie R. M. Hausmann Larissa Myaskovsky Christian Niyonkuru Michelle L. Oyster Galen E. Switzer Kelly H. Burkitt Michael J. Fine Shasha Gao Michael L. Boninger 《The journal of spinal cord medicine》2015,38(1):102-110
Context
Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.Objective
Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.Design
Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.Setting
Four national SCI Model Systems sites.Participants
Individuals with SCI (N = 162) and their SCI physicians (N = 14).Outcome measures
SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.Results
Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = −4.54, 95% CI= −8.79, −0.28).Conclusion
This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes. 相似文献3.
Jamie M. Zeitzer Ban Ku Doug Ota B. Jenny Kiratli 《The journal of spinal cord medicine》2014,37(1):46-53
Objective
To determine the effectiveness of a melatonin agonist for treating sleep disturbances in individuals with tetraplegia.Design
Placebo-controlled, double-blind, crossover, randomized control trial.Setting
At home.Participants
Eight individuals with tetraplegia, having an absence of endogenous melatonin production and the presence of a sleep disorder.Interventions
Three weeks of 8 mg of ramelteon (melatonin agonist) and 3 weeks of placebo (crossover, randomized order) with 2 weeks of baseline prior to and 2 weeks of washout between active conditions.Outcome
Change in objective and subjective sleep.Measures
Wrist actigraphy, post-sleep questionnaire, Stanford sleepiness scale, SF-36.Results
We observed no consistent changes in either subjective or objective measures of sleep, including subjective sleep latency (P = 0.55, Friedman test), number of awakenings (P = 0.17, Friedman test), subjective total sleep time (P = 0.45, Friedman test), subjective morning alertness (P = 0.35, Friedman test), objective wake after sleep onset (P = 0.70, Friedman test), or objective sleep efficiency (P = 0.78, Friedman test). There were significant increases in both objective total sleep time (P < 0.05, Friedman test), subjective time in bed (P < 0.05, Friedman test), and subjective sleep quality (P < 0.05, Friedman test), although these occurred in both arms. There were no significant changes in any of the nine SF-36 subscale scores (Friedman test, Ps >Bonferroni adjusted α of 0.005).Conclusion
In this pilot study, we were unable to show effectiveness of pharmacological replacement of melatonin for the treatment of self-reported sleep problems in individuals with tetraplegia.Trial Registration
ClinicalTrials.gov # . NCT00507546相似文献4.
Jia-Chi Wang Rai-Chi Chan Yun-An Tsai Wen-Cheng Huang Henrich Cheng Han-Lin Wu Shih-Fong Huang 《The journal of spinal cord medicine》2015,38(5):587-592
Objective
To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain.Design
Cross sectional and comparative investigation using the unified questionnaire.Setting
Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan.Participants
Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously).Outcome measures
Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale.Results
Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r = 0.278, P = 0.017) and lower self-perceived health scores (r = −0.433, P < 0.001) but not SCIM scores (P = 0.342).Conclusion
Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels. 相似文献5.
Mahmoud Joghtaei Amir Massoud Arab Hamed Hashemi-Nasl Mohammad Taghi Joghataei Mohammad Osman Tokhi 《The journal of spinal cord medicine》2015,38(2):170-177
Objective
Stiffness and viscosity represent passive resistances to joint motion related with the structural properties of the joint tissue and of the musculotendinous complex. Both parameters can be affected in patients with spinal cord injury (SCI). The purpose of this study was to measure passive knee stiffness and viscosity in patients with SCI with paraplegia and healthy subjects using Wartenberg pendulum test.Design
Non-experimental, cross-sectional, case–control design.Setting
An outpatient physical therapy clinic, University of social welfare and Rehabilitation Science, Iran.Patients
A sample of convenience sample of 30 subjects participated in the study. Subjects were categorized into two groups: individuals with paraplegic SCI (n = 15, age: 34.60 ± 9.18 years) and 15 able-bodied individuals as control group (n = 15, age: 30.66 ± 11.13 years).Interventions
Not applicable.Main measures
Passive pendulum test of Wartenberg was used to measure passive viscous-elastic parameters of the knee (stiffness, viscosity) in all subjects.Results
Statistical analysis (independent t-test) revealed significant difference in the joint stiffness between healthy subjects and those with paraplegic SCI (P = 0.01). However, no significant difference was found in the viscosity between two groups (P = 0.17). Except for first peak flexion angle, all other displacement kinematic parameters exhibited no statistically significant difference between normal subjects and subjects with SCI.Conclusions
Patients with SCI have significantly greater joint stiffness compared to able-bodied subjects. 相似文献6.
Ursula S. Hofstoetter William B. McKay Keith E. Tansey Winfried Mayr Helmut Kern Karen Minassian 《The journal of spinal cord medicine》2014,37(2):202-211
Context/objective
To examine the effects of transcutaneous spinal cord stimulation (tSCS) on lower-limb spasticity.Design
Interventional pilot study to produce preliminary data.Setting
Department of Physical Medicine and Rehabilitation, Wilhelminenspital, Vienna, Austria.Participants
Three subjects with chronic motor-incomplete spinal cord injury (SCI) who could walk ≥10 m.Interventions
Two interconnected stimulating skin electrodes (Ø 5 cm) were placed paraspinally at the T11/T12 vertebral levels, and two rectangular electrodes (8 × 13 cm) on the abdomen for the reference. Biphasic 2 ms-width pulses were delivered at 50 Hz for 30 minutes at intensities producing paraesthesias but no motor responses in the lower limbs.Outcome measures
The Wartenberg pendulum test and neurological recordings of surface-electromyography (EMG) were used to assess effects on exaggerated reflex excitability. Non-functional co-activation during volitional movement was evaluated. The timed 10-m walk test provided measures of clinical function.Results
The index of spasticity derived from the pendulum test changed from 0.8 ± 0.4 pre- to 0.9 ± 0.3 post-stimulation, with an improvement in the subject with the lowest pre-stimulation index. Exaggerated reflex responsiveness was decreased after tSCS across all subjects, with the most profound effect on passive lower-limb movement (pre- to post-tSCS EMG ratio: 0.2 ± 0.1), as was non-functional co-activation during voluntary movement. Gait speed values increased in two subjects by 39%.Conclusion
These preliminary results suggest that tSCS, similar to epidurally delivered stimulation, may be used for spasticity control, without negatively impacting residual motor control in incomplete SCI. Further study in a larger population is warranted. 相似文献7.
Mehmet Akif Türko?lu Gülsüm ?zlem Elpek Volkan Do?ru Hasan ?al?? Asl? U?ar Cumhur Ar?c? 《International journal of surgery case reports》2014,5(1):8-11
INTRODUCTION
İn this paper, we present a rare case of primary dedifferantiated liposarcoma (DDLS) of the colon, management of which is unclear and difficult to cope with.PRESENTATION OF CASE
71 year old female patient with complaints of abdominal pain and swelling was referred to our clinic with the diagnosis of intraabdominal mass. 23 cm × 19 cm × 18 cm tumor starting from the neighborhood of left liver lobe and extending toward pelvic floor was detected on computed tomography. At laparotomy, a multilobulated, soft and yellowish mass was arising from transvers colon and invading greater curvature of stomach. En-bloc removal of the tumor including segmental colon and gastric wedge resection was performed. Postoperative histopathological diagnosis was consistent with dedifferentiated liposarcoma.DISCUSSION
Liposarcomas are rarely encountered in the gastrointestinal tract. Previously, only ten cases of primary liposarcoma of the colon have been reported worldwide and to our knowledge DDLS of transverse colon is the first case reported in the literature. DDLS is a high-grade aggressive tumor carrying the ability to metastasize. Despite complete removal of tumor recurrence is common in DDLS.CONCLUSION
The constellation of findings in our patient demonstrates that liposarcomas which histologically exhibit dedifferentiation are associated with a poor clinical prognosis and advocating surgery alone is not recommended. 相似文献8.
Alexander S. McLawhorn Hollis G. Potter Michael B. Cross Friedrich Boettner Weiyang Lim Yuo-yu Lee Paul M. Pellicci 《Clinical orthopaedics and related research》2015,473(10):3183-3189
Background
The enhanced posterior soft tissue repair has reduced the frequency of dislocation after primary THA performed through the posterolateral approach. However, the long-term integrity of the repair is unknown and could influence surgeon choice regarding surgical technique and THA approach.Questions/Purposes
We asked: (1) What is the durability of the enhanced posterior soft tissue repair at a minimum of 49 months using MRI to evaluate soft tissue to bone integrity? (2) How does the appearance of the posterior soft tissues change during this time? (3) Are there patient characteristics associated with the long-term imaging appearance of the posterior repair?Methods
All patients without a contraindication for MRI who were undergoing unilateral primary uncemented THA through a posterior approach between February and May 2005 were eligible for inclusion. Ninety percent consented to participate (36 of 40 patients), and 30 patients were followed prospectively with MRI postoperatively and again at 3 months; of those, 22 (73%; 12 men, 10 women) completed the study by having another MRI study at a minimum of 49 months (mean, 51 months; range, 49–59 months). Each patient underwent metal-artifact–reduction sequence MRI to evaluate the integrity of the posterior soft tissues, which had been repaired anatomically during primary THA at a minimum of 4 years earlier. The results were compared with those of prior MR images obtained immediately after surgery and at 3 months postoperatively. All patients were given a self-reported modified Harris hip score at the time of the most recent MRI study (maximum score = 81).Results
At latest followup, 21 of 22 (96%) patients had a posterior capsule in contact with bone, and 21 of 22 (96%) had an intact quadratus femoris. Twenty-one patients (96%) had soft tissue or a scar from the piriformis and conjoined tendons in continuity with bone. In these cases, the interface between the piriformis and conjoined tendons and the greater trochanter observed immediately postoperatively and at 3 months postoperatively became filled with hypointense tissue, with signal characteristics similar to tendon. Time from surgery was most associated with changes in native tendon-to-bone distances (p < 0.001) and MRI signal intensity of the repair (p < 0.001).Conclusions
At followup of just more than 4 years, the posterior capsule and quadratus femoris most often were healed to bone. In the majority of patients, scar tissue between the piriformis and conjoined tendons and bone matured to achieve orientation and signal intensity resembling native tendon. We believe the enhanced posterior soft tissue repair facilitates this process. Our results provide a plausible explanation for improved postoperative stability observed in patients receiving an enhanced soft tissue repair compared with those in whom a repair is not performed.Level of Evidence
Level IV, therapeutic study. 相似文献9.
Kevin A. Jacobs Patricia Burns Jochen Kressler Mark S. Nash 《The journal of spinal cord medicine》2013,36(5):427-435
Context/objective
To describe and compare substrate oxidation and partitioning during voluntary arm ergometry in individuals with paraplegia and non-disabled individuals over a wide range of exercise intensities.Design
Cross-sectional study.Setting
Clinical research facility.Participants
Ten apparently healthy, sedentary men with paraplegia and seven healthy, non-disabled subjects.Interventions
Rest and continuous progressive voluntary arm ergometry between 30 and 80% of peak aerobic capacity (VO2peak).Outcome measures
Total energy expenditure and whole body rates of fat and carbohydrate oxidation.Results
A maximal whole body fat oxidation (WBFO) rate of 0.13 ± 0.07 g/minute was reached at 41 ± 9% VO2peak for subjects with paraplegia, although carbohydrate became the predominant fuel source during exercise exceeding an intensity of 30–40% VO2peak. Both the maximal WBFO rate (0.06 ± 0.04 g/minute) and the intensity at which it occurred (13 ± 3% VO2peak) were significantly lower for the non-disabled subjects than those with paraplegia.Conclusion
Sedentary individuals with paraplegia are more capable of oxidizing fat during voluntary arm ergometry than non-disabled individuals perhaps due to local adaptations of upper body skeletal muscle used for daily locomotion. However, carbohydrate is the predominant fuel source oxidized across a wide range of intensities during voluntary arm ergometry in those with paraplegia, while WBFO is limited and maximally achieved at low exercise intensities compared to that achieved by able-bodied individuals during leg ergometry. These findings may partially explain the diminished rates of fat loss imposed by acute bouts of physical activity in those with paraplegia. 相似文献10.
Lisa M. Lombardo Stephanie N. Bailey Kevin M. Foglyano Michael E. Miller Gilles Pinault Ronald J. Triolo 《The journal of spinal cord medicine》2015,38(1):115-122
Objective
Explore whether electromyography (EMG) control of electrical stimulation for walking after incomplete spinal cord injury (SCI) can affect ability to modulate speed and alter gait spatial-temporal parameters compared to cyclic repetition of pre-programmed stimulation.Design
Single case study with subject acting as own concurrent control.Setting
Hospital-based biomechanics laboratory.Participants
Single subject with C6 AIS D SCI using an implanted neuroprosthesis for walking.Interventions
Lower extremity muscle activation via an implanted system with two different control methods: (1) pre-programmed pattern of stimulation, and (2) EMG-controlled stimulation based on signals from the gastrocnemius and quadriceps.Outcome measures
Gait speed, distance, and subjective rating of difficulty during 2-minute walks. Range of walking speeds and associated cadences, stride lengths, stride times, and double support times during quantitative gait analysis.Results
EMG control resulted in statistically significant increases in both walking speed and distance (P < 0.001) over cyclic stimulation during 2-minute walks. Maximum walking speed with EMG control (0.48 m/second) was significantly (P < 0.001) faster than the fastest automatic pattern (0.39 m/second), with increased cadence and decreased stride and double support times (P < 0.000) but no change in stride length (z = −0.085; P = 0.932). The slowest walking with EMG control (0.25 m/second) was virtually indistinguishable from the slowest with automatic cycling (z = −0.239; P = 0.811).Conclusion
EMG control can increase the ability to modulate comfortable walking speed over pre-programmed cyclic stimulation. While control methods did not differ at the lowest speed, EMG-triggered stimulation allowed significantly faster walking than cyclic stimulation. The expanded range of available walking speeds could permit users to better avoid obstacles and naturally adapt to various environments. Further research is required to definitively determine the robustness, generalizability, and functional implications of these results. 相似文献11.
Ichiro Sekiya Takeshi Muneta Masafumi Horie Hideyuki Koga 《Clinical orthopaedics and related research》2015,473(7):2316-2326
Background
Transplantation of mesenchymal stem cells (MSCs) is one possible strategy to achieve articular cartilage repair. We previously reported that synovial MSCs were highly proliferative and able to undergo chondrogenesis. We also found that placing a suspension of synovial MSCs on a cartilage defect for 10 minutes promoted cartilage repair in rabbit and pig models. However, the in vivo efficacy of this approach has not been tested clinically.Questions/purposes
We asked whether transplantation of synovial MSCs improves (1) MRI features, (2) histologic features, and (3) clinical evaluation scores in patients with cartilage defects in the knee?Methods
Patients with a symptomatic single cartilage lesion of the femoral condyle were indicated for inclusion in our study, and between April 2008 and April 2011, 10 patients were enrolled in this study. All patients completed followups of 3 years or more. The average followup period was 52 months (range, 37–80 months). Synovial MSCs were expanded with 10% autologous human serum for 14 days after digestion. For transplantation, the patient was positioned so that the cartilage defect was facing upward, and synovial MSC suspension was placed on the cartilage defect with a syringe under arthroscopic control. The defect with the applied suspension then was held in the upward position for 10 minutes. Five patients underwent concomitant ACL reconstructions, among whom two had meniscus suturing performed simultaneously. For MRI quantification, the cartilage defect was scored from 0 to 5. Second-look arthroscopy was performed for four patients and biopsy specimens were evaluated histologically. Clinical outcome was assessed using the Lysholm score and Tegner Activity Level Scale at final followup. Comparisons of MRI and Lysholm scores before and after treatment for each patient were analyzed using the Wilcoxon signed-rank test.Results
MRI score (median ± 95% CI) was 1.0 ± 0.3 before and 5.0 ± 0.7 after, and increased after treatment in each patient (p = 0.005). Second-look arthroscopy in four patients showed that the cartilage defect appeared to be qualitatively better in all cases. Histologic analyses showed hyaline cartilage in three patients and fibrous cartilage in one at the deep zone. The Lysholm score (median ± 95% CI) was 76 ± 7 before and 95 ± 3 after, and increased after treatment in each patient (p = 0.005). The Tegner Activity Level Scale did not decrease after treatment in each patient.Conclusions
For this small initial case series, transplantation of synovial MSCs was effective in terms of MRI score, qualitative histology, and Lysholm score. The use of synovial MSCs has an advantage in that the cells can be prepared at passage 0 in only 14 days. Transplantation of synovial MSCs may be less invasive than mosaicplasty and autologous chondrocyte implantation. To conclusively show the effectiveness of this treatment requires comparative studies, especially with more established arthroscopic procedures, such as marrow stimulation techniques.Level of Evidence
Level IV, therapeutic study. 相似文献12.
Cherie P. Erkmen Richard J. Barth Jr. Vignesh Raman 《International journal of surgery case reports》2014,5(7):424-427
INTRODUCTION
Chordomas are rare but aggressive tumors due to local recurrence and distant metastases. They originate commonly in the sphenooccipital and sacrococcygeal regions, and metastasize to the lungs, bone, skin, liver, and lymph nodes. They occur more frequently in men and people over the age of 40.PRESENTATION OF CASE
A 28 year-old female presented with sacrococcygeal chordoma for which she received wide local excision and adjuvant radiation therapy. She enjoyed an unusual disease-free survival for 11 years until a routine surveillance scan of the pelvis identified local recurrence. Further work up revealed bilateral pulmonary metastases. She underwent local excision of the recurrent tumor and video-assisted thoracoscopic (VATS) wedge resection of pulmonary metastases. She also received adjuvant radiation therapy to the recurrent resection bed. Two years later, she remains free of disease and symptoms.DISCUSSION
Chordomas are commonly insensitive to chemotherapy and radiation, making surgery the most successful therapeutic modality. However, there are few guidelines on the surveillance and treatment of recurrent chordoma. We report success with aggressive surgical resection of recurrence and metastasis as well as adjuvant radiation therapy.CONCLUSION
The prolonged survival of our patient underscores the importance of (1) aggressive surgical resection of chordoma, whether primary, recurrent, or metastatic, with adjuvant radiation therapy, (2) minimization of surgical seeding of tumor, and (3) diligent cancer surveillance. 相似文献13.
Abbas Norouzi Javidan Hadis Sabour Sahar Latifi Farzad Shidfar Mohammad Reza Vafa Ramin Heshmat Hasan Emami Razavi Bagher Larijani Hamidreza Aghaei Meybodi 《The journal of spinal cord medicine》2014,37(6):744-750
Objectives
We described the associations between demographic and injury-related factors on bone mineral density (BMD) of the spine and the hip among adult patients with chronic spinal cord injury (SCI).Design
BMD in spinal and femoral bone sites were assessed. Multivariate analysis was performed to evaluate the relationship between anthropometric and injury-related factors with BMD. Serum level and amount of dietary intake of calcium, phosphor, and 25-hydroxy vitamin D were measured.Setting
A referral tertiary rehabilitation center in Iran.Participants
Patients with SCI who had no previous history of endocrine disorders and were not on specific medications entered the investigation. Those with non-traumatic SCI, pregnant, or with substance dependency were excluded as well.Interventions
No interventions were applied.Main study outcome measures
Dual X-ray absorptiometry was performed to estimate BMD. Body mass index was positively associated with higher femoral (P < 0.01, r = 0.56) and hip (P < 0.0001, r = 0.82) BMD only in female participants. The high prevalence of vitamin D deficiency (60%) was noticeable.Results
Older male patients revealed lower BMD only in spinal vertebrae (P < 0.02, r = −0.21). A significant higher BMD loss in lumbar vertebras in male patients with complete spinal cord lesion (P < 0.009) was detected. Spinal reduction of BMD was more severe when the level of injury was above T6 (P < 0.02).Conclusion
Along with the clarification of age, gender, post injury duration, and the other factors'' effect on the BMD in the SCI patients, here we have also shown the noticeable prevalence of the 25-hydoxy vitamin D deficiency in these patients which needs attention. 相似文献14.
Sharon Gabison Molly C. Verrier Sylvie Nadeau Dany H. Gagnon Audrey Roy Heather M. Flett 《The journal of spinal cord medicine》2014,37(5):537-547
Context
Trunk control is essential to engage in activities of daily living. Measuring trunk strength and function in persons with spinal cord injury (SCI) is difficult. Trunk function has not been studied in non-traumatic SCI (NTSCI).Objectives
To characterize changes in trunk strength and seated functional reach in individuals with NTSCI during inpatient rehabilitation. To determine if trunk strength and seated reach differ between walkers and wheelchair users. To explore relationships between trunk and hip strength and seated functional reach.Design
Observational study.Setting
Two SCI rehabilitation facilities.Participants
32 subacute inpatients (mean age 48.0 ± 15.4 years).Outcome measures
Isometric strength of trunk and hip and function (Multidirectional Reach Test: MDRT) were assessed at admission and within 2 weeks of discharge. Analysis of variance was conducted for admission measures (MDRT, hip and trunk strength) between walkers and wheelchair users. Changes in MDRT, hip and trunk strength were evaluated using parametric and non-parametric statistics. The level of association between changes in values of MRDT and strength was also examined.Results
Significant differences between walkers and wheelchair users were found for strength measures (P < 0.05) but not for MDRT. Left- and right-sided reaches increased in wheelchair users only (P < 0.05). Associations between changes in hip strength, trunk strength, and reach distance were found (R = 0.67–0.73).Conclusion
In clinical settings, it is feasible and relevant to assess trunk, hip strength, and MRDT. Future studies require strategies to increase the number of participants assessed, in order to inform clinicians about relevant rehabilitation interventions. 相似文献15.
16.
Yal?n Dirik Arda ??nar Feridun Yumruk?al Levent Eralp 《International journal of surgery case reports》2014,5(11):840-844
INTRODUCTION
We report a case with lymph node metastasis of osteosarcoma, which is a rare entity in comparison to hematogeneous lung or bone metastasis.PRESENTATION OF CASE
Twenty-seven years old male patient referred to our clinic complaining of ongoing left knee pain and swelling since one month without a history of prior trauma. Magnetic resonance imaging (MRI) revealed a mass of malignant nature which causes more prominent expansion and destruction of the bone distally with periosteal reaction. A lymphadenomegaly 16 mm × 13 mm in diameter was also present in the popliteal fossa having the same signal pattern with the primary lesion. Thirteen weeks following the first referral of the patient, wide resection and reconstruction with modular tumor prosthesis was performed. Popliteal lymph node was excised through the same incision. Pathologic examination of the resected speciman reported osteoblastic osteosarcoma. The lymph node extirpated from the popliteal fossa was reported to be a metastasis of the primary tumor.DISCUSSION
Osteosarcoma of the long bones is the most common primary malignant bone neoplasm of both childhood and adulthood. Osteosarcomas commonly metastasize hematogeneously to the lungs and bones. Lymph node metastasis is a rare entity. Similar studies report rates between 2.3% and 4%. It is not clearly explained, how lymph node metastasis in osteosarcoma occurs despite lack of lymphatic drainage in normal cortical and spongious bone.CONCLUSION
Lymph node metastasis of osteosarcoma is a rare entity and metastatic patterns could not be clearly explained. On the other hand, the effects of lymph node metastasis on prognosis are also not clearly defined and further studies are needed. 相似文献17.
Michèle Hubli Katharine D. Currie Christopher R. West Cameron M. Gee Andrei V. Krassioukov 《The journal of spinal cord medicine》2014,37(6):782-785
Objective/background
Aortic pulse wave velocity (PWV), the gold-standard assessment of central arterial stiffness, has prognostic value for cardiovascular disease risk in able-bodied individuals. The aim of this study was to compare aortic PWV in athletes and non-athletes with spinal cord injury (SCI).Design
Cross-sectional comparison.Methods
Aortic PWV was assessed in 20 individuals with motor-complete, chronic SCI (C2–T5; 18 ± 8 years post-injury) using applanation tonometry at the carotid and femoral arterial sites. Ten elite hand-cyclists were matched for sex to 10 non-athletes; age and time since injury were comparable between the groups. Heart rate and discrete brachial blood pressure measurements were collected throughout testing.Outcome measures
Aortic PWV, blood pressure, heart rate.Results
Aortic PWV was significantly lower in athletes vs. non-athletes (6.9 ± 1.0 vs. 8.7 ± 2.5 m/second, P = 0.044). There were no significant between-group differences in resting supine mean arterial blood pressure (91 ± 19 vs. 81 ± 10 mmHg) and heart rate (60 ± 10 vs. 58 ± 6 b.p.m.).Conclusion
Athletes with SCI exhibited improved central arterial stiffness compared to non-athletes, which is in agreement with the previous able-bodied literature. This finding implies that chronic exercise training may improve arterial health and potentially lower cardiovascular disease risk in the SCI population. 相似文献18.
Charlesnika T. Evans Jennifer N. Hill Marylou Guihan Amy Chin Barry Goldstein Michael S. A. Richardson Vicki Anderson Kathleen Risa Susan Kellie Kenzie A. Cameron 《The journal of spinal cord medicine》2014,37(2):152-161
Objectives
To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).Design
Blinded, block-randomized controlled pilot trial.Setting
Two Department of Veterans Affairs (VA) SCI Centers.Participants
Veterans were recruited March–September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.Intervention
Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.Outcome measures
Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.Results
Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25–3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI −0.08–2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.Conclusions
A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants’ knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status. 相似文献19.
Avraam Ploumis Jayne M. Donovan Mobolaji O. Olurinde Dana M. Clark Jason C. Wu Douglas J. Sohn Kevin C. O'Connor 《The journal of spinal cord medicine》2015,38(2):193-198