Discrete sensors distribution for accurate plantar pressure analyses

The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23–58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC = 0.99; vGRF SCC = 0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system.     

A three-dimensional computed tomography study of distal femoral morphology in Japanese patients: Gender differences and component fit

BackgroundPrevious anthropometric studies have reported gender differences in distal femoral morphology. However, to date, very few studies have investigated the knee morphology of Japanese adults and possible gender differences. The purpose of this study was to examine the distal femoral morphology of Japanese patients, to characterize anatomical differences between male and female, and to evaluate the need to create gender-specific knee prostheses.Material and methodsWe evaluated 80 knees in 40 male and 40 female Japanese patients scheduled for total knee arthroplasty (TKA). The mediolateral (ML) and anteroposterior (AP) dimensions of the knees at different levels were measured preoperatively using three-dimensional computed tomography, and ML/AP aspect ratios were calculated.ResultsOn the distal femoral cut surface, the mean ML widths were 74.9 mm for male and 65.1 mm for female, and the mean AP lengths were 63.4 mm for male and 58.9 mm for female. Such values were generally smaller compared to data from European and North American studies. In this study, the mean ML/AP aspect ratios were 1.31 for male and 1.25 for female, higher than those from non-Asian regions. The ML/AP ratios of Japanese patients were negatively correlated with distal femoral AP length.ConclusionsJapanese female had a relatively narrower femoral width for a given AP length than male. Our study suggests the utility of Japanese-specific implants and provides useful insights for manufacturers to design components of appropriate sizes and aspect ratios for Japanese TKA patients.     

Changes in sitting posture induce multiplanar changes in chest wall shape and motion with breathing

This study examined the effect of sitting posture on regional chest wall shape in three dimensions, chest wall motion (measured with electromagnetic motion analysis system), and relative contributions of the ribcage and abdomen to tidal volume (%RC/V_t) (measured with inductance plethysmography) in 7 healthy volunteers. In seven seated postures, increased dead space breathing automatically increased V_t (to 1.5 V_t) to match volume between conditions and study the effects of posture independent of volume changes. %RC/V_t (p < 0.05), chest wall shape (p < 0.05) and motion during breathing differed between postures. Compared to a reference posture, movement at the 9th rib lateral diameter increased in the thoracolumbar extension posture (p < 0.008). In slumped posture movement at the AP diameters at T1 and axilla increased (p < 0.00001). Rotation postures decreased movement in the lateral diameter at the axilla (p < 0.0007). The data show that single plane changes in sitting posture alter three-dimensional ribcage configuration and chest wall kinematics during breathing, while maintaining constant respiratory function.     

Comparison of electrocardiogram aVR QRS metrics,as indices of the sums of leads I and II,and all 6 limb leads

Electrocardiogram (ECG) peak-to peak amplitude (Pk-pk) of the limb leads, in the form of sums of leads I and II (I + II), or all 6 limb leads (Σ6Lblds), and lead aVR have been employed for the monitoring of patients with edematous states (ES), including heart failure (HF), or those undergoing hemodialysis (HD). The aim of this study was to compare aVR metrics (net QRS area [NQRSA], total QRS area [TQRSA], Pk-pk, and QRS root mean square [QRSRMS]) as indices of the corresponding metrics of I + II and Σ6Lblds. Automated measurements of the above metrics deriving from a set of randomly selected 1784 ECGs were compared and inter-correlated. NQRSA of aVR showed the best correlation with I + II (r = ?0.99) and Σ6Lblds (r = ?0.78), while Pk-pk the worst (r = 0.68) and (r = 0.62), correspondingly. NQRSA of aVR has advantages over Pk-pk, reflecting I + II or Σ6Lblds, and thus it might be employed in serial ECGs for the monitoring of patients with ES, including HF, and HD. However the present paper constitutes a methodological work, and thus the performance of NQRSA of aVR in monitoring patients with ES needs to be substantiated by a future study. Automated measurements of NQRSA of aVR are provided by many contemporary electrocardiographs upon recording of the ECG and could be put to use at the “point of care”.     

Nonlinear properties of cardiac rhythm and respiratory signal under paced breathing in young and middle-aged healthy subjects

We examined the effects of gender and age in young and middle-aged subjects on the level of cardio-respiratory interaction by analyzing properties of cardiac, respiratory and cardiac-respiratory regulatory mechanisms under paced breathing. In 56 healthy subjects, ECG (RR interval) and respiratory signal were simultaneously acquired in supine position at paced (0.1–0.45 Hz, steps of 0.05 Hz) and spontaneous breathing. The participants were divided into gender matched group of young adults (19–25 years old) and middle-aged adults (35–44 years old). Power spectral analysis was applied on RR interval time series and spectral components in very low frequency (VLF), low frequency (LF) and high frequency (HF) ranges were computed. We also calculated sample entropy of RR interval series (SampEnRR), respiratory series (SampEnResp), and their cross-sample entropy (cross-SampEn). Under paced breathing, reduction of all spectral powers with age (p < 0.05) is not gender dependent but reduction of some entropy measures is; SampEnRR and SampEnResp were lower only in men (p < 0.05). In the middle-aged subjects, effect of gender on spectral measures is significant; males had lower HF (p < 0.05). Pattern of dependencies of SampEn and cross-SampEn on paced breathing frequency were significantly different in men (young vs. middle-aged, p = 0.001 and p = 0.037) and in middle-aged subjects (females vs. males, p = 0.011 and p = 0.008). In middle-aged males, lower entropy measures indicated reduced and less complex partial cardiac and respiratory control, and central cardio-respiratory control. In conclusion, in healthy middle-aged subjects changes in cardio-respiratory coupling are detectable only in males.     

Increased expression of the intercellular adhesion molecule-1 (ICAM-1) on peripheral blood neutrophils in acute pancreatitis

PurposeConsidering the important role of neutrophils’ activation in the pathogenesis of acute pancreatitis (AP), the aim of our study was to evaluate the expression of leukocytes’ adhesion molecules in patients with AP.Patients/methodsThirty-five patients (16 women and 19 men; age 32–77 years, median 56 years) with AP were prospectively included into our study. The absolute number of leukocytes was estimated by haematologic analyser. Surface neutrophils antigens (CD) were assayed by the direct fluorescence method for whole blood, using a flow cytometer.ResultsAt the day 1, significant increase of ICAM-1 expression was found in patients with severe AP (S-AP) (7280 mm⁻³ vs 2850 mm⁻³ in healthy control; p < 0.05). In the days 2, 3 and 5 it sharply decreased and peaked again to 4860 mm⁻³ at the day 10. In patients with mild AP (M-AP), not significant elevation of ICAM-1 quickly returned to normal level. In both forms of AP, neutrophil CD62L (L-selectin) expression reached the highest level at the day 1 (8800 mm⁻³ and 9020 mm⁻³, respectively in M-AP and S-AP, in comparison to 3400 mm⁻³ in control; p < 0.05). Expression of CD69 (neutrophils’ marker of early activation) significantly increased in both M-AP and S-AP.ConclusionsWe have found an early and significant increase of peripheral blood neutrophil CD54/ICAM-1 expression, specific for S-AP but not for M-AP. It may provide a good marker predicting severe course of pancreatitis.     

Bilateral vagotomy attenuates the severity of secretagogue-induced acute pancreatitis in the rat

PurposeWe assessed the effect of bilateral vagotomy (BV) on the course of acute caerulein-induced pancreatitis (AP) in the rat.Material/methodsThe study was performed on Wistar rats surgically prepared by subdiaphragmatic BV. Control group underwent sham operation. Four days later, AP was induced by subcutaneous injection of caerulein (25 μg/kg/5 h) to the conscious animals with or without BV. After administration of caerulein the blood samples were taken for determination of serum lipase activity and interleukin-10 (IL-10) concentration. Pancreatic tissue samples were subjected to histological examinations and to the measurement of lipid peroxidation products (MDA + 4-HNE) concentration and the activity of an antioxidant enzyme – glutathione peroxidase (GPx). After application of caerulein pancreatic blood flow was measured by laser Doppler flowmetry.ResultsAP was manifested by oedema and neutrophil infiltration of the pancreatic tissue and accompanied by significant increases of serum lipase activity, serum concentration of IL-10 and pancreatic concentration of MDA + 4HNE (ca. 50×, 2× and 4× respectively p ≥ 0.05). Pancreatic activity of GPx and pancreatic blood flow were decreased (both by 60%). In vagotomised rats with AP serum lipase activity and pancreatic concentration of MDA + 4-HNE were lower whereas Il-10 concentration and pancreatic activity of GPx, as well as pancreatic blood flow were significantly higher as compared to AP rats with intact vagal nerves. In AP rats with vagotomy all histological signs of pancreatitis were significantly reduced.ConclusionsBilateral vagotomy resulted in the significant attenuation of caerulein-induced pancreatitis in the rat.     

Tibial tunnel widening after hamstring anterior cruciate ligament reconstructions: Comparison between Rigidfix and bio-Transfix

BackgroundThere is no study comparing tibial tunnel widening after hamstring anterior cruciate ligament (ACL) reconstructions between RigidFix(r) and Bio-TransFix(r).MethodsHamstring ACL reconstructions using RigidFix(r) in 56 patients and Bio-TransFix(r) in 41 with a minimum of 2 years postoperative evaluation were reviewed. Tibial fixation was performed using Intrafix in both groups. On the anterior–posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and instrumented laxity testing using the KT-1000 arthrometer.ResultsOn the AP and lateral radiographs, the average diameter of the tibial tunnel in the Bio-TransFix(r) group significantly increased after 6 months compared to the immediate postoperative measurement (p = 0.002 and p = 0.002, respectively). However, the average diameter of the tibial tunnel in the RigidFix(r) group did not increase after 6 months compared to the immediate postoperative measurement. Tunnel widening at 12 months postoperatively in the Bio-TransFix(r) group was significantly more than that of the RigidFix(r) group on AP and lateral radiographs (p = 0.012 and 0.016, respectively). Tunnel widening at 24 months postoperatively showed a significant difference between the two groups (p = 0.000 and 0.000, respectively). Fifteen patients (36.6%) in the Bio-TransFix(r) group and 15 patients (26.8%) in the RigidFix(r) group showed tunnel widening. There were no significant differences in results of the Lachman and pivot-shift tests, and mean KT-1000 measurement between the two groups.ConclusionThe Bio-TransFix(r) group showed progressive tibial tunnel widening after 6 months postoperatively but no clinical signs of instability.Level of evidenceLevel III.     

Intraoperative fluoroscopy shows better agreement and interchangeability in tibial tunnel location during single bundle anterior cruciate ligament reconstruction with postoperative three-dimensional computed tomography compared with an intraoperative image-free navigation system

BackgroundFluoroscopy and navigation systems provide an accurate and reproducible method of guiding anatomical tunnel positioning during anterior cruciate ligament reconstruction (ACLR). The aim was to evaluate the differences in tibial tunnel location assessed by both an intraoperative navigation system and fluoroscopy, validated using a one-week postoperative three-dimensional computed tomography (3DCT).MethodsThe tibial tunnel location in a consecutive series of 35 patients who received a single-bundle ACLR was evaluated by intraoperative navigation system, fluoroscopic image and compared with postoperative 3DCT position. The location to the anterior–posterior (AP) and medial–lateral (ML) direction were compared between all three methods.ResultsThe tibial tunnel locations were 46.7 ± 4.5%, 44.5 ± 1.9%, and 43.6 ± 2.4% in ML direction, and 42.8 ± 7.6%, 37.9 ± 3.8%, and 37.9 ± 3.7% in AP direction using an intraoperative navigation system, fluoroscopic image and postoperative 3DCT, respectively. Significant differences between the navigation system and fluoroscopic image (ML, P = 0.001; AP, P = 0.006), and the navigation system and 3DCT (ML, P = 0.001; AP, P < 0.001) were seen. However, there was no significant difference between fluoroscopy and 3DCT (ML, P = 0.315; AP, P = 0.999). There was a significant lack of agreement for analyses measured using a navigation system and 3DCT. Fluoroscopy and 3DCT demonstrated an acceptable agreement (ML, r_pt = − 0.21, P = 0.232; AP, r_pt = 0.04, P = 0.826).ConclusionsA tibial tunnel location assessed by intraoperative fluoroscopy shows better agreement and interchangeability with one-week postoperative 3DCT validation during single-bundle ACLR compared with an intraoperative image-free navigation system.     

A comparison of Star Excursion Balance Test reach distances between ACL deficient patients and asymptomatic controls

ACL injury has been associated with a decrease in proprioceptive performance and specifically postural control. Tests of postural control have been criticised for not being sufficiently challenging. The Star Excursion Balance Test (SEBT) has been proposed to offer sufficient challenge to be a sensitive test for detecting performance deficits related to pathology. The purpose of this study was to determine if decrements SEBT reach distance is associated with ACL deficiency (ACLD). Twenty five ACLD patients ACLD (17 male and 8 female, mean age 30 (SD 4.5) years) and twenty five matched controls were examined carrying out the SEBT. Factorial ANOVA showed the main effects of limb (p = 0.006) and direction (p < 0.001) and interaction of limb and direction (p = 0.015) all had significant differences between the groups. Further analysis revealed significant differences between the control group and the ACLD limb for the limb movement directions of anterior (p = 0.0032), lateral (p = 0.005), posterior-medial (p = 0.0024) and medial (p = 0.001). There were also significant differences between the control limbs and uninjured limb of the patients for the directions of medial (p = 0.001) and lateral (p = 0.001). ACLD patients appear to have deficiencies in their dynamic postural control when compared to normal asymptomatic subjects. Interestingly, in the ACLD patients, their uninjured leg show deficits compared to the control in two of the four directions the ACLD leg was deficient, this may be indicative of a postural control deficit in these patients, which may have predisposed to the ACL injury and would warrant further study.     

Bone mineral density in pediatric survivors of Hodgkin and non-Hodgkin lymphomas

PurposeTo assess skeletal mass in survivors of childhood Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) 1–5 years after treatment, and to identify potential risk factors influencing bone mineral density (BMD).Patients/methodsThis cross-sectional study was conducted in a cohort of 43 survivors (HD = 31; NHL = 12); mean age: 16.21 ± 4.4. Total body bone mineral content (TBMC) and density (TBBMD), and lumbar spine density (LSBMD) were determined using dual-energy X-ray absorptiometry.ResultsThree of all 43 patients developed low BMD. No significant differences in height, weight, and/or BMD Z-scores were found between HD and NHL survivors, children who received and did not receive radiotherapy, and the groups with different chemotherapeutic blocks. No differences were noted between the Z-scores of BMC (mean ± SD: 0.31 ± 1.29 vs. −0.089 ± 0.61, p = 0.165), TBBMD (mean ± SD: −0.32 ± 1.21 vs. −0.27 ± 0.91, p = 0.76), or the LSBMD (mean ± SD: −0.183 ± 1.54 vs. −0.17 ± 0.87, p = 0.637) in subgroups, in accordance with time after therapy (subgroup I < 2 years and subgroup II > 2 years after treatment). In HD survivors, age at diagnosis only affected the TBBMD Z-score (a decrease of 0.127 in total BMD Z-score per each year, R² = 0.999, p < 0.001).ConclusionsChildhood lymphoma survivors demonstrate no significant deficits in bone mass and tend to maintain their BMD within the normal range when presenting during one to five years’ follow-up. However, this specific group requires longitudinal investigation to assess the pattern of peak bone mass achievement and the risk of future bone loss.     

Assessment of tibiofemoral position in total knee arthroplasty using the active flexion lateral radiograph

This study is a retrospective comparative cohort radiographic analysis of 114 consecutive patients who underwent posterior cruciate retaining (PCR) total knee arthroplasty (TKA), medial and patellofemoral compartment bicruciate retaining arthroplasty (BCR), or bicruciate substituting (BCS) TKA. In an effort to obtain a quantitative measurement of both anteroposterior (AP) tibiofemoral position and active knee flexion we have routinely taken post-operative lateral radiographs in a position of maximal active flexion. Passive range of motion (PRoM) after TKA was significantly greater than pre-operative passive range of motion for each cohort (p < 0.001). When comparing post-operative active range of motion (ARoM) to PRoM, there was a statistically significant difference within the PCR and BCR cohorts (p < 0.001 and p < 0.005, respectively), while none was detected in the BCS group (p = 0.09). The mean rollback of PCR was ? 1.2 mm, BCR was ? 3.3 mm and BCS was ? 12.0 mm. The mean rollback of all three groups was similar to measurements reported from previous fluoroscopic historical control data. Our findings indicate that tibiofemoral AP translation during knee flexion can be assessed on an active flexion lateral knee radiograph and provide additional information that is not available from a routine lateral radiograph.     

Gender differences of the morphology of the distal femur and proximal tibia in a Korean population

PurposeWe conducted this study to determine whether the sizes of distal femurs and proximal tibiae in Korean men and women are different, and to assess suitability of the sizes of prostheses currently used in Korea.Materials and methodsWe performed morphological analysis of proximal tibia and distal femur on 115 patients (56 male, 59 female) using MRI to investigate a gender difference. Tibial mediolateral dimension (tMAP), tibial medial anteroposterior dimension (tMAP), tibial lateral anteroposterior dimension (tLAP) femoral mediolateral dimension (fML), femoral medial anteroposterior dimension (fMAP), and femoral lateral anteroposterior dimension (fLAP) were measured. The ratio of tMAP and tLAP to tML (plateau aspect ratio, tAP/tML × 100%), and that of fMAP and fLAP to fML (condylar aspect ratio, fAP/fML × 100%) were calculated. The measurements were compared with the similar dimensions of four total knee implants currently used.ResultsThe tML and tAP lengths showed a significant gender difference (P < 0.05). The plateau aspect ratio (tMAP/tML) revealed a significant difference between male (0.74 ± 0.05) and female (0.68 ± 0.04, P < 0.05). For morphotype of distal femur, males were found to have significantly large values (P < 0.05) in the parameters, except for fLAP. With regards to the ratio of the ML width to the AP length, the women showed a narrower ML width than the men. Both genders were distributed within the range of the dimensions of the prostheses currently used prostheses.ConclusionsKorean population revealed that women have smaller dimensions than male counterparts. In both genders, a relatively small size of prostheses matches distal femur and proximal tibia better among the implants currently used in Korea.     

Can an accelerometer enhance the utility of the Timed Up & Go Test when evaluating patients with Parkinson's disease?

IntroductionThe Timed Up and Go (TUG) test is a widely used measure of mobility and fall risk in older adults and in Parkinson's disease (PD). We tested the hypothesis that body-fixed accelerometers can provide insight into TUG performance in PD patients.MethodsWe examined 17 patients with PD (Hoehn and Yahr score: 2.7 ± 0.7; ON state) and 15 age-matched healthy controls; mean ages were 66.8 ± 5.9 years, 67.6 ± 9.6 years, respectively. Subjects wore a 3D-accelerometer (ADXL330, Analog Devices) on the lower back while performing the TUG test. Sit-to-Stand and Stand-to-Sit times were extracted from the anterior–posterior (AP) signal. Parameters included Sit-to-Stand, Stand-to-Sit durations, amplitude range (Range) and slopes (Jerk). Acceleration median and standard deviation (SD) were also calculated.ResultsStopwatch-based TUG duration tended to be higher for the PD patients compared to the control group, although not significantly (p = 0.08). In contrast, the TUG duration that was extracted from the acceleration signal was significantly (p < 0.02) higher in the PD group compared to the control group. Many acceleration-parameters were also significantly different (p < 0.05) between groups; most were not correlated with TUG duration.ConclusionsAccelerometer-derived parameters are sensitive to group differences, indicating that PD patients have poorer mobility during specific aspects of the TUG. In addition to test duration, these measures may serve as complementary and objective bio-markers of PD to augment the evaluation of disease progression and the response to therapeutic interventions.     

Gender-based differences in the dimensions of the femoral trochlea and condyles in the Chinese population: Correlation to the risk of femoral component overhang

BackgroundFemoral component overhang has been observed in total knee arthroplasty with different prostheses. The purpose of this study is to assess gender-based anatomical differences of the distal femur and femoral trochlea in the Chinese population and analyze the risk sites of femoral component overhang in relation to any significant anatomical differences.MethodsMeasurements of distal condylar and femoral trochlea were made through three-dimensional computed tomographic modeling of 200 normal Chinese knees; the anatomical differences between genders and its relations to the femoral component overhang were analyzed. Four implants were also measured and compared.ResultsThe ML/AP ratios of the femoral condyles showed statistically significant gender-based variation (Men:Women = 1.06:1.03, P < 0.0001). Both the proximal and distal ML widths of the trochlea were generally larger in the men than those of the women. Regression analysis of the morphological data showed that as the measuring level moves distally along the femur, the coronal width deviation between genders progressively increases to peak at the distal condyles. Female subjects had a smaller aspect ratio than those of four implants and a smaller trochlear ML width than those of three implants.ConclusionsThe males show significantly greater coronal dimensions of the trochlea than women which are likely to contribute to the higher prevalence of prosthetic overhang in women with some standard implants.Clinical relevanceThe overhang is most likely to occur in the distal femoral condyle and the distal region of the femoral trochlea when a standard knee prosthetic system is used in the Chinese women.     

Low-dose 17-β-estradiol cream for vaginal atrophy in a cohort without prolapse: Serum levels and vaginal response including tissue biomarkers associated with tissue remodeling

ObjectivesDescribe the effect of 50 mcg vaginal 17-β-estradiol (E2) cream on vaginal maturation, serum estrogen levels, atrophic symptoms, and biomarkers of oxidative stress and tissue remodeling in postmenopausal women without prolapse.MethodsSeventeen women, 65 years or older, applied intravaginal E2 cream nightly for eight weeks, then twice weekly for eight weeks. Vaginal biopsies, serial blood draws, and atrophic symptoms were obtained at baseline, eight, and sixteen weeks. Changes in atrophic symptoms, vaginal maturation indices (VMI), and serum E2 were measured. Immunohistochemical staining characterized levels of transforming growth factor-beta (TGF-β), nuclear factor kappa B (NFKB), inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and thrombospondin (TSP).ResultsSerum E2 levels (pg/ml) were unchanged from baseline (mean (SD)) 7.7 (3.3) to eight 9.7 (5.7) and sixteen 8.7 (5.8) (p = 0.24) weeks. VMI (mean (SD)) improved from baseline 34.2 (18.3) to eight 56.7 (13.1) and sixteen 54.5 (11.3) (p < 0.001) weeks with no difference between eight and sixteen weeks. Vaginal dryness (p = 0.03) and itching (p = 0.02) improved. Tissue biomarker levels did not change (TGF-β p = 0.35, NFKB p = 0.74, eNOS p = 0.80, iNOS p = 0.24, TSP p = 0.80).DiscussionVaginal E2 improved atrophic symptoms and VMI without elevating serum E2. Tissue remodeling biomarkers did not change.     

Automatic summarization of MEDLINE citations for evidence-based medical treatment: A topic-oriented evaluation

As the number of electronic biomedical textual resources increases, it becomes harder for physicians to find useful answers at the point of care. Information retrieval applications provide access to databases; however, little research has been done on using automatic summarization to help navigate the documents returned by these systems. After presenting a semantic abstraction automatic summarization system for MEDLINE citations, we concentrate on evaluating its ability to identify useful drug interventions for 53 diseases. The evaluation methodology uses existing sources of evidence-based medicine as surrogates for a physician-annotated reference standard. Mean average precision (MAP) and a clinical usefulness score developed for this study were computed as performance metrics. The automatic summarization system significantly outperformed the baseline in both metrics. The MAP gain was 0.17 (p < 0.01) and the increase in the overall score of clinical usefulness was 0.39 (p < 0.05).     

Effects of aripiprazole adjunctive to standard antidepressant treatment on the core symptoms of depression: A post-hoc,pooled analysis of two large,placebo-controlled studies

BackgroundAlthough antipsychotic agents have a long history of use in depression, their effectiveness in treating core symptoms of depression such as loss of interest has been questioned. Adjunctive aripiprazole is beneficial for the treatment of patients with major depressive disorder but its effects on specific symptoms have not been reported. The objective of this study was to examine the effects of aripiprazole on core symptoms of depression.MethodsThis is a post-hoc, pooled analysis of two trials of aripiprazole augmentation of standard antidepressants (ADT) in patients with major depression. Patients with an inadequate response to ADT received adjunctive aripiprazole (n = 373) or placebo (n = 368) for 6 weeks. Change on four subscales of the 17-item Hamilton Depression Rating Scale (HAM-D17) that capture core depression symptoms was determined and change on individual HAM-D items also was assessed. The magnitude of within-group change for the subscales and individual items was expressed as effect size (ES) and between-group significance tested with ANCOVA. The magnitude of change was also examined comparing the response rates for aripiprazole and placebo on HAM-D17 and the four subscales. Change on three composite subscales — anxiety, insomnia and drive was also examined.ResultsWithin-group change on the four core subscales was substantial (ES = 1.1–1.2) and similar to that for the 17-item HAM-D total score. Between-group comparisons indicated mean change and response rates were significantly greater with adjunctive aripiprazole than placebo for each core subscale (all p < 0.01). Individual HAM-D17 items showing the greatest change from baseline with adjunctive aripiprazole: depressed mood (within-group ES = 1.03) work and activities (ES = 0.86), guilt (ES = 0.77) and psychic anxiety (ES = 0.67) are the same symptoms identified by each of the core subscales and each of these items differed significantly from change on that item with placebo (p < 0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than placebo with respect to mean change for anxiety, insomnia and drive (all p < 0.001).ConclusionsAripiprazole augmentation of standard ADT results in significant, clinically meaningful changes in the core symptoms of depression. It is also associated with significant change in anxiety, insomnia, and drive components of the 17-item HAM-D.     

A novel technique,dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: A preliminary biomechanical study

BackgroundAnterior cruciate ligament (ACL) rupture is a common lesion. Current treatment emphasizes arthroscopic ACL reconstruction via a graft, although this approach is associated with potential drawbacks. A new method of dynamic intraligamentary stabilization (DIS) was subjected to biomechanical analysis to determine whether it provides the necessary knee stability for optimal ACL healing.MethodsSix human knees from cadavers were harvested. The patellar tendon, joint capsule and all muscular attachments to the tibia and femur were removed, leaving the collateral and the cruciate ligaments intact. The knees were stabilized and the ACL kinematics analyzed. Anterior–posterior (AP) stability measurements evaluated the knees in the following conditions: (i) intact ACL, (ii) ACL rupture, (iii) ACL rupture with primary stabilization, (iv) primary stabilization after 50 motion cycles, (v) ACL rupture with DIS, and (vi) DIS after 50 motion cycles.ResultsAfter primary suture stabilization, average AP laxity was 3.2 mm, which increased to an average of 11.26 mm after 50 movement cycles. With primary ACL stabilization using DIS, however, average laxity values were consistently lower than those of the intact ligament, increasing from an initial AP laxity of 3.00 mm to just 3.2 mm after 50 movement cycles.ConclusionsDynamic intraligamentary stabilization established and maintained close contact between the two ends of the ruptured ACL, thus ensuring optimal conditions for potential healing after primary reconstruction. The present ex vivo findings show that the DIS technique is able to restore AP stability of the knee.     

Shoulder pain and time dependent structure in wheelchair propulsion variability

Manual wheelchair propulsion places considerable repetitive mechanical strain on the upper limbs leading to shoulder injury and pain. While recent research indicates that the amount of variability in wheelchair propulsion and shoulder pain may be related. There has been minimal inquiry into the fluctuation over time (i.e. time-dependent structure) in wheelchair propulsion variability. Consequently the purpose of this investigation was to examine if the time-dependent structure in the wheelchair propulsion parameters are related to shoulder pain. 27 experienced wheelchair users manually propelled their own wheelchair fitted with a SMARTWheel on a roller at 1.1 m/s for 3 min. Time-dependent structure of cycle-to-cycle fluctuations in contact angle and inter push time interval was quantified using sample entropy (SampEn) and compared between the groups with/without shoulder pain using non-parametric statistics. Overall findings were, (1) variability observed in contact angle fluctuations during manual wheelchair propulsion is structured (Z=3.15;p<0.05), (2) individuals with shoulder pain exhibited higher SampEn magnitude for contact angle during wheelchair propulsion than those without pain (χ²(1)=6.12;p<0.05); and (3) SampEn of contact angle correlated significantly with self-reported shoulder pain (r_{s (WUSPI)} =0.41;r_{s (VAS)}=0.56;p<0.05). It was concluded that the time-dependent structure in wheelchair propulsion may provide novel information for tracking and monitoring shoulder pain.