Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50 Hz frequency, with low intensity of 20 Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study.ResultsFifty participants with non-specific low back pain (control group n = 25; experimental group n = 25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.     

Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study

BackgroundWomen with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts.MethodsA linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume > 1200 ml, age 45.9 y SD 9.9 y, BMI 29.0 kg/m² SD 3.8 kg/m²) and 26 women with small breasts (bilateral breast volume < 800 ml, age 43.8 y SD10.9 y, BMI 23.3 kg/m² SD 2.9 kg/m²).FindingsWomen with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3–58.0 versus 24.1, 95%CI 12.5–37.8), accompanied by a larger flexion torque (5.9 Nm, 95%CI 4.5–5.8 Nm versus 0.9 Nm, 95%CI 0.8–2.4 Nm), greater thoracic kyphosis (34°, 95%CI 31–38° versus 27°, 95% CI 24–31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158–163° versus 169°, 95%CI 166–172°), and decreased scapular retraction endurance-strength (511.4 s, 95%CI 362.2–691.3 s versus 875.8 s, 95%CI 691.5–1028.4 s) compared to the women with small breasts.InterpretationDifferences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.     

Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational,multicenter, cross-sectional study

ObjectivesTo investigate if burnout in the Intensive Care Unit (ICU) is influenced by aspects of personality, religiosity and job satisfaction.Research methodologyCross-sectional study, designed to assess burnout in the ICU and to investigate possible determinants. Three different questionnaires were used: the Malach Burnout Inventory, the Eysenck Personality Questionnaire and the Spiritual/Religious Attitudes Questionnaire. Predicting factors for high burnout were identified by multivariate logistic regression analysis.Setting/ParticipantsThis national study was addressed to physicians and nurses working full-time in 18 Greek ICU departments from June to December 2015.ResultsThe participation rate was 67.9% (n = 149) and 65% (n = 320) for ICU physicians and nurses, respectively). High job satisfaction was recorded in both doctors (80.8%) and nurses (63.4%). Burnout was observed in 32.8% of the study participants, higher in nurses compared to doctors (p < 0.001). Multivariate analysis revealed that neuroticism was a positive and extraversion a negative predictor of exhaustion (OR 5.1, 95%CI 2.7–9.7, p < 0.001 and OR 0.49, 95%CI 0.28–0.87, p = 0.014, respectively). Moreover, three other factors were identified: Job satisfaction (OR 0.26, 95%CI 0.14–0.48, p < 0.001), satisfaction with current End-of-Life care (OR 0.41, 95%CI 0.23–0.76, p = 0.005) and isolation feelings after decisions to forego life sustaining treatments (OR 3.48, 95%CI 1.25–9.65, p = 0.017).ConclusionsPersonality traits, job satisfaction and the way End-of-Life care is practiced influence burnout in the ICU.     

Tumor necrosis factor alpha (TNF-α) polymorphisms in Chinese patients with Graves' disease

ObjectivesTumor necrosis factor alpha (TNF-α) may play a central role in the development of Graves' disease (GD). The aim of this study was to investigate the association of TNF-α polymorphisms with GD in Chinese population.Design and methodsGenomic DNA was extracted from peripheral blood lymphocyte of 436 GD patients and 316 control subjects. TNF-α polymorphisms at positions ? 308 (G-308A, rs1800629), ? 238 (G-238A, rs361525), and + 419 (G + 419A, rs3093661) were genotyped.ResultsThe distribution of TNF-α ? 238 and + 419 allelic frequencies between GD and control individuals was significantly different. Both the G alleles of TNF-α ? 238 (OR 2.385, 95%CI 1.359–4.184) and + 419 (OR 2.293, 95%CI 1.303–4.035) SNPs conferred higher risk of GD as compared with A alleles. No significant difference of ? 308 allelic frequency was observed. Further haplotype analysis revealed that the haplotype GGG was associated with an increased risk of GD (OR 1.554, 95%CI 1.125–2.146), whereas the haplotype GAA was found to be protective (OR 0.419, 95%CI 0.239–0.736).ConclusionsThis study demonstrated the association of TNF-α gene with GD in Chinese patients.     

Pressure pain hypersensitivity and referred pain from muscle trigger points in elite male wheelchair basketball players

BackgroundShoulder injuries are common in individuals who use wheelchairs.ObjectivesThis study investigated the presence of mechanical pain hypersensitivity and trigger points in the neck-shoulder muscles in elite wheelchair basketball players with/without shoulder pain and asymptomatic able-bodied elite basketball players.MethodsEighteen male wheelchair basketball players with shoulder pain, 22 players without shoulder pain, and 20 able-bodied elite male basketball players were recruited. Pressure pain thresholds were assessed over C5-C6 zygapophyseal joint, deltoid muscle, and second metacarpal. Trigger points in the upper trapezius, supraspinatus, teres minor, infraspinatus, teres major, latissimus dorsi, subscapularis, pectoralis minor, pectoralis major and deltoid muscles were also examined.ResultsWheelchair basketball players with shoulder pain showed lower pressure pain thresholds over the C5-C6 joint and second metacarpal than elite wheelchair basketball players without pain (between-groups differences: 1.1, 95%CI 0.4, 1.8 and 1.8, 95%CI 0.8, 2.8, respectively) and able-bodied basketball players without pain (between-groups differences: 0.8, 95%CI 0.4, 1.2; 1.6, 95%CI 0.8, 2.4, respectively). The mean number of myofascial trigger points for wheelchair basketball players with unilateral shoulder pain was 4.8 ± 2.7 (2 ± 1 active, 2.9 ± 2.2 latent). Wheelchair basketball players and able-bodied basketball players without shoulder pain exhibited a similar number of latent trigger points (2.4 ± 2.0 and 2.4 ± 1.8, respectively). Wheelchair basketball players with shoulder pain exhibited higher number of active myofascial trigger points than those without pain (either with or without wheelchair), but all groups had a similar number of latent trigger points (P < 0.05).ConclusionsThe reported mechanical pain hypersensitivity suggests that active trigger points may play a role in the development of shoulder pain in elite male wheelchair basketball players.     

Does experimental low back pain change posteroanterior lumbar spinal stiffness and trunk muscle activity? A randomized crossover study

BackgroundWhile some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroanterior spinal stiffness and concurrent trunk muscle activity.MethodIn separate sessions five days apart, nine asymptomatic participants received equal volume injections of hypertonic or isotonic saline in random order into the L3–L5 interspinous ligaments. Pain intensity, spinal stiffness (global and terminal stiffness) at the L3 level, and the surface electromyographic activity of six trunk muscles were measured before, immediately after, and 25-minute after injections. These outcome measures under different saline conditions were compared by generalized estimating equations.FindingsCompared to isotonic saline injections, hypertonic saline injections evoked significantly higher pain intensity (mean difference: 5.7/10), higher global (mean difference: 0.73 N/mm) and terminal stiffness (mean difference: 0.58 N/mm), and increased activity of four trunk muscles during indentation (P < 0.05). Both spinal stiffness and trunk muscle activity returned to baseline levels as pain subsided.InterpretationWhile previous clinical research reported inconsistent findings regarding the association between spinal stiffness and low back pain, our study revealed that experimental pain caused temporary increases in spinal stiffness and concurrent trunk muscle co-contraction during indentation, which helps explain the temporal relation between spinal stiffness and low back pain observed in some clinical studies. Our results substantiate the role of spinal stiffness assessments in monitoring back pain progression.     

Lumbar extensor muscle force control is associated with disability in people with chronic low back pain

BackgroundThe ability to control lumbar extensor force output is necessary for daily activities. However, it is unknown whether this ability is impaired in chronic low back pain patients. Similarly, it is unknown whether lumbar extensor force control is related to the disability levels of chronic low back pain patients.MethodsThirty-three chronic low back pain and 20 healthy people performed lumbar extension force-matching task where they increased and decreased their force output to match a variable target force within 20%–50% maximal voluntary isometric contraction. Force control was quantified as the root-mean-square-error between participants' force output and target force across the entire, during the increasing and decreasing portions of the force curve. Within- and between-group differences in force-matching error and the relationship between back pain group's force-matching results and their Oswestry Disability Index scores were assessed using ANCOVA and linear regression respectively.FindingsBack pain group demonstrated more overall force-matching error (mean difference = 1.60 [0.78, 2.43], P < 0.01) and more force-matching error while increasing force output (mean difference = 2.19 [1.01, 3.37], P < 0.01) than control group. The back pain group demonstrated more force-matching error while increasing than decreasing force output (mean difference = 1.74, P < 0.001, 95%CI [0.87, 2.61]). A unit increase in force-matching error while decreasing force output is associated with a 47% increase in Oswestry score in back pain group (R² = 0.19, P = 0.006).InterpretationLumbar extensor muscle force control is compromised in chronic low back pain patients. Force-matching error predicts disability, confirming the validity of our force control protocol for chronic low back pain patients.     

Effects of cryolipolysis on lower abdomen fat thickness of healthy women and patient satisfaction: a randomized controlled trial

ObjectiveTo analyze the effects of cryolipolysis on the fat thickness of the lower abdomen of healthy women and patient's satisfaction.MethodsDesign and setting: a randomized controlled trial, with concealed allocation and blinded assessor. Participants: 34 healthy women between 18 and 48 years, skinfold in the lower abdomen ≥3 cm, BMI between 18.5 and 27 kg/m², low level of physical activity, and no contraindication to cryolipolysis were allocated to intervention group (IG, n = 17) or control group (CG, n = 17). Interventions: The IG received one session of cryolipolysis with −10 °C of temperature for 50 min. The CG was not submitted to any kind of intervention. Both groups did the evaluation protocols at baseline, 30, 60 and 90 days after the intervention. Main outcome measures: fat thickness was measured by ultrasonography (US), skinfold (SF) and abdominal circumference (AC1 and AC2).ResultsNo significant differences between the IG and CG were demonstrated at any evaluation at any time of follow up for the variables US (30 days: 0.05 cm (95%CI: −0.12; 0.22), 60 days: 0.05 cm (95%CI: −0.11; 0.20) and 90 days: 0.04 cm (95%CI: −0.7; 0.25)), SF (30 days: −0.09 cm (95%CI: −0.25; 0.08), 60 days: −0.14 cm (95%CI: −0.36; 0.09) and 90 days: −0.001 cm (95%CI: −0.237; 0.234)), AC1 (30 days: 0.42 cm (95%CI: −1.1; 1.9), 60 days: −0.1 cm (95%CI: −1.74; 1.54) and 90 days: −0.007 cm (−1.9; 1.9)) and AC2 (30 days: 0.183 cm (95%CI: −0.84; 1.20), 60 days: −0.13 cm (95%CI: −1.61; 1.35) and 90 days: −0.31 cm (95%CI: −1.61; 1.00)).ConclusionsThe current study showed that a single application of the utilized protocol of cryolipolysis does not produce any significant effect on fat thickness of the lower abdomen of healthy women.Clinical Trial Registration number: NCT03160976 (https://clinicaltrials.gov/ct2/show/NCT03160976).Contribution of the Paper: the study is one of the first studies in the literature with methodological rigor to report an unfavorable result for localized abdominal fat treatment with a single session of cryolipolysis.     

Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial

BackgroundProprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability.ObjectiveTo examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain.MethodsForty-four chronic low back pain participants aged 18–50 years were randomized either to a three-week proprioceptive neuromuscular facilitation training or to a control group receiving general trunk exercises. Pain intensity, disability and static balance ability were measured before and after the three-week intervention.ResultsThe proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p < 0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p < 0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09 mm², 95% CI: 64.93 to 175.25, p < 0.01 and 336.27 mm², 95% CI: 109.67 to 562.87, p < 0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68 mm/s, 95% CI: 4.41 to 8.95, p < 0.01 and 6.77 mm/s, 95% CI: 4.01 to 9.54, p < 0.01, respectively).ConclusionThe three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.     

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

ObjectiveTo establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain.DesignA prospective cross-sectional observational study.SettingMultidisciplinary out-patient pain clinics in three university teaching hospitals.PatientsNew patients (n = 131) referred to the pain clinic with a history of chronic pain (>12 weeks).MethodsA questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign).ResultsOf the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p < 0.001), being unemployed or retired (p = 0.005), less education (p < 0.001), lower income, increased comorbidities (p = 0.038), being less likely to utilise allied health services (p = 0.001), poorer disease-related knowledge (p = 0.002), and poorer beliefs about pain (p < 0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p = 0.05) and beliefs about pain (B = −2.3, S.E = 0.9, p = 0.01) remained independently associated with HL.ConclusionInadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.     

Effectiveness of focused meditation for patients with chronic low back pain—A randomized controlled clinical trial

ObjectivesWe aimed to evaluate the effectiveness of an 8-week meditation program (focused meditation) in patients with chronic low-back pain.DesignA randomized clinical trial was conducted on 68 patients (55 years;75% female) with chronic low-back pain who scored >40 mm on a 100 mm Visual-Analogue-Scale. Subjects were allocated to an 8-week meditation program (focused meditation) with weekly 75 min classes or to a self-care exercise program with a wait-list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed baseline and after 4 and 8 weeks. The primary outcome measure was the change in mean back pain at rest after 8 weeks. Secondary outcomes included function, pain-related bothersomeness, perceived stress, quality-of-life (QOL), and psychological outcomes.ResultsTwelve (meditation) and 4 (exercise) patients were lost to follow-up. The primary outcome, pain at rest after 8 weeks, was reduced from 59.3 ± 13.9 mm to 40.8 ± 21.8 mm with meditation vs. 52.9 ± 11.8 mm to 37.3 ± 18.2 mm with exercise (adjusted group difference: −1.4 (95%CI:11.6;8.8;p = n.s.) Perceived stress was significantly more reduced with meditation (p = 0.011). No significant treatment effects were found for other secondary outcomes as pain-related bothersomeness, function, quality-of-life and psychological scores, although the meditation group consistently showed non-significant better improvements compared to the exercise group.ConclusionsFocused meditation and self-care exercise lead to comparable, symptomatic improvements in patients with chronic low back pain. Future studies should include longer-term follow-ups and develop guided meditation programs to support compliance.     

Care problems and nursing interventions related to oral intake in German nursing homes and hospitals: a descriptive mulitcentre study

BackgroundReduced nutritional intake in care-dependent patients is a risk factor for malnutrition. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition.ObjectivesTo report the prevalence of problems that potentially led to decreased nutritional intake. To investigate the association between these problems and body mass index (BMI).To investigate the association between increased care dependency and BMI. To document nutrition-related interventions.DesignCross-sectional multicentre study.SettingA total of 15 hospitals (H) and 76 nursing homes (NH) in Germany were included.ParticipantsA total of 2930 hospital patients and 5521 nursing home residents were included in the study. The mean age was 66.6 ± 16.7 years (in H) and 84.9 ± 9.8 years (in NH); 14.7% (in H) and 50.4% (in NH) were almost or completely care dependent. A BMI ≤ 20 kg/m² was found in 8.5% (in H) and 16.7% (in NH).ResultsMost hospital patients were eating and drinking independently (72.2%), whereas 58.4% of the nursing home residents needed assistance. Major problems in hospitals were polypharmacy (18.6%), loss of appetite (14.6%) and pain (7.8%); in nursing home common problems were functional problems of the upper extremities (17%), loss of appetite (15.5%) and polypharmacy (15.5%). Patients with a high level of care dependency had higher rates of BMI ≤ 20 kg/m². In both settings (H and NH), BMI ≤ 20 kg/m² was significantly associated with loss of appetite (odds ratio (OR) 2.6, 95%CI 1.9–3.5 and OR 7.0, 95%CI 5.9–8.3), nausea (OR 2.1, 95%CI 1.3–3.3 and OR 2.8, 95%CI 1.9–4.1), chewing problems (OR 2.1, 95%CI 1.2–3.4 and OR 2.5, 95%CI 2.1–3.1) and swallowing problems (OR 2.3, 95%CI 1.4–3.6 and OR 2.3, 95%CI 1.9–2.8). Nutrition-related nursing interventions were employed more frequently in nursing homes than in hospitals.ConclusionA high care dependency in general and in terms of eating and drinking should be addressed in daily care to ensure sufficient nutritional intake. Additional problems, such as loss of appetite, should also be addressed with suitable interventions to prevent malnutrition. Nutrition-related interventions need to be increased in German health care facilities.     

The effect of Chinese herbal medicine on hemorrhagic shock: A systematic review and meta-analysis

BackgroundChinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy.ObjectiveTo evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients.MethodsWe screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias.ResultsFifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR = 0.24, 95%CI:0.13–0.46, P < 0.0001), reduce the incidence of MODS (RR = 0.47, 95%CI: 0.34–0.66,P < 0.00001), symptomatic improvement: increase blood pressure (BP) (MD = 8.83, 95%CI:6.82–10.84,P < 0.00001), regulate heart rate (MD = −7.6,95%CI:−9.17 to −6.02,P < 0.00001), increase urine volume (MD = 7.26, 95%CI:5.00–9.53, P < 0.00001), compared with conventional therapy alone. No serious adverse events were reported.ConclusionsCHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.     

Oxygen therapy for acute myocardial infarction: A systematic review and meta-analysis

BackgroundPotential benefits or risks of oxygen inhalation for patients with acute myocardial infarction are not fully understood.ObjectiveWe performed this study to systematically assess the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction.DesignA systematic review and meta-analysis.Data sourcesWe searched randomized controlled trials systematically in PubMed, EMBASE, Web of Science and Cochrane Library up to June 2016.Review methodsRandomized controlled trials that estimated the effectiveness and safety of oxygen therapy for patients with acute myocardial infarction were identified by two independent reviewers. The primary outcomes were short-term mortality and recurrent rate of myocardial infarction, and the secondary outcomes were arrhythmia incidence and pain incidence. Relative risks (RRs) and 95% confidence intervals (CIs) were used to measure the pooled data.ResultsA total of five randomized controlled trials were in accordance with inclusion criteria and were included in this meta-analysis. Compared with no oxygen group, the oxygen group did not significantly reduce short-term death (RR: 1.08, 95%CI: 0.31–3.74), and there was moderate heterogeneity (I² = 50.8%, P < 0.107) among studies. We found a significant increase in the rate of recurrent myocardial infarction (RR: 6.73, 95%CI: 1.80–25.17, I² = 0.0%, P = 0.598) in the oxygen group. The oxygen group did not have a significant reduction in arrhythmia (RR: 1.12, 95%CI: 0.91–1.36; I² = 46.2%, P < 0.156) or pain (RR: 0.97, 95%CI: 0.91–1.04; I² = 7.2%, P = 0.340).ConclusionsOxygen inhalation did not benefit patients with acute myocardial infarction with normal oxygen saturation. It may increase the rate of recurrent myocardial infarction. High quality trials with larger sample sizes are required.     

Impaired performance of women with patellofemoral pain during functional tests

ObjectiveTo compare the performance, reliability, and validity of functional tests between women with and without patellofemoral pain.MethodsTwenty women with a diagnosis of patellofemoral pain between 18 and 40 years of age and 20 age-matched pain-free controls participated in the study. All participants performed a set of five function tests: sitting-rising test, sit-to-stand in 30 seconds, stair-climb test, stair descent test, and six-minute step test. To investigate reliability, participants were assessed on two different days, seven days apart, by two independent investigators blinded to the results of the other investigator. Validity was evaluated through associations with the results on the Anterior Knee Pain Scale.ResultsPerformance in the tests was worse in women with patellofemoral pain than in the control group for the sit-to-stand in 30 seconds (mean difference [MD] 3.4reps; 95%CI: 0.4, 6.4), stair-climb test (MD: 0.36 s; 95%CI: 0.1, 0.63), and six-minute step test (MD: 45reps; 95%CI: 20, 70). No differences were observed for the sitting-rising and stair descent tests. All tests in both groups showed moderate to excellent intra- and inter-rater reliability (intraclass correlation coefficients: 0.61 to 0.91 and 0.72 to 0.96, respectively). Finally, only the results on the sit-to-stand in 30 seconds test correlated with the Anterior Knee Pain Scale (r = 0.44, p = 0.047) in the patellofemoral pain group.ConclusionWomen with patellofemoral pain present lower performance on some functional tests. Functional tests are reliable in patients with patellofemoral pain, although they are not associated with the results on the Anterior Knee Pain Scale self-questionnaire.     

Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

BackgroundSingle biomarker approaches provide only moderate accuracy in the non-invasive detection of exercise-induced myocardial ischemia. We therefore assessed the combination of the two most promising single biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP).MethodsConsecutive patients with suspected myocardial ischemia referred to stress myocardial perfusion single-photon emission tomography imaging (MPI) were enrolled. Clinical judgment (CJ) of the treating cardiologist regarding myocardial ischemia, quantified using a visual analogue scale, and blood concentrations of hs-cTnI and BNP were determined before and after stress. The presence of myocardial ischemia was adjudicated by independent cardiologists using MPI, blinded to biomarker measurements. Death and acute myocardial infarction (AMI) during follow-up were the prognostic endpoints.ResultsAmong 1142 consecutive patients inducible myocardial ischemia was found in 456 (40%) of all patients. For the detection of inducible myocardial ischemia, CJ before exercise stress testing (CJb) showed an area under the receiver-operating-characteristics curve (AUC) of 0.66 (95%CI 0.63–0.69), hs-cTnI 0.70 (95%CI 0.67–0.73, p = 0.07 vs CJb), and BNP 0.66 (95%CI 0.62–0.69, p = 0.98). The use of a dual-biomarker strategy combining hs-cTnI and BNP with CJb did not provide a significant advantage over the combination of hs-cTnI alone and CJb (AUC 0.74, 95%CI 0.72–0.77 vs AUC 0.74, 95%CI 0.71–0.77, p = 0.16). Hs-cTnI showed good prognostic value for AMI (HR 1.6, 95%CI 1.3–1.9), and BNP for death (HR 1.6, 95%CI 1.3–2.1).ConclusionA dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.Summary and highlightsWe included 1142 consecutive patients with suspected inducible ischemia, and evaluated the added value of the biomarkers high-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP), alone and in combination, on top of clinical judgment.Clinical trial registrationBiochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148     

Advanced life support provider course in Italy: A 5-year nationwide study to identify the determinants of course success

IntroductionThe advanced life support (ALS) provider course is the gold standard for teaching and assessing competence in advanced resuscitation. Outcomes over a 5-year period of European Resuscitation (ERC)/IRC ALS provider courses in Italy were investigated, and the factors associated with course success are described.MethodsIn 2008, the Italian Resuscitation Council (IRC) created a database in which every ERC/IRC ALS course was recorded. Data from courses organized from 2008 to 2012 were analysed. The data included: candidate's age and degree (medical doctor (MD) or nurse), medical specialty of MD candidates, course outcomes, duration and reference guidelines, number of instructors and course director. Relationships between the course outcomes and the courses and candidates’ characteristics were analysed using logistic regression.ResultsA total of 13,624 candidates were evaluated from 871 courses. Among the candidates, 55% were MDs and 45% were nurses. Ninety-seven percent of candidates passed the final evaluation, while 3% failed. Candidates who passed were younger (37 [31–44] vs. 43 [37–50] years, p < 0.0001) and had a greater pre-course resuscitation knowledge (multiple choice quiz (MCQ) score: 88 [83–93] vs. 80 [73–87], p < 0.0001) compared to those who failed. The course pass rate was higher for MDs compared to nurses (98% vs. 95%, p < 0.0001) and participants in emergency disciplines were most significantly associated with course success (χ² 71, p < 0.0001). In the multivariate analysis, an older age (OR 0.926, 95%CI [0.915–0.937]) was independently associated with course failure, while being a MD (OR 3.021, 95%CI [2.212–4.132]), having a higher pre-course MCQ score (OR 1.033, 95%CI [1.026–1.040]) together with a higher candidate/instructor ratio (OR 1.314, 95%CI [1.067–1.618]), and having a longer course duration (OR 1.717, 95%CI [1.090–2.703]), were independently associated with success.ConclusionsYounger age, professional background, and pre-course resuscitation knowledge are the most important predictors of ALS provider course success, together with higher candidate/instructor ratios and longer course durations.     

Efficacy and safety of Chinese herbal medicine Wenxin Keli for ventricular premature be ats: A systematic review

BackgroundTo evaluate the efficacy and safety of the Chinese herbal extract Wenxin Keli, alone or in combination with Western medicine, for ventricular premature beats.MethodsThis systematic review was registered at PROSPERO (registration number CRD42013003200). A systematic literature search of 8 core electronic databases and 3 clinical trial registries in Chinese and English, yielded 10 trials whose randomness verified by contacting the authors. The included trials were assessed by the Cochrane risk of bias tool.ResultsWenxin Keli might be more efficacious than placebo (Change of VPBs numbers, RR, 1.61, 95%CI, 1.48–1.76, P < 0.00001, I² = 0%;VPBs- related symptom, RR, 2.10, 95%CI, 1.91–2.30, P < 0.00001, I² = 0%), and the dual therapy of Wenxin Keli plus amiodarone might also be more effective than the monotherapy of amiodarone (Change of VPBs numbers, RR, 1.23, 95%CI, 1.10–1.39, P = 0.0005, I² = 0%; VPBs- related symptom, RR, 1.51., 95%CI, 1.30–1.76, P < 0.00001, I² = 0%), whereas Wenxin Keli might be comparable to metoprolol, propafenone or mexiletine (Change of VPBs numbers: metoprolol, RR, 1.01, 95%CI, 0.91–1.11, P = 0.88, I² = 0%; propafenone, RR, 1.05, 95%CI, 0.93–1.19, P = 0.44, I² = 0%; mexiletine, RR, 1.06, 95%CI, 0.96–1.17, P = 0.28. VPBs- related symptom: metoprolol, RR, 0.95, 95%CI, 0.87–1.04, P = 0.27, I² = 0%, propafenone. RR, 1.10, 95%CI, 0.93–1.30, P = 0.29, I² = 29%, mexiletine,RR, 0.94, 95%CI, 0.78–1.12, P = 0.47). Participants with ventricular premature beats’ numbers < 360 beats/h or with coronary heart disease benefited the most of the Wenxin Keli therapy (Change of VPBs numbers:RR, 1.10, 95%CI, 1.02–1.20, P = 0.02, I² = 44%; RR, 1.71, 95%CI, 1.18–2.49, P = 0.005, I² = 54%, respectively). The safety analysis revealed that Wenxin Keli did not statistically significant differed from the Western medicine in respect of the incidence of total adverse drug reactions (RR, 0.59, 95%CI, 0.35–1.01, P = 0.05, I² = 0%), but Wenxin Keli might be associated with a reduced risk of proarrhythmic reactions (P = 0.007). The quality of the methodology of included trials was generally low. Several limitations existed that affected the validity of the findings, including the small sample size, insufficient randomization methods, poorly defined eligibility criteria, short duration of follow-up, absence of hard endpoints, and high risk of publication bias(P = 0.013).ConclusionsWenxin Keli might be a promising alternative and complementary medicine for ventricular premature beats.     

Gender difference of shoulder-pelvic kinematic integration for trunk rotation directions in healthy older adults

BackgroundThe trunk coordination pattern has been extensively studied, and there is a higher pain prevalence and asymmetry in female older adults. However, there is a lack of investigation of different directions of trunk rotation and asymmetrical compensatory strategies of motor control between genders. The purpose of this study was to investigate shoulder and pelvic ranges of motion (ROM) as well as relative phases (RP) for the different directions of trunk rotation between genders in healthy older adults.MethodsThere were 62 right hand dominant older adults in this study (31 female subjects (68.4 [5.62] years) and 31 male subjects (68.7 [5.68] years)). The participants performed trunk axial rotation from the left to the right direction (RP1) and then returned to the left side (RP2), three times repeatedly in standing. The measurements included shoulder and pelvic ROM, RP1, and RP2. The RP was defined as the average absolute relative phase, which was the difference between the phase angle of the shoulder and the phase angle of the pelvis during trunk rotation.FindingsThe female group demonstrated significantly greater pelvic rotation compared to the male group (98.64 [24.67] vs. 86.96 [18.97]; t = 2.09, p = 0.04) during trunk rotation. The pelvic ROM demonstrated a significant positive correlation with shoulder ROM in both genders; however, the RP was negatively correlated with the pelvis. For pelvic rotation, the male group demonstrated a negative correlation with RP1 (r = − 0.68, p < 0.01) and RP2 (r = − 0.60, p < 0.01) while the female group demonstrated a negative correlation with RP2 (r = − 0.53, p < 0.01). The ageing factor demonstrated negative correlations with ROM for the shoulder and pelvis in both genders.InterpretationAlthough no gender difference was indicated on the direction of RP, the pelvic ROM was significantly lesser in the male group. The male group demonstrated lesser pelvic rotation in both directions of rotation; however, the female group showed lesser pelvic rotation in RP2. The male group demonstrated stiffened pelvic rotation and greater shoulder rotation in both directions while the female group demonstrated pelvic stiffness only in the direction from right to left rotation. Clinicians need to consider this directional asymmetry of trunk rotation to enhance integrated shoulder-pelvic coordination in female older adults.Mini abstractA coordinative pattern of different directions of trunk rotation was investigated in healthy older adults. The pelvic range of motion was lesser in the male group compared with the female group. The female group demonstrated pelvic stiffness only in the direction from right to left rotation, while the male group demonstrated pelvic stiffness in both directions. Clinicians need to understand the gender difference of directional coordination as integrated coordination in female older adults.     

Acid-base disturbances in acute poisoning and their association with survival

PurposeThe purpose was to investigate the association between acid-base disturbances and mortality in acute poisoning.Materials and methodsWe performed a retrospective cross-sectional exploratory study on all acutely poisoned patients older than 12 years who had been admitted to the main tertiary toxicology hospital in Tehran between March and August 2010.ResultsOf a total of 1167 patients (median age = 25 years, 50.9% male), 98 died (74.5% male). Psychotropic medications were the most common cause of poisoning (36.5%), whereas narcotics and psychodysleptics were the most common cause of death (23.5%). Mixed respiratory alkalosis and metabolic acidosis with normal pH were the most common acid-base status (333, 28.5%). However, patients with primary metabolic acidosis and respiratory compensation had significantly higher mortality (31 cases, 18.8%). Logistic regression analysis identified age (odds ratio [OR], 1.051; 95% confidence interval [CI], 1.031-1.070; P < .001), intensive care unit admission (OR, 12.405; 95% CI, 7.178-21.440; P < .001), consciousness level (OR, 1.752; 95% CI, 1.301-2.359; P < .001), hospitalization period (OR, 1.1361; 95% CI, 1.079-1.195; P < .001), severe metabolic acidosis (OR, 6.016; 95% CI, 1.647-21.968; P = .007), and primary respiratory alkalosis (OR, 5.579; 95% CI, 1.353-23.001; P = .017) as death predictors during hospitalization (P < .001).ConclusionOn-arrival acid-base status predicts survival and can be used in prognostication of the poisoned patients.