Effects of hip and trunk muscle strengthening on hip function and lower limb kinematics during step-down task

BackgroundStrengthening of the hip and trunk muscles has the potential to change lower limb kinematic patterns, such as excessive hip medial rotation and adduction during weight-bearing tasks. This study aimed to investigate the effect of hip and trunk muscles strengthening on hip muscle performance, hip passive properties, and lower limb kinematics during step-down task in women.MethodsThirty-four young women who demonstrated dynamic knee valgus during step-down were divided into two groups. The experimental group underwent three weekly sessions of strengthening exercises for eight weeks, and the control group continued their usual activities. The following evaluations were carried out: (a) isokinetic maximum concentric and eccentric work of hip lateral rotators, (b) isokinetic hip passive torque of lateral rotation and resting transverse plane position, and (c) three-dimensional kinematics of the lower limb during step-down.FindingsThe strengthening program increased concentric (P < 0.001) and eccentric (P < 0.001) work of hip lateral rotators, and changed hip resting position toward lateral rotation (P < 0.001). The intervention did not significantly change hip passive torque (P = 0.089, main effect). The program reduced hip (P = 0.002), thigh (P = 0.024) and shank (P = 0.005) adduction during step-down task. Hip, thigh and knee kinematics in transverse plane and foot kinematics in frontal plane did not significantly modify after intervention (P ≥ 0.069, main effect).InterpretationHip and trunk strengthening reduced lower limb adduction during step-down. The changes in hip maximum work and resting position may have contributed to the observed kinematic effects.     

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

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

Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque

BackgroundThe use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation.ObjectivesTo establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement.MethodsEighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer.ResultsSimple linear regression analysis revealed that HEX torque was associated with HER torque (r = 0.80; p < 0.0001), resulting in the following prediction equation: HER_torque= −0.02 + (0.58 * HEX_torque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference = 0.02; 95% CI = −0.115, 0.072) and older adults (mean difference = 0.05; 95% CI = −0.02, 0.12).ConclusionThe HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.     

Sex-specific hip osteoarthritis-associated gait abnormalities: Alterations in dynamic hip abductor function differ in men and women

BackgroundHip osteoarthritis results in abnormal gait mechanics, but it is not known whether abnormalities are the same in men and women. The hypothesis tested was that gait abnormalities are different in men and women with hip osteoarthritis vs. sex-specific asymptomatic groups.Methods150 subjects with mild through severe radiographic hip osteoarthritis and 159 asymptomatic subjects were identified from an Institutional Review Board-approved motion analysis data repository. Sagittal plane hip range of motion and peak external moments about the hip, in all three planes, averaged from normal speed walking trials, were compared for men and women, with and without hip osteoarthritis using analysis of variance.FindingsThere were significant sex by group interactions for the external peak hip adduction and external rotation moments (P = 0.009–0.045). Although asymptomatic women had peak adduction and external rotation moments that were respectively 12% higher and 23% lower than asymptomatic men (P = 0.026–0.037), these variables did not differ between men and women with hip osteoarthritis (P ≥ 0.684). The osteoarthritis vs. asymptomatic group difference in the peak hip adduction moment was 45% larger in women than in men. The osteoarthritis vs. asymptomatic group difference in the peak hip external rotation moment was 55% larger for men than for women (P < 0.001). Sex did not influence the association between radiographic severity and gait variables.InterpretationNormal sex differences in gait were not seen in hip osteoarthritis. Sex-specific adaptations may reflect different aspects of hip abductor function. Men and women with hip osteoarthritis may require different interventions to improve function.     

Age explains limited hip extension recovery at one year from total hip arthroplasty

BackgroundTo investigate the dependency of the one-year recovery in gait after total hip arthroplasty on age and preoperative conditions.MethodsLongitudinal retrospective study on 20 elderly patients with unilateral total hip arthroplasty consequent to hip osteoarthritis, assessed by gait analysis before surgery (T0), 2 weeks (T1), 6 (T2) and 12 months (T3) post-surgery. A set of variables assessing primary gait deviations and compensatory mechanisms were extracted from gait analysis data. Their variations throughout the one-year period were analyzed through a repeated measures ANOVA. Their dependency on preoperative conditions (age, hip passive limitations and Thomas Test) at one year after surgery were assessed through a correlation analysis and an ANCOVA.FindingsHip sagittal range significantly increased (P < 0.05) after each measurement session from mean 21 (SD 10) degrees at T0, to 31 (6) at T1, to 34 (6) at T2 until 36 (4) degrees at T3. The peak of hip and ankle power generation significantly increased from T0 to T3, with a progressive reduction of compensatory mechanisms towards normal values.At T3, preoperative hip passive extension and Thomas Test score did not affect hip sagittal range during gait, while age did (P < 0.05, R² = 0.36). Ankle and hip peak powers were also correlated with age (P = 0.033 and P = 0.008, respectively). In our sample, age was the main cause of hip sagittal joint range limitation.InterpretationAt one year from total hip arthroplasty, age affects hip joint limitations and gait recovery more than preoperative passive restrictions due to muscle shortening.     

The immediate effects of foot orthoses on hip and knee kinematics and muscle activity during a functional step-up task in individuals with patellofemoral pain

BackgroundEvidence shows that anti-pronating foot orthoses improve patellofemoral pain, but there is a paucity of evidence concerning mechanisms. We investigated the immediate effects of prefabricated foot orthoses on (i) hip and knee kinematics; (ii) electromyography variables of vastus medialis oblique, vastus lateralis and gluteus medius during a functional step-up task, and (iii) associated clinical measures.MethodsHip muscle activity and kinematics were measured during a step-up task with and without an anti-pronating foot orthoses, in people (n = 20, 9 M, 11 F) with patellofemoral pain. Additionally, we measured knee function, foot posture index, isometric hip abductor and knee extensor strength and weight-bearing ankle dorsiflexion.FindingsReduced hip adduction (0.82°, P = 0.01), knee internal rotation (0.46°, P = 0.03), and decreased gluteus medius peak amplitude (0.9 mV, P = 0.043) were observed after ground contact in the ‘with orthoses’ condition. With the addition of orthoses, a more pronated foot posture correlated with earlier vastus medialis oblique onset (r = − 0.51, P = 0.02) whilst higher Kujala scores correlated with earlier gluteus medius onset (r = 0.52, P = 0.02).InterpretationAlthough small in magnitude, reductions in hip adduction, knee internal rotation and gluteus medius amplitude observed immediately following orthoses application during a task that commonly aggravates symptoms, offer a potential mechanism for their effectiveness in patellofemoral pain management. Given the potential for cumulative effects of weight bearing repetitions completed with a foot orthoses, for example during repeated stair ascent, the differences are likely to be clinically meaningful.     

An evidence map of yoga for low back pain

ObjectiveYoga is being increasingly studied as a treatment strategy for a variety of different clinical conditions, including low back pain (LBP). We set out to conduct an evidence map of yoga for the treatment, prevention and recurrence of acute or chronic low back pain (cLBP).MethodsWe searched Medline, Cochrane Database of Systematic Reviews, EMBASE, Allied and Complementary Medicine Database and ClinicalTrials.gov for randomized controlled trials (RCT), systematic reviews or planned studies on the treatment or prevention of acute back pain or cLBP. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of included studies.ResultsThree eligible systematic reviews were identified that included 10 RCTs (n = 956) that evaluated yoga for non-specific cLBP. We did not identify additional RCTs beyond those included in the systematic reviews. Our search of ClinicalTrials.gov identified one small (n = 10) unpublished trial and one large (n = 320) planned clinical trial. The most recent good quality systematic review indicated significant effects for short- and long-term pain reduction (n = 6 trials; standardized mean difference [SMD] −0.48; 95% CI, −0.65 to −0.31; I² = 0% and n = 5; SMD −0.33; 95% CI, −0.59 to −0.07; I² = 48%, respectively). Long-term effects for back specific disability were also identified (n = 5; SMD −0.35; 95% CI, −0.55 to −0.15; I² = 20%). No studies were identified evaluating yoga for prevention or treatment of acute LBP.ConclusionEvidence suggests benefit of yoga in midlife adults with non-specific cLBP for short- and long-term pain and back-specific disability, but the effects of yoga for health-related quality of life, well- being and acute LBP are uncertain. Without additional studies, further systematic reviews are unlikely to be informative.     

Anti-spastic effects of footbaths in post-stroke patients: A proof-of-principle study

ObjectivesTo investigate whether a footbath inhibits spasticity in the hemiplegic lower limbs of post-stroke patients.DesignRandomized, controlled study.SettingRehabilitation education and research hospital.InterventionsTwenty-two post-stroke patients were randomly allocated to control or experimental groups. After relaxing in a supine posture for 30 min, the experimental group subject's legs were immersed in 41 °C water below the knee joint for 15 min, while the control group remained in a resting posture.Main outcome measuresModified Ashworth Scale (MAS) scores of the affected triceps surae muscle and F-wave parameters (i.e., F-wave amplitude, F/M ratio, and F-wave persistence) were recorded before, immediately after, and 30 min after each intervention. Physiological parameters were simultaneously monitored to determine the thermo-therapeutic mechanisms and side effects of footbath usage.ResultsAt the time immediately after the intervention, F-wave amplitudes decreased significantly in the experimental group, compared to the control group (p < 0.01, difference: −106.8; 95% CI; −181.58 to −32.09). F-wave amplitudes decreased significantly after 30-min intervention in the experimental group, with a total reduction of 161.2 μV being recorded compared to 8.8 μV increase in the control group (p < 0.01, difference: −170.0; 95% CI; −252.73 to −87.33). There were also significant differences between the experimental and control group for both F/M ratio and F-wave persistence, immediately after and 30 min after the intervention. Further, there were significant differences between the experimental and control group for the MAS scores immediately after the intervention (p < 0.05, difference: −0.72; 95% CI; −1.262 to −0.193), and 30 min after the intervention (p < 0.05, difference: −0.73; 95% CI; −1.162 to −0.293).ConclusionThese findings demonstrate that the use of footbaths is an effective non-pharmacological anti-spastic treatment for use in stroke rehabilitation.     

Tanreqing injection for acute bronchitis disease: A systematic review and meta-analysis of randomized controlled trials

BackgroundAcute bronchitis (AB) is one of the common diseases. Tanreqing injection (TRQ) was widely used to treat patients with acute bronchitis, and many randomized controlled trials have been conducted to investigate its efficacy.ObjectiveThe purpose of this systematic review is to evaluate the efficacy and safety of TRQ for AB.MethodsEight English and Chinese electronic databases, up to October 2014, were searched to identify randomized controlled trials on TRQ for AB. Two reviewers independently extracted data and assessed the quality of each trial by using Cochrane handbook. Meta-analysis was carried out by using Review Manager software.ResultA total of 49 trials with 5131 participants were collected. Data of three main outcomes were pooled and analyzed as following: (1) effective rates: TRQ versus antibiotics (RR 1.12; 95% CI 1.05, 1.18; P = 0.0002); TRQ plus antiviral drugs versus antiviral drugs (RR: 5.12; 95% CI 3.03, 8.66; P < 0.00001); TRQ plus antibiotics versus antibiotics (RR 3.46; 95% CI 2.59, 4.62; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (RR 2.03; 95% CI 1.10, 3.74; P = 0.02); TRQ plus conventional therapy versus conventional therapy alone (RR 1.21; 95% CI 1.15, 1.27; P < 0.00001). (2) Time for fever resolution: TRQ plus antiviral drugs versus antiviral drugs (MD: −1.08; 95% CI −1.59, −0.57; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD −1.33; 95% CI −1.81, −0.86; P < 0.00001); TRQ versus antibiotics plus antiviral drugs (MD −0.88; 95% CI −1.25, −0.51; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.06; 95% CI −1.13, −0.98; P < 0.00001). (3) Resolution of cough: TRQ plus antiviral drugs versus antiviral drugs (MD: −2.09; 95% CI −3.11, −1.43; P < 0.00001); TRQ plus antibiotics versus antibiotics (MD: −2.65; 95% CI −2.88, −2.42; P < 0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD −1.84; 95% CI −2.85, −0.83; P = 0.0003). Four trials described the adverse drug reactions of TRQ, while no severe adverse drug reactions reported.ConclusionsAs a therapy for AB, TRQ has potentially beneficial effect in improving effective rates, reducing the time to resolution of fever, cough, crackles and absorption of shadows on X-ray. However, due to the limitations of methodological quality of the included trials, it is difficult to make a conclusive recommendation about TRQ treating patients with AB. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of TRQ.     

Nigella sativa improves glucose homeostasis and serum lipids in type 2 diabetes: A systematic review and meta-analysis

Background & objective(s)Global prevalence of type 2 diabetes (T2D) is very high and is currently growing alarmingly. With respect to recent researchers' attention to the potential role of herbal medicine in disease prevention and management, the present meta-analysis review investigates the effectiveness of Nigella sativa (N. sativa), a popular herb, in T2D.MethodsLiterature search was conducted covering PubMed/Medline, Scopus, and Cochrane Registry of Clinical Trials up to February 2017 to obtain the relevant published intervention studies. Study selection, quality rating and data extraction of studies were investigated by two independent reviewers. Heterogeneity was assessed using I-squared (I²) statistics test. Subgroup analysis was done to assess type of N. sativa supplement as source of heterogeneity. Effect sizes of eligible studies were pooled using STATA software version 12 (STATA corp, College Station, TX, USA).ResultsSeven trials were included in the meta-analysis of glycemic and serum lipid profile end points. Supplementation with N. sativa significantly improved fasting blood sugar (FBS) [−17.84 mg/dl, 95% CI: −21.19 to −14.49, p < 0.001], HbA1c [−0.71%, 95% CI: −1.04 to −0.39, p < 0.001], total-cholesterol (TC) [WMD: −22.99 mg/dl, 95% CI: −32.16 to −13.83, p < 0.001] and LDL-cholesterol (LDL-c) [−22.38 mg/dl, 95% CI: −33.60 to −11.15, p < 0.001]. The overall effects for triglyceride (TG) [−6.80 mg/dl, 95% CI: −33.59 to 19.99, p = 0.61] and HDL-cholesterol (HDL-c) [0.37 mg/dl, 95% CI: −1.59 to 2.33, p = 0.71] were insignificant. Subgroup analysis revealed significant reduction on TG with N. sativa seed oil [−14.8 mg/dl, 95% CI: −23.1 to −6.5, p < 0.001], while TG was increased with seed powder [29.4 mg/dl, 95% CI: 16.9–42.0, p < 0.001]. All measures, but HbA1c, showed no evidence of publication bias.ConclusionAlthough, the meta-analysis conducted included a few number of studies, but has shown promising results on the effectiveness of N. sativa on glucose homeostasis and serum lipids. Current findings suggest N. sativa supplementation a suitable choice in managing the complications of T2D, although future researches are necessary.     

Three-dimensional hip and knee kinematics during walking,running, and single-limb drop landing in females with and without genu valgum

BackgroundDynamic knee valgus in females has been associated with various knee pathologies. Abnormal 3D hip and knee kinematics contribute prominently to this presentation, and these may become more aberrant with more demanding tasks. Underlying genu valgus may also accentuate such kinematics, but this effect has never been tested. Therefore, the purpose of this study was to compare 3D hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgus malalignment. We expected abnormal kinematics to become more evident in the valgus subjects as task demands increased.MethodsEighteen healthy females with genu valgum and 18 female controls with normal alignment underwent 3D motion analysis while performing walking, running, and single-limb drop-landing trials. Sagittal, frontal, and transverse plane hip and knee kinematics were compared between groups across tasks using analyses of variance and between-group effect sizes.FindingsGroup differences did not generally increase with higher forces. The valgus females demonstrated decreased hip flexion (ES = 0.72–0.88) and increased knee abduction (ES = 0.87–1.47) across the tasks. During running and single-limb drop landing, they showed increased knee external rotation (ES = 0.69–0.73). Finally, during walking, the valgus females showed increased hip adduction (ES = 0.69).InterpretationThese results suggest that females with genu valgus alignment utilize aberrant hip and knee mechanics previously associated with dynamic valgus in the literature, but that these pathomechanics do not generally worsen with rising task demands. Healthy females that present with genu valgus may be natively at elevated risk for knee pathology.     

Fatigue of the hip abductors results in increased medial–lateral center of pressure excursion and altered peroneus longus activation during a unipedal landing task

BackgroundPrevious studies have reported that diminished hip abductor muscle strength is associated with a loss of frontal plane postural stability and increased risk for ankle sprain. The purpose of this study was to determine whether hip abductor fatigue results in compensatory changes in neuromuscular activation of the peroneus longus (an important lateral stabilizer of the ankle) during a unipedal landing task.MethodsThirty healthy females performed a unipedal landing task before and after completing a hip abductor fatigue protocol. Paired t-tests were used to assess changes in medial–lateral center of pressure displacement, and EMG (electromyographic) amplitude of the peroneus longus following hip abductor fatigue. Changes in peroneus longus onset timing also were assessed.FindingsFollowing the hip abductor fatigue protocol, participants exhibited increased mean center of pressure displacement (7.7 (1.5) vs. 9.2 (2.0) cm, P < 0.01), and increased EMG amplitude of peroneus longus (0.75 (0.18) vs. 0.86 (0.21), P < 0.01) during the deceleration phase of landing. Post-fatigue, significantly earlier peroneus longus onset timing prior to landing was observed (88.9 (24.9) vs. 121.9 (25.7) ms, P < 0.01).InterpretationThe increased EMG amplitude and earlier onset of the peroneus longus appears to be a protective compensatory adaptation to stabilize the ankle in response to frontal plane postural instability induced by hip abductor fatigue.     

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.     

Sex differences in trunk,pelvis, hip and knee kinematics and eccentric hip torque in adolescents

BackgroundAdolescents have a high incidence of knee joint dysfunctions, with up to 28% of adolescents reporting knee pain. Although adolescent females have a greater incidence of knee injuries in comparison to males, few studies conducted biomechanical evaluations in this population aiming to identify sex differences. If trunk and/or lower limb biomechanical impairments are identified in female adolescents, the implementation of early interventions for injury prevention will be better justified. The purpose of this study was to compare the trunk, pelvis, hip and knee kinematics during a single-leg squat task, as well as the isokinetic eccentric hip torque, between male and female healthy adolescents.MethodsForty-four healthy adolescents were divided into two groups, group of males (n = 22) and group of females (n = 22). Kinematics during single-leg squat were assessed using a electromagnetic tracking system. For the evaluation of eccentric hip torque in the three planes an isokinetic dynamometer was used. Group differences were assessed using a one-way multivariate analysis of variance.FindingsResults showed that adolescent females presented greater hip adduction, hip external rotation and knee abduction, as well as smaller trunk flexion during single-leg squat in comparison to males. Additionally, adolescent females showed smaller isokinetic eccentric hip torque normalized by body mass in all planes in comparison to males.InterpretationThese sex differences in terms of trunk/lower limb kinematics and eccentric hip torque generation might play an important role in the greater incidence of overuse knee injuries observed in adolescent females.     

Patterns of hip migration in non-ambulant children with cerebral palsy: A prospective cohort study

BackgroundIn children with cerebral palsy (CP), we have little information on when hip migration (HM) starts, what causes hip displacement, how HM changes over time, and how to halt this migration to avoid surgery.ObjectivesWe aimed to estimate the prevalence of HM percentage (HMP) >4 0% in a homogeneous population of non-ambulant children with CP and model the changes in HMP over a 2.6-year mean follow-up.MethodsFrom September 2009 to September 2015, this observational, prospective, multicenter cohort study recruited 235 children from 51 centers who were 3 to 10 years old and had levels IV and V of the Gross Motor Function Classification System for CP. The outcomes were yearly HMP measurements by the Reimers index. Only children with at least one hip with HMP ≤ 40% at baseline were included in trajectory modeling. Comparisons of chidren's characteristics between trajectory groups were adjusted by the false discovery rate method.ResultsThe prevalence of children with at least one hip with HMP > 40% was estimated at 24.3% (95% confidence interval 18.6–30.0). Pelvic obliquity was observed in 51.4% and 24.4% of children with asymmetric and symmetric HMP (P = 0.002). The trajectory modelling identified 3 types of MP changes over time. Many children (67.4% and 79.3% for the right and left hip) could be assigned to the “stable” trajectory group.ConclusionsIn non-ambulant children with CP, the prevalence of HM requiring surgery is low and most hips remain practically stable over time.     

Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial

BackgroundObsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that is causally linked to dysregulation of the serotonergic system. The aim of this study is to investigate the efficacy of Withania somnifera (W. somnifera) root extract as an adjunct therapy to standard OCD treatment.MethodsThirty patients with a confirmed diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria participated in this randomized double-blind placebo-controlled trial and were randomly assigned to the treatment group (W. somnifera extract, 120 mg/day; n = 15) or the placebo group (n = 15). All patients were under treatment with Selective Serotonin Re-uptake Inhibitors (SSRIs), and were instructed to take 4 capsules of the extract or placebo per day, preferably after meals, for a period of six weeks. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used in order to assess the severity of OCD symptoms at baseline and at the end of the trial. Statistical analyses were performed using SPSS software and Y-BOCS values were presented as median and range (Min-Max).ResultsComparison of the change in Y-BOCS score during the course of the trial revealed a significantly greater effect of W. somnifera (26 (14–40) [pre-treatment] versus 14 (4–40) [post-treatment]; change: −8 (−23 to 0)) versus placebo (18 (11–33) [pre-treatment] versus 16 (10–31) [post-treatment]; change: −2 (−4 to 0)) (P < 0.001). The extract was safe and no adverse event was reported during the trial.ConclusionW. somnifera extract may be beneficial as a safe and effective adjunct to SSRIs in the treatment of OCD.     

Effects of V279F in the Lp-PLA2 gene on markers of oxidative stress and inflammation in Koreans

BackgroundA single nucleotide polymorphism (SNP), V279F, in the lipoprotein-associated phospholipase A₂ (Lp-PLA₂) gene is known to influence enzyme activity. It is unclear whether Lp-PLA₂ exerts pro- or antiatherogenic effects in humans. We investigated the interplay between V279F, Lp-PLA₂ activity, oxidative stress and inflammation.MethodsWe genotyped 2914 healthy Koreans (43–79 years) for the Lp-PLA₂ V279F and measured anthropometric parameters, lipid profile, fatty acid composition, lipid peroxides, inflammatory markers and Lp-PLA₂ levels.ResultsLp-PLA₂ activity was 24% lower in V/F subjects (n = 641) than in those with the V/V genotype (n = 2227). Enzyme activity was undetectable in F/F subjects. Lp-PLA₂ activity was positively correlated with LDL-cholesterol (r = 0.134, P < 0.001), ox-LDL (r = 0.064, P < 0.01), 8-epi-PGF_2α (r = 0.198, P < 0.001), free fatty acid (r = 0.082, P < 0.001), and fibrinogen (r = 0.112, P < 0.01) levels. Additionally, ox-LDL, 8-epi-PGF_2α, free fatty acid, and fibrinogen levels were positively correlated with hs-CRP. V279F was associated with LDL-cholesterol and arachidonic acid (AA) in serum phospholipid. F/F subjects had lower LDL-cholesterol than V/V subjects (V/V: 120.9 ± 0.69, V/F: 119.4 ± 1.26, F/F: 109.2 ± 4.84 mg/dl, P = 0.025). A significant association between the F/F genotype and increasing AA in serum phospholipids was found in subjects with high LDL-cholesterol (≥ 130 mg/dl) (P = 0.003) but not in those with low LDL-cholesterol (< 130 mg/dl). F/F subjects in the high LDL-cholesterol group had CRP concentrations about three times higher than those with V/V or V/F genotypes (V/V: 1.25 ± 0.09, V/F: 0.97 ± 0.12, F/F: 3.20 ± 0.88 mg/dl, P < 0.001).ConclusionsThe recessive effects of Lp-PLA₂ V279F on LDL-cholesterol and significant correlations between Lp-PLA₂ activity and LDL-cholesterol, 8-epi-PGF_2α and fibrinogen support a pro-oxidative or pro-atherogenic role for this enzyme. Paradoxically, the combination of the complete deficiency of Lp-PLA₂ activity and high LDL-cholesterol enhanced lipid peroxidation and inflammation.