Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

Factors of the evolution of fatigue dimensions in patients with breast cancer during the 2 years after surgery

Women with breast cancer are increasingly being cured of the disease but fatigue remains the most frequently reported symptom. The aims of our study were to identify distinct trajectories in four fatigue dimensions during 2 years after breast cancer surgery and to explore the demographic, clinical and personality characteristics associated with these profiles. We included women from the prospective longitudinal multicenter FATSEIN cohort in France. They completed the Multidimensional Fatigue Inventory for nine follow-ups over 24 months after surgery. A group-based trajectory model identified distinct trajectories in each fatigue dimension. Multinomial logistic regression determined the factors associated with each profile. From the 459 women followed, 3–5 fatigue trajectories were revealed in each fatigue dimension, from its absence to its severest degree. In our multivariate analysis, the risk of severe fatigue was decreased in all dimensions by a high quality of life before surgery (measured by the European Organization for Research and Treatment of Cancer 30-item QoL questionnaire; e.g., for general and physical fatigue: OR = 0.93, 95% CI 0.91, 0.96), especially a high physical and emotional functions for general and physical fatigue, and a high cognitive function for mental fatigue. Both severe mental fatigue and severely reduced motivation worsened with low optimism before surgery (e.g., for mental fatigue: OR = 0.93, 95% CI 0.89, 0.97). Severely reduced activities increased by having chemotherapy (OR = 9.41, 95% CI 2.28, 38.79). Targeting women at risk for severe fatigue can provide early preventive and curative treatment and appropriate psychological support.     

Circulating CD56dim natural killer cells and CD56+ T cells that produce interferon‐γ or interleukin‐10 are expanded in asymptomatic,E antigen‐negative patients with persistent hepatitis B virus infection

Infection with hepatitis B virus (HBV) can result in spontaneous resolution or chronic infection, which can remain asymptomatic or can progress to cirrhosis and/or hepatocellular carcinoma. The host immune response is thought to be a major determinant of the outcome of HBV infection and virus‐specific cytotoxic T lymphocytes (CTL) can mediate immunity against the virus and cause liver pathology. Antigen‐nonspecific innate lymphocytes may also contribute to HBV infection and liver disease, therefore, we examined the frequencies, phenotypes, cytolytic activities and cytokine profiles of circulating natural killer (NK) cells, CD1d‐restricted invariant natural killer T (iNKT) cells and CD56⁺ T cells in 102 asymptomatic HBV‐infected patients and compared them with those in 66 uninfected control subjects. NK cells expressing low levels of CD56 (CD56^dim) and CD56⁺ T cells were significantly expanded in the circulation of HBV‐infected patients compared with control subjects. CD1d expression and iNKT cell frequencies were similar in both groups. Despite these expansions, we did not detect augmented natural or cytokine‐induced cytotoxicity in the HBV‐infected subjects. All lymphocyte populations studied produced interferon‐γ (IFN‐γ) significantly more frequently when taken from HBV‐infected patients compared with when taken from healthy controls. Additionally, NK cells from the patients more frequently produced interleukin‐10. As our HBV‐infected cohort consisted of asymptomatic patients with low viral loads, we propose that CD56^dim NK cells and CD56⁺ T cells control HBV infection by noncytolytic mechanisms.     

The Effects of Soy Consumption before Diagnosis on Breast Cancer Survival: The Multiethnic Cohort Study

This study tested the hypothesis that prediagnostic soy intake was inversely associated with all-cause and breast cancer-specific mortality. The analyses included 3842 women in the Multiethnic Cohort (MEC) study of African Americans, Native Hawaiians, Japanese Americans, Latinos, and Caucasians, who completed a quantitative food frequency questionnaire, aged ≥50 yr at cohort entry, and diagnosed with primary invasive breast cancer following cohort entry (1993–2007). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards regression with adjustment for known clinical and lifestyle factors. During a mean follow-up after diagnosis of invasive breast cancer of 6.2 ± 3.8 yr, there were 804 deaths including 376 breast cancer-specific deaths. The HR (95%CI) for all-cause and breast cancer-specific morality comparing the highest versus lowest tertiles were 1.03 (0.81–1.33) and 1.03 (0.71–1.50) for soy products and 0.99 (0.82–1.20) and 0.95 (0.71–1.28) for total isoflavones, respectively (P_trend > 0.60 for all). There was limited evidence of differences by hormone receptor status, tumor stage, or ethnic group. Prediagnostic soy intake was unrelated to mortality in postmenopausal women. Our findings are consistent with the literature that soy consumption does not adversely affect breast cancer survival in women.     

Is a family history of coronary heart disease an independent coronary risk factor?

The importance of a positive family history as a primary risk factor for coronary heart disease was examined in a case history study. Of 792 consecutive male patients aged under 60 years who survived a first episode of unstable angina or myocardial infarction, 326 had a negative family history, 298 had a positive history, and in 168 a family history could not be established with certainty. There was no significant difference in the distribution of the three primary coronary risk factors--cigarette smoking, hypertension, and hypercholesterolaemia--between those with and those without a positive family history. The 133 subjects with a positive family history of premature coronary heart disease (occurrence in near relatives under 60 years) were significantly younger than those with a negative family history. It is concluded that there is little evidence to confirm a positive family history as an important independent risk factor for coronary heart disease, although there may be familial aggregation of subjects with a high susceptibility to the effects of the three primary risk factors, cigarette smoking, hypertension, and hyperlipidaemia.     

Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland.

AIMS: To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand METHODS: A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other). RESULTS: Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P =0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 +/- 1.7 vs. 5.7 +/- 1.1 mmol/l, P < 0.001; finger-prick glucose 5.7 +/- 1.0 vs. 5.2 +/- 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia. CONCLUSIONS: Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.