Treatment of tumors of the cervical spine

In 34 patients with primary or metastatic tumors of the cervical spine over a ten-year period, the presenting symptom was neck pain. Eleven patients demonstrated evidence of radiculopathy, one a myelopathy, and three a combined myeloradiculopathy. Surgical stabilization, combined in eight cases with cord decompression, successfully relieved pain and prevented further neurologic deterioration in 17 of 18 patients with radioresistant tumors. Complications included two patients who were treated with short posterior fusions displacing as a result of tumors progressing above and below the fusion, and one patient in whom an anterior methacrylate mass became dislodged and appeared to jeopardize the esophagus. Methacrylate was used to augment the grafts posteriorly to facilitate early mobilization without the need for a halo splint. Mean patient survival was not significantly increased by surgical intervention (26 weeks vs. 20 weeks). While most lesions of the cervical spine can best be managed by nonoperative methods, in selected patients long posterior fusion with wires and methacrylate appears successful in relieving pain, halting progress of neurologic deficits, and facilitating early mobilization.     

Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale

BACKGROUND: Balance confidence is an important indicator of functional mobility and independence in older adults. Preliminary psychometric evidence for the Activities-specific Balance Confidence (ABC) Scale is promising, with a series of four studies adding information on the discriminative and evaluative properties of this tool. METHODS: The original validation sample was reinterviewed one year later. In the second study, the ABC was administered to 475 older adults ranging from home care clients to highly functioning individuals in community exercise programs. The third study compared 31 residents of retirement homes given a 10-week balance control exercise program and fall education with 32 residents who received only fall education. The fourth study examined balance confidence preoperatively and postoperatively for 27 patients undergoing hip or knee replacement. RESULTS: ABC scores remained stable over 12 months in higher functioning elders, but deteriorated in retirement home residents over 26 weeks. Ten weeks of balance training significantly improved balance confidence, as did hip or knee replacement with standard physical therapy. ABC scores lower than 50 indicated a low level of physical functioning characteristic of home care clients. ABC scores above 50 and lower than 80 indicated a moderate level of functioning characteristic of elders in retirement homes and persons with chronic health conditions. ABC scores above 80 are indicative of highly functioning, usually physically active older adults, and are achievable through exercise and rehabilitative therapies. CONCLUSIONS. Balance confidence is amenable to change and able to distinguish between elders at various levels of functional mobility. These results provide comparative benchmarks for researchers and clinicians working with different groups of older adults.     

The burden of alcohol on health care during COVID-19

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID-19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non-injury emergency room presentations. We provide some broad comparisons between alcohol-attributable and COVID-19-related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol-attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID-19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health-care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health-care services and public health more generally, it is essential that modest, evidence-based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health-care services and provide much-needed revenues for governments at this critical time.     

Interlimb Muscle and Fat Comparisons in Persons With Lower-Limb Amputation

Sherk VD, Bemben MG, Bemben DA. Interlimb muscle and fat comparisons in persons with lower-limb amputation.

Objectives

To investigate differences in muscle and fat tissue between amputated and intact limbs in subjects with transfemoral and transtibial amputations and to determine the effect of amputation level on limb differences. We hypothesized that the amputated limb would have a higher relative amount of fat than the intact limb, and transfemoral amputees would have greater limb differences in muscle size than transtibial amputees.

Design

Cross-sectional, repeated-measures design.

Setting

Laboratory.

Participants

Subjects included persons with unilateral transfemoral (TF) (n=5) and transtibial (TT) (n=7) amputations and age- and sex-matched nonamputation controls (n=12).

Interventions

Not applicable.

Main Outcome Measures

Muscle cross-sectional areas and fat cross-sectional areas of the end of residual limbs were compared with similar cross-sectional sites of the intact limb by using peripheral quantitative computed tomography scans. Thigh and lower-leg fat mass (FM) and bone-free lean body mass were measured by dual-energy x-ray absorptiometry.

Results

There was a 93% to 117% difference between limbs in muscle cross-sectional areas for TF and TT. TT had a between-limb difference of 39% for fat cross-sectional areas. Thigh bone-free lean body masses and FM were significantly (P<.05) lower for the amputated limb for both TF and TT. Thigh percent fat was significantly (P<.05) higher in the amputated thigh for TF and TT, but limb differences were greater in TF.

Conclusions

Muscle atrophy was prevalent in the residual limb with larger relative amounts of fat in the thighs, especially in TF subjects.     

Inflammation marker,damage marker and anabolic hormone responses to resistance training with vascular restriction in older males

The goal of this study was to examine anabolic hormone, muscle damage marker and inflammation marker responses to two types of resistance training protocols in older men. Thirty‐six healthy older males (mean age = 56·6 ± 0·6 years) completed 6 weeks of high‐intensity resistance training (HI‐RT), low‐intensity resistance training with vascular restriction (LI‐BFR) or no exercise control group (CON) three times per week. Three upper body exercises were performed by both exercise groups at the same intensity (at 80% 1‐RM), but lower body exercises were performed by the HI‐RT group at 80% 1‐RM and by the LI‐BFR group at 20% 1‐RM with vascular restriction. Resting serum creatine kinase (CK), interleukin 6 (IL‐6), insulin‐like growth factor‐I (IGF‐I), IGF binding protein 3 (IGFBP‐3) and testosterone (T) were measured before and after training. No significant group differences in resting CK, IL‐6, IGF‐I, IGFBP‐3 and T were detected following training (P>0·05). In addition, there were no significant changes in muscle cross‐sectional area (CSA), but a trend for significant decreases in the percent changes in thigh subcutaneous fat (P = 0·051). Although training‐induced anabolic hormone response did not reach statistical significance, our findings on CK and IL‐6 indicated that the LI‐BFR training protocol was safe and well tolerated for older men to perform to improve muscular strength.     

The chronic obstructive pulmonary disease exacerbation

Chronic obstructive pulmonary disease is the only leading cause of death with a rising prevalence. The medical and economic costs arising from acute exacerbations of COPD are therefore expected to increase over the coming years. Although exacerbations may be initiated by multiple factors, the most common identifiable associations are with bacterial and viral infections. These are associated with approximately 50% to 70% and 20% to 30% of COPD exacerbations, respectively. In addition to smoking cessation, annual influenza vaccination is the most important method for preventing exacerbations. Controlled O2 is the most important intervention for patients with acute hypoxic respiratory failure. Evidence from randomized, controlled trials justifies the use of corticosteroids, bronchodilators (but not theophylline), noninvasive positive-pressure ventilation (in selected patients), and antibiotics, particularly for severe exacerbations. Antibiotics should be chosen according to the patient's risk for treatment failure and the potential for antibiotic resistance. In the acute setting, combined treatment with beta-agonist and anticholinergic bronchodilators is reasonable but not supported by randomized controlled studies. Physicians should identify and, when possible, correct malnutrition. Chest physiotherapy has no proven role in the management of acute exacerbations.