Towards an ICF-based clinical measure of functioning in people with ankylosing spondylitis: A methodological exploration

Objective. To explore whether it is possible to construct clinical measures of functioning for patients with ankylosing spondylitis (AS) by integrating information obtained across categories of the International Classification of Functioning, Disability and Health (ICF).

Methods. Sixty-eight ICF categories that were identified as relevant by patients with AS and that covered body functions, structures, and activity and participation were analysed based on the Rasch model for ordered response options. The following properties were studied: unidimensionality, reliability, fit of the ICF categories to the Rasch model, the appropriateness of the order of the response options of the ICF qualifier, and the targeting between the ICF categories and the person's abilities.

Results. After accounting for disordered thresholds and misfitting ICF categories, a clinical measure of functioning for AS was proposed that contained 64 ICF categories. On the basis of a transformation table, the raw scores obtained by adding the answers to the 64 ICF categories can be transformed to the Rasch logit scale and to a meaningful interval scale ranging from zero to 100.

Conclusion. For the first time, it has been shown that clinical measures of functioning, in principle, can be constructed based on the comprehensive ICF framework covering body functions and structures and activities and participation domains. The results of this investigation are preliminary and must be validated, but they are promising and can contribute to the acceptance and usefulness of the ICF in clinical practice.     

Effect of Different Insoles on Postural Balance: A Systematic Review

[Purpose] The aim of the present study was to perform a systematic review of the literature on the effect of different insoles on postural balance. [Subjects and Methods] A systematic review was conducted of four databases. The papers retrieved were evaluated based on the following inclusion criteria: 1) design: controlled clinical trial; 2) intervention: insole; 3) outcome: change in static postural balance; and 4) year of publication: 2005 to 2012. [Results] Twelve controlled trials were found comparing the effects of different insoles on postural balance. The papers had methodological quality scores of 3 or 4 on the PEDro scale. [Conclusion] Insoles have benefits that favor better postural balance and control.Key words: Postural balance, Proprioception, Foot     

Integrierte Psychosomatik in einer gynäkologisch/geburtshilflichen Abteilung

A psychosomatic approach has now gained acceptance in many gynecological practices. In hospitals, however, integration of a psychosomatic approach depends on difficult-to-manage organizational changes as well as the qualification and number of personnel. Since the inclusion of “basic psychosomatic medicine” in specialist training for gynecologists and obstetricians, we can be relatively optimistic as regards personnel. Psychosomatic medicine is “relationship medicine”, and it is absolutely essential that the doctor-patient relationship can bear a certain amount of strain. How this quality of relationship can be achieved in hospitals is the topic of current discussions on structural reorganization. By team building in the wards, by decentralizing decisions, by as many staff as possible gaining a level of psychosocial competence, and by blurring the divide between in and out-patient treatment, we may be able to transform traditional gynecological clinics into “women's health centers”, which may be more in keeping with women's expectations and needs.     

The dopamine D-2 antagonist, Ro 22-1319, inhibits the persistent behavioral syndrome induced by iminodipropionitrile (IDPN) in mice

Chronic administration of beta,beta'-iminodipropionitrile causes a persistent syndrome of excitement, choreoathetoid movements, and circling (the "ECC-syndrome") which persists indefinitely after termination of the IDPN injections. Ro 22-1319 is a specific D-2 dopamine receptor antagonist which was recently synthesized to fit a hypothetical model of the D-2 receptor. Ro 22-1319 inhibited several aspects of the ECC-syndrome, although some of its components, such as backward pedaling and forepaw treading reminiscent of the serotonin syndrome, were exacerbated. These results suggest that several neurotransmitter systems may be involved in the ECC-syndrome.     

A new heparin fragment decreases liver ischemia-reperfusion injury

<正>To the Editor:Ischemia-reperfusion injury following surgery and transplantation can lead to irreversible multiorgan failure.Intracellular calcium overload is associated to cellular death during ischemiareperfusion.A recently discovered heparin fragment (HF),trisulfated disaccharide (TD),that acts on sodium-calcium exchanger(NCX) decreasing intracellular Ca²⁺,showed effectiveness on protecting hepatocytes from ischemia-reperfusion injury [1],     

The Uncertainty Propagation for Carbon Atomic Interactions in Graphene under Resonant Vibration Based on Stochastic Finite Element Model

Graphene is one of the most promising two-dimensional nanomaterials with broad applications in many fields. However, the variations and fluctuations in the material and geometrical properties are challenging issues that require more concern. In order to quantify uncertainty and analyze the impacts of uncertainty, a stochastic finite element model (SFEM) is proposed to propagate uncertainty for carbon atomic interactions under resonant vibration. Compared with the conventional truss or beam finite element models, both carbon atoms and carbon covalent bonds are considered by introducing plane elements. In addition, the determined values of the material and geometrical parameters are expanded into the related interval ranges with uniform probability density distributions. Based on the SFEM, the uncertainty propagation is performed by the Monte Carlo stochastic sampling process, and the resonant frequencies of graphene are provided by finite element computation. Furthermore, the correlation coefficients of characteristic parameters are computed based on the database of SFEM. The vibration modes of graphene with the extreme geometrical values are also provided and analyzed. According to the computed results, the minimum and maximum values of the first resonant frequency are 0.2131 and 16.894 THz, respectively, and the variance is 2.5899 THz. The proposed SFEM is an effective method to propagate uncertainty and analyze the impacts of uncertainty in the carbon atomic interactions of graphene. The work in this paper provides an important supplement to the atomic interaction modeling in nanomaterials.     

Methylenetetrahydrofolate reductase gene C677T and A1298C polymorphisms, plasma homocysteine, folate, and vitamin B12 levels and the extent of coronary artery disease

The question of whether mild hyperhomocysteinemia is a risk factor for coronary artery disease (CAD) has long been debated and is still unclear. We investigated whether there is a link between methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphisms or plasma homocysteine and CAD. This is a case-control study that included 2,121 consecutive patients (cases) with angiographically proved CAD and 617 patients without CAD (controls). MTHFR gene C677T and A1298C polymorphisms, plasma homocysteine, folate, and vitamin B(12) concentrations were determined and coronary angiography was performed in all subjects. The distribution of MTHFR gene C677T genotypes in patients (or controls) was: CC-genotype in 915 cases, 43.1% (266 controls, 43.1%); CT-genotype in 955 cases, 45.0%, (283 controls, 45.9%); and TT-genotype in 251 cases, 11.9% (68 controls, 11.0%) (p = 0.84). The distribution of MTHFR gene A1298C genotypes in patients (or controls) was: AA-genotype in 973 cases, 45.9% (281 controls, 45.5%); AC-genotype in 905 cases, 42.7% (284 controls, 46.0%); and CC-genotype in 243 cases, 11.4% (52 controls, 8.5%) (p = 0.07). Patients with CAD had higher levels of plasma homocysteine (12.9 +/- 5.1 vs 11.9 +/- 4.5 micromol/L, p <0.001) and lower levels of folate (9.5 +/- 3.1 vs 9.9 +/- 3.8 ng/ml, p = 0.008) than controls. After adjustment for other risk factors for CAD, plasma homocysteine (p = 0.89), MTHFR gene C677T (p = 0.38), or A1298C polymorphisms (p = 0.13) were not independent correlates of CAD. This study demonstrated that MTHFR gene C677T or A1298C polymorphisms are not associated with the presence of angiographic CAD. Although there is an apparent association between elevated levels of homocysteine and CAD, this association is not independent of conventional cardiovascular risk factors.     

Scoring sacroiliac joints by magnetic resonance imaging. A multiple-reader reliability experiment

Magnetic resonance imaging (MRI) of the sacroiliac (SI) joints and the spine is increasingly important in the assessment of inflammatory activity and structural damage in clinical trials with patients with ankylosing spondylitis (AS). We investigated inter-reader reliability and sensitivity to change of several scoring systems to assess disease activity and change in disease activity in patients with AS. Twenty sets of consecutive MRI, derived from a randomized clinical trial comparing an active drug with placebo and selected on the basis of the presence of activity at baseline, were presented electronically to 7 experienced readers from different countries (Europe, Canada). Readers scored the MRI by 3 different methods including: a global score (grading activity per SI joint); a more comprehensive global score (grading activity per SI joint per quadrant); and a detailed scoring system [Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system], which scores 6 images, divided into quadrants, with additional scores for "depth" and "intensity." A fourth and a fifth scoring system were constructed afterwards. The fourth method included the SPARCC score minus the additional scores for "depth" and "intensity," and the fifth method included the SPARCC slice with the maximum score. Inter-reader reliability was investigated by calculating intraclass correlation coefficients (ICC) for all readers together and for all possible reader pairs. Sensitivity to change was investigated by calculating standardized response means (SRM) on change scores that were made positive. Overall inter-reader ICC per method were between 0.47 and 0.58 for scoring status, and between 0.40 and 0.53 for scoring change. ICC per possible reader pairs showed much more fluctuation per method, with lowest observed values close to zero (no agreement) and highest observed values over 0.80 (excellent agreement). In general, agreement of status scores was somewhat better than agreement of change scores, and agreement of the comprehensive SPARCC scoring system was somewhat better than agreement of the more condensed systems. Sensitivity to change differed per reader, but in general was somewhat better for the comprehensive SPARCC system. This experiment under "real life," far from optimal conditions demonstrates the feasibility of scoring exercises for method comparison, provides evidence for the reliability and sensitivity to change of scoring systems to be used in assessing activity of SI joints in clinical trials, and sets the conditions for further validation research in this field.