Effects of experimentally induced low back pain on the sit-to-stand movement and electroencephalographic contingent negative variation

It is becoming increasingly evident that people with chronic, recurrent low back pain (LBP) exhibit changes in cerebrocortical activity that associate with altered postural coordination, suggesting a need for a better understanding of how the experience of LBP alters postural coordination and cerebrocortical activity. To characterize changes in postural coordination and pre-movement cerebrocortical activity related to the experience of acutely induced LBP, 14 healthy participants with no history of LBP performed sit-to-stand movements in 3 sequential conditions: (1) without experimentally induced LBP; NoPain1, (2) with movement-associated LBP induced by electrocutaneous stimulation; Pain, and (3) again without induced LBP; NoPain2. The Pain condition elicited altered muscle activation and redistributed forces under the seat and feet prior to movement, decreased peak vertical force exerted under the feet during weight transfer, longer movement times, as well as decreased and earlier peak hip extension. Stepwise regression models demonstrated that electroencephalographic amplitudes of contingent negative variation during the Pain condition significantly correlated with the participants’ change in sit-to-stand measures between the NoPain1 and Pain conditions, as well as with the subsequent difference in sit-to-stand measures between the NoPain1 and NoPain2 conditions. The results, therefore, identify the contingent negative variation as a correlate for the extent of an individual’s LBP-related movement modifications and to the subsequent change in movement patterns from before to after the experience of acutely induced LBP, thereby providing a direction for future studies aimed to understand the neural mechanisms underlying the development of altered movement patterns with LBP.     

Evaluation of the Accuracy of Nursing Diagnoses in a Brazilian Emergency Service

PURPOSE. The study aims to verify the accuracy of 10 prevalent nursing diagnoses (NDs) in the emergency service of a Brazilian university hospital. METHODS. The accuracy of 10 prevalent diagnoses was evaluated using the Lunney (1990 ) scale. The evaluation was based on data recorded from patient charts by nurses. Each diagnosis was evaluated in three separate clinical instances, resulting in a total of 30 evaluations. FINDINGS. The evaluation characterized 24% (7) of the NDs as highly accurate, while 76% (23) were considered to be of low accuracy. CONCLUSION. The low levels of accuracy detected in some diagnoses highlight the need for nurses to develop skills in accurately applying the diagnostic process involving the use of NDs. However, in order to confirm (or not) the observed low levels of diagnostic accuracy, studies with larger sample sizes should be carried out. This is essential as it is recommended that care processes be supported by knowledge about accuracy. IMPLICATIONS FOR NURSING PRACTICE. Educational interventions should be implemented that hone the ability to make accurate NDs in clinical nursing practice. Further studies are also needed to evaluate the accuracy of NDs elaborated by nurses in different clinical contexts. OBJETIVO. Verificar o grau de acurácia dos diagnósticos de enfermagem (DE) prevalentes em um serviço de emergência em um hospital brasileiro. MÉTODO. O grau de acurácia foi avaliado através da escala de Lunney (1990 ). Essa avaliação foi realizada a partir dos dados registrados pelos enfermeiros no prontuário do pacientes. Cada DE foi avaliado em 3 situações clínicas diferentes, totalizando 30 avaliações. RESULTADOS: A avaliação da acurácia dos DE apontou que 24% (07) foram classificados com alto grau de acurácia e 76% (23) com baixo grau de acurácia. CONCLUSÕES. A baixa acurácia detectada demonstra a necessidade de que os enfermeiros desenvolvam habilidades para aplicar acuradamente o processo diagnóstico com o uso das classificações dos DE. Entretanto, para confirmar (ou não) a baixa acurácia diagnóstica deve‐se desenvolver estudos com amostra maiores. Recomenda‐se, pois, que o processo de cuidar seja sustentado por conhecimentos sobre a acurácia. IMPLICAÇÕES PARA A PRáTICA EM ENFERMAGEM. Faz‐se necessário direcionar práticas educativas que promovam o desenvolvimento de habilidades para elaborar DE acurados na prática clínica de enfermagem. É preciso, pois, o contínuo desenvolvimento de estudos que avaliem a acurácia dos DE elaborados pelos enfermeiros nos diferentes contextos clínicos     

Two cases of torsades de pointes associated with Takotsubo cardiomyopathy as the second insult

Torsades de pointes (TdP) is a fatal polymorphic ventricular tachyarrhythmia that is related to QTc prolongation. Takotsubo cardiomyopathy (TCM) is characterized by acute transient left ventricular dysfunction without obstructive coronary artery disease. The QTc interval is always prolonged in TCM; however, TdP is rarely reported in patients with TCM. Despite that the electrocardiograms of patients with TCM unexceptionally demonstrate marked QTc interval prolongation, TdP is rarely associated with TCM, leading to the proposal that TCM is another cause of acquired long QT syndrome and another insult to the repolarization reserve. We identified 2 cases that reinforce this concept.     

Noncanonical Wnt signaling mediates androgen-dependent tumor growth in a mouse model of prostate cancer

Prostate cancer development is associated with hyperactive androgen signaling. However, the molecular link between androgen receptor (AR) function and humoral factors remains elusive. A prostate cancer mouse model was generated by selectively mutating the AR threonine 877 into alanine in prostatic epithelial cells through Cre-ERT2-mediated targeted somatic mutagenesis. Such AR point mutant mice (ARpe-T877A/Y) developed hypertrophic prostates with responses to both an androgen antagonist and estrogen, although no prostatic tumor was seen. In prostate cancer model transgenic mice, the onset of prostatic tumorigenesis as well as tumor growth was significantly potentiated by introduction of the AR T877A mutation into the prostate. Genetic screening of mice identified Wnt-5a as an activator. Enhanced Wnt-5a expression was detected in the malignant prostate tumors of patients, whereas in benign prostatic hyperplasia such aberrant up-regulation was not obvious. These findings suggest that a noncanonical Wnt signal stimulates development of prostatic tumors with AR hyperfunction.     

Subclinical hypothyroidism is independently associated with albuminuria in people with type 2 diabetes

We examined a possible association between subclinical hypothyroidism and albuminuria in 159 people with type 2 diabetes. Patients with subclinical hypothyroidism had significantly higher levels of urinary albumin-to-creatinine ratio (UACR) than those with euthyroidism. Multivariate logistic regression analyses demonstrated that serum TSH level was an independent risk factor of albuminuria.     

Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis

Hase K, Suzuki E, Matsumoto M, Fujiwara T, Liu M. Effects of therapeutic gait training using a prosthesis and a treadmill for ambulatory patients with hemiparesis.

Objective

To examine the short-term effects of a newly developed hemiparetic gait training in which patients walk with a prosthesis applied to the nonparetic leg in the flexed knee position.

Design

Pre-post nonrandomized controlled trial.

Setting

Rehabilitation center and gait laboratory of a university hospital.

Participants

Community-dwelling ambulatory volunteers (N=22) with chronic hemiparesis caused by a unilateral stroke.

Intervention

Study subjects participated in a gait training program using either a below-knee prosthesis or a treadmill. Treadmill gait training was performed at a speed approximating the maximum gait velocity for each patient. The 3-week program consisted of a 5-minute gait training session 2 to 3 times a day.

Main Outcome Measures

The ground reaction forces, stance time, step length and cadence during walking at a comfortable speed, and maximum gait speed, as well as the Berg Balance Score, were estimated before and after each training program.

Results

In comparison with changes after the treadmill gait training, analyses of covariance demonstrated a significant increase of the fore-aft ground reaction forces during the paretic propulsion phase and a significant increase in the relative durations of the paretic and nonparetic single stance involved in a gait cycle after the prosthetic gait training (P<.05).

Conclusions

Prosthetic gait training would have different effects on a hemiparetic gait than treadmill gait training. The gait-related task inducing the dominant use of the paretic leg to support the body may be useful as a rehabilitative treatment to improve the kinetic abilities in the paretic stance period.