Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

ObjectiveTo compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.DesignProspective cohort study with propensity score matching.SettingData collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.ParticipantsA consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.InterventionsExercises and orthotics versus orthotics alone.Main Outcome MeasuresPrimary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).ResultsA larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).ConclusionsNon-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.     

Closer: A videoconference intervention for distance caregivers of cancer patients

Distance caregivers (DCGs) represent a growing demographic. The emotional burden of caregiving for a family member with cancer is amplified by the logistical challenges of providing support from afar. DCGs feel higher levels of distress, anxiety, and depression compared with local caregivers. Videoconference technology may alleviate both the emotional and practical burdens faced by DCGs. This is an ongoing randomized controlled trial in 32 outpatient ambulatory clinics at a large, urban, comprehensive cancer center. To date, 332 patient‐DCG dyads have been enrolled. DCGs must have internet access and have been identified by the patient as a source of support. The intervention period is 4 months. DCGs are randomized to one of three arms: DCGs in Arm 1 receive four coaching sessions with an advanced practice nurse or social worker and four videoconference appointments during the oncologist‐patient office visit. DCGs in Arm 2 participate in four videoconference appointments with the oncologist and patient, and Arm 3 is the control group, which receives access to information through a website. Primary outcome variables are DCG distress, anxiety, depression, burden, self‐efficacy, and emotional support. These data are collected electronically at baseline, 4 months, and 6 months. Patient distress, anxiety, and depression are also assessed at these same intervals using brief in‐person interviews. The change in each of the DCG outcomes over time will be examined by a repeated measures analysis of covariance.     

Effects of combined aerobic and resistance training in patients with heart failure: A meta‐analysis of randomized,controlled trials

Cardiac rehabilitation programs consisting of core features of exercise training for patients with heart failure have demonstrated a wide range of physical and psychological benefits. In study, a meta‐analysis of combined aerobic and resistance training was conducted on various outcomes in patients with heart failure. Database searches included EMBASE, PubMed, Medline, Cochrane Library, Web of Science, OVID, and CINAHL. Only randomized, controlled trials were included. Review Manager 5.3 software was used to perform the meta‐analysis. In total, 12 studies and 516 patients were included. The results demonstrated that combined aerobic and resistance training is effective in promoting exercise capacity, muscle strength, and 6 min walk distance. Furthermore, combined training significantly improves the quality of life of patients with heart failure. However, there was no significant difference found for outcomes of depression and sleep. Future studies with rigorous methodological designs and long‐term follow ups are recommended to evaluate the sustainable benefits of combined aerobic and resistance intervention programs.     

Regression equations to estimate the 2‐min walk distance in an adult Asian population aged 40–75 years

Background and objective

There is increased use of the 2‐min walk test (2MWT) to assess functional exercise capacity. However, the distance achieved during this test may be difficult to interpret in the absence of reference values from a local population. Regression equations to estimate the 2‐min walk distance (2MWD) only exist for American and Brazilian populations. The objective of this study was to develop regression equations to estimate the 2MWD in Malaysian adults who were free from major health problems.

Methods

Eighty‐seven adults (43 males; mean ± SD age: 57.1 ± 9.6 years) performed two 2MWT using a standardized protocol. Heart rate (HR) was recorded every 30 s during the test. Stepwise multiple regression analysis was performed using age, gender, height, weight and change in HR (ΔHR) as independent variables, and better of the two 2MWD as the dependent variable. A second regression equation, without ΔHR, was planned if ΔHR was retained as one of the predictors of the 2MWD in the first equation.

Results

The better of the two 2MWD was 200 ± 34 m. Males walked 33 ± 6 m further than females (P < 0.001). The two regression equations were 196 − 1.1 × age, years + 1.0 × ΔHR, bpm + 31.2 × gender (R² = 0.73) and 279 − 1.7 × age, years + 35.9 × gender (R² = 0.47) with females = 0 and males = 1.

Conclusion

The equations derived in this study may facilitate the interpretation of the 2MWD in clinical populations in Malaysia, as well as in countries with similar cultural backgrounds to Malaysia.

     

河南和新疆地区HIV-1毒株gp120和gag基因的变异分析

目的分析中国河南和新疆地区艾滋病病毒Ⅰ型(HIV-1)毒株gp120和gag基因全长序列的变异特征。方法PCR扩增河南和新疆HIV-1确认阳性样本前病毒DNA gp120和gag全长基因,测序得到40份gp120和41份gag基因序列,用GCG软件包等软件进行分析。结果河南省HIV-1毒株为B′亚型,新疆维吾尔自治区HIV-1毒株为CRF07 BC亚型。B′亚型毒株gp120基因中变异程度最大的区段是V5区段,最小的是C1区段;CRF07BC亚型毒株中变异最大的是V1区段,最小的是C4区段。两种亚型毒株gp120和gag基因的Ks/Ka值<1(P<0.05)。结论对于病毒基因全长序列的分析可以更多地反映病毒的特性。gp120基因各个区段在B′和CRF07BC亚型毒株中的变异程度不一致。B′和CRF07 BC亚型毒株的gp120基因和gag基因都受到正向选择压力的作用。     

Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension

BACKGROUND: Sildenafil inhibits phosphodiesterase-5, enhancing cyclic guanosine monophosphate- mediated relaxation of pulmonary vasculature and is effective in treating patients with pulmonary arterial hypertension (PAH). METHODS: Patients with PAH (n = 278) received oral sildenafil (20, 40, or 80 mg three times daily) in a 12-week, double-blind, placebo-controlled study and an open-label extension. Health-related quality of life (HRQoL) was recorded by patients using the Medical Outcomes Study 36-item short form (SF-36) and EuroQol 5D (EQ-5D) questionnaires at baseline and after 12 and 24 weeks of therapy. Data are presented for patients who received sildenafil for up to 24 weeks. RESULTS: Sildenafil-treated patients, compared with placebo-treated patients, exhibited significant improvement in exercise capacity at week 12 (p < 0.001). Increases from baseline to week 12 were observed in all SF-36 domains for sildenafil-treated patients, with statistically significant improvements, compared with placebo-treated control subjects, in physical functioning (p < 0.001), general health (p < 0.001), and vitality (p < 0.05). Statistically significant improvements were also observed for the EQ-5D current health status (p < 0.01) and utility index (p < 0.01). These benefits were maintained for 24 weeks. Treatment groups were pooled for analyses as the results for the 6-min walk distance, SF-36, and EQ-5D were not dose dependent. CONCLUSIONS: Sildenafil improves HRQoL of PAH patients. These improvements appear to be maintained for at least 24 weeks. The effects are strongest in domains addressing the physical impact of health on daily activities and patients' overall perception of health.     

视网膜眼底图像中视盘的检测方法

视盘的准确检测对视网膜眼底图像的其他特征,如血管和微动脉瘤的精确检测非常重要。本文提出一种结合视盘亮度和圆形度特征的视盘检测方法,先对眼底图像进行预处理,然后运用数学形态学运算去除血管的干扰,采用阈值分割提取出可能为视盘的区域,最后再根据视盘的面积和圆形度特征检测出真正的视盘区域。实验结果表明,本文算法具有较高的定位精度和较快的定位速度。     

Plasma 15-F2t-isoprostane in idiopathic pulmonary arterial hypertension

Background

15-F_2t-isoprostane (15-F_2t-IsoP), a prostaglandin F₂-like compound, is widely recognized as a biomarker of chronic heart failure. This study investigated the potential role and prognostic significance of plasma 15-F_2t-IsoP in patients with idiopathic pulmonary arterial hypertension (IPAH).

Methods

Plasma 15-F_2t-IsoP concentrations were determined in 80 consecutive IPAH patients at the time of their first right heart catheterization, and monitored for 30 ± 12 months. The expression of 15-F_2t-IsoP protein in autopsy lung samples was determined by immunohistochemical staining.

Results

Plasma 15-F_2t-IsoP concentrations were significantly increased in patients with IPAH compared with healthy controls (91 pg/ml vs. 30 pg/ml, respectively; P < 0.001). Patients with baseline 15-F_2t-IsoP concentrations ≥ 97 pg/ml had a significantly lower survival rate than those with lower baseline concentrations (P < 0.001). During follow-up, 15-F_2t-IsoP concentrations in survivors decreased, whereas concentrations in non-surviving patients increased further (P < 0.05). Elevated concentrations of 15-F_2t-IsoP were correlated with a severity of WHO functional class, lower 6-minute walking distance and mixed venous oxygen saturation, higher mean right atrial pressure and brain natriuretic peptide. Multivariate analysis revealed that the plasma 15-F_2t-IsoP concentration was an independent factor associated with mortality. Histological studies showed that the expression of 15-F_2t-IsoP was up-regulated in remodeled pulmonary vessels.

Conclusions

An elevated plasma 15-F_2t-IsoP concentration and a further increase during follow-up may be a risk factor for higher mortality in patients with IPAH.     

Ceramides are associated with inflammatory processes in human mediastinal adipose tissue

Background and AimCeramides are poorly characterized in human adipose tissue. The aim of this study was to investigate concentrations of different ceramide species in human subcutaneous and visceral adipose tissue depots and to determine associations between ceramides and global gene expression profiles.Methods and ResultsConcentrations of six ceramide species were determined in plasma and in subcutaneous and mediastinal adipose tissue from 10 overweight subjects (BMI 29.4 ± 4.9 kg/m²). In the adipose tissue biopsies gene expression arrays were performed and relationships between ceramides and gene expression analyzed. Immunostaining of the two adipose tissue depots was performed in an independent group of 10 patients. Mediastinal adipose tissue contained significantly higher concentrations (p < 0.05) of all six ceramide species than the subcutaneous depot. Of the six ceramides in plasma, concentrations of only two (Cer d18:1/18:0 and Cer d18:1/22:0) correlated significantly (p < 0.05) with the corresponding species in mediastinal adipose tissue, but there were no significant correlations between ceramides in plasma and subcutaneous adipose tissue. Multivariate analysis identified significant correlations between the total ceramide concentration and global gene expression within mediastinal, but not subcutaneous adipose tissue, according to cross-validation. Gene ontology analysis of genes related to ceramides in the mediastinal depot revealed that genes positively correlated with ceramides were associated mainly with immune and inflammatory categories, while genes negatively correlated with ceramides were associated mainly with lipid and carbohydrate metabolism.ConclusionsCeramides in human mediastinal adipose tissue may be involved in inflammation and lipid and carbohydrate metabolism.