Effect of ACL graft material on joint forces during a simulated in vivo motion in the porcine knee: Examining force during the initial cycles

This study compared three‐dimensional forces in knees containing anterior cruciate ligament (ACL) graft materials versus the native porcine ACL. A six‐degree‐of‐freedom (DOF) robot simulated gait while recording the joint forces and moments. Knees were subjected to 10 cycles of simulated gait in intact, ACL‐deficient, and ACL‐reconstructed knee states to examine time zero biomechanical performance. Reconstruction was performed using bone‐patellar tendon‐bone allograft (BPTB), reconstructive porcine tissue matrix (RTM), and an RTM‐polymer hybrid (Hybrid). Forces and moments were examined about anatomic DOFs throughout the gait cycle and at three key points during gait: heel strike (HS), mid stance (MS), toe off (TO). Compared to native ACL, each graft restored antero‐posterior (A‐P) forces throughout gait. However, all failed to mimic normal joint forces in other DOFs. For example, each reconstructed knee showed greater compressive forces at HS and TO compared to the native ACL knee. Overall, the Hybrid graft restored more of the native ACL forces following reconstruction than did BPTB, while RTM grafts were the least successful. If early onset osteoarthritis is in part caused by altered knee kinematics, then understanding how reconstruction materials restore critical force generation during gait is an essential step in improving a patient's long‐term prognosis. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1458–1463, 2014.     

Aging and Diversity: An Active Learning Experience,by Chandra M. Mehorta and Lisa S. Wagner

This study evaluated a 10-week chair yoga intervention on cognition, balance, activities of daily living (ADLs), anxiety, and depression for persons with Alzheimer's disease (AD). Residents were assigned to three groups: (a) mild AD (n?=?6), (b) moderate AD (n?=?6), or (c) severe AD (n?=?7). There was no significant change in balance, anxiety, or cognition. ADLs showed a significant effect (p?=?.02), which suggests that yoga may have more benefit early in the progression of AD. Depression increased significantly (p < .01). Yoga over an extended period of time with a larger sample size may demonstrate benefits to persons with AD and serve as means to improve overall quality of life.     

“You can’t get there from here”: Critical obstacles to current estimates of the ESRD risks of young living kidney donors

Short studies that generate lifetime end‐stage renal disease (ESRD) risks for young living kidney donors have conflicted with the knowledge and practice of nontransplant specialists. A widely accepted online risk calculator (OLRC) is no exception. It uses 6.4 year observations and an ostensibly empiric methodology to predict low lifetime risks for normal young candidates. But the nonspecific ESRD risk factors identified in this study are likely features of kidney diseases that were already underway at study entry. No practicing nephrologist would use their absence to predict any specific kidney disease that had yet to begin, which is essential for excluding high‐risk individuals. The OLRC's risk estimates are particularly low because it also does not assign to young adults about 70% of the lifetime ESRD that they will experience as they age, which is part of their risk. It reinforces traditional concepts of low donor risk, minimizing the potential relevance of recent, sometimes concerning, long‐term outcome data. These data suggest many similarities between postdonation ESRD and ESRD in the general population, about which much is already known. Despite our best efforts, the heterogeneity and exponential accumulation of end‐stage kidney diseases over time prevent long‐term predictions of risk for young kidney donors.     

补阳还五汤加减在社区脑卒中后疲劳患者中的运用

目的观察补阳还五汤加减治疗社区脑卒中后疲劳患者的临床疗效。方法本研究于2016年6月～2018年6月将符合入组标准的63例北京社区脑卒中患者,随机分为对照组和治疗组。对照组接受内科常规药物对症治疗。治疗组在补阳还五汤的基础上根据患者的症状进行加减。4周后对患者的疲劳严重度、生存质量和日常生活能力进行评分,与治疗前评分进行比较分析。结果入组的脑卒中后疲劳患者经过治疗后,疲劳严重度评分、生存质量评分和日常生活能力评分均较治疗前改善(P0.05);补阳还五汤治疗组患者在改善疲劳严重度评分、日常生活能力评分方面优于对照组(P0.05),两组在改善生存质量改善方面效果相近(P0.05)。结论应用补阳还五汤加减治疗脑卒中后疲劳,能显著改善患者的疲劳程度和日常生活能力,提高生存质量,对临床指导具有较好的参考意义。     

Visual Concerns that Interfere with Daily Activities in Patients on Rehabilitation Units: A Descriptive Study

The purpose of this study was to estimate the prevalence of patients with visual concerns that interfere with their activities of daily living (ADL) performance in physical rehabilitation units through occupational therapy assessment. Over the two-month study period, 215 adult inpatients from a physical rehabilitation hospital were evaluated using the Brief Vision Screen (BVS) through ADL. The BVS assessed four areas of visual concerns, namely left visual field, focusing, and near- and low-contrast acuity, while patients engaged in ADL. The occupational therapists identified 33% of patients who had at least one area of visual concern, with the largest proportion diagnosed with stroke (55%), followed by pulmonary disease (40%) and joint replacement (35%). When comparing the four areas of visual concerns in the BVS between the two major diagnostic groups (acquired brain injury, ABI and non-acquired brain injury, non-ABI), a significantly higher proportion of patients with ABI were identified as having left hemianopsia concerns compared to patients with non-ABI. No significant difference was observed in other areas of visual concern between the two groups. Findings indicated that visual concerns that interfere with ADL performance among older patients in rehabilitation units are common. The high proportion of patients with pulmonary disease identified as having visual concerns warranted further confirmation and investigation. Preliminary evidence to support the psychometric properties of the BVS for identifying visual concerns in patients on rehabilitation units was established.     

Recovery from addiction in two types of sober living houses: 12-Month outcomes

Objective: Sustained abstinence for many alcohol- and drug-dependent persons might be enhanced by providing an alcohol- and drug-free living environment that supports recovery. Sober living houses (SLHs) are alcohol- and drug-free living environments for individuals attempting to maintain abstinence. Costs are covered by resident fees and residents can stay as long as they wish.

Method: The present study examined 300 individuals who entered: (1) SLHs associated with an outpatient treatment program (N = 55) or (2) freestanding SLHs not affiliated with formal treatment (N = 245). A repeated-measure design examined alcohol, drug, and other problem areas at baseline, 6 months, and 12 months. Mixed model regressions were used to assess how problems changed for individuals within each type of SLH over the 3 time points.

Results: Residents in both types of houses made significant reductions in the maximum number of days of substance use per month between baseline and 6 months and these reductions were maintained at 12 months. On Addiction Severity Index (ASI) scales that assessed alcohol, drug, employment, and legal problems residents either made significant improvement or maintained low baseline severity of problems at 6 and 12 months. On other measures, residents entered the houses with moderately high severity that did not improve (ASI Medical and Family/Social severity) or improved modestly (psychiatric symptoms on the Brief Symptom Inventory).

Conclusion: Addiction recovery systems should recognize the potential utility of SLHs and examine the types of houses that are feasible in specific communities.