Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial

Objective

To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).

Combination therapy with ciprofloxacin and third-generation cephalosporin versus third-generation cephalosporin monotherapy in Escherichia coli meningitis in infants: a multicentre propensity score–matched observational study

ObjectivesEscherichia coli is the second cause of bacterial meningitis in neonates. Despite the use for 35 years of third-generation cephalosporins (3GCs), high morbidity and mortality rates with E. coli meningitis continue to occur. Because ciprofloxacin has good microbiologic activity against E. coli and good penetration in cerebrospinal fluid and brain, some authors have suggested adding ciprofloxacin to a 3GC regimen. The objective of this study was to assess combining 3GCs with ciprofloxacin versus 3GCs alone in a cohort of infants with E. coli meningitis.MethodsWe included all cases of E. coli meningitis diagnosed in infants <12 months of age that were prospectively collected through the French paediatric meningitis surveillance network between 2001 and 2016. The main outcome was the proportion of short-term neurologic complications with versus without ciprofloxacin. The analysis was conducted retrospectively by multivariable regression and propensity score (PS) analysis.ResultsAmong the 367 infants enrolled, 201 (54.8%) of 367 had ciprofloxacin and 3GC cotreatment and 166 (45.2%) of 367 only a 3GC. Median age and weight were 15 days (range, 1–318 days) and 3.42 kg (range, 0.66–9.4 kg). A total of 86 (23.4%) of 367 infants presented neurologic complications (seizures, strokes, empyema, abscesses, hydrocephalus, arachnoiditis); 57 received ciprofloxacin cotreatment. Complications were associated with ciprofloxacin cotreatment on multivariable analysis (odds ratio (OR) = 1.9; 95% confidence interval (CI), 1.1–3.4) and PS analysis (OR = 1.9; 95% CI, 1.1–3.3). Mortality rate did not differ with and without ciprofloxacin: 22 (10.9%) of 201 versus 16 (9.6%) of 166 deaths (OR = 0.7; 95% CI, 0.3–1.6; PS analysis).ConclusionsCiprofloxacin added to 3GCs at least offers no advantage for neurologic outcome and mortality in infants with E. coli meningitis.     

Examining the Function In Sitting Test for Validity,Responsiveness, and Minimal Clinically Important Difference in Inpatient Rehabilitation

ObjectivesTo determine the responsiveness of the Function In Sitting Test (FIST), compare scores at admission and discharge from inpatient rehabilitation (IPR) with other balance and function measures, and determine the minimal clinically important difference (MCID).DesignProspective, nonblinded, reference-standard comparison study.SettingFour accredited inpatient rehabilitation units.ParticipantsPopulation-based sample of adults (N=125) with sitting balance dysfunction, excluding persons with spinal cord injury, significant bracing/orthotics, and inability to perform testing safely.InterventionsNot applicable.Main Outcome MeasuresFIST, FIM, and Berg Balance Scale (BBS) at admission and discharge, and Global Rating of Change for function and balance at discharge.ResultsThe FIST demonstrated good to excellent concurrent validity with the BBS and FIM at admission and discharge (Spearman ρ=.71–.85). Significant improvement (P<.000; 95% confidence interval [CI], 10.73–15.41) occurred in the FIST from admission (mean ± SD: 36.81±15.53) to discharge (mean ± SD: 49.88±6.90). The standard error of measurement for the FIST was 1.40, resulting in a minimal detectable change of 5.5 points. The receiver operator characteristic curve differentiated participants with meaningful balance changes (area under the curve, .78; P>.000; 95% CI, .66–.91), with a change in FIST score of ≥6.5 points designating the MCID. Findings support the strong responsiveness of the FIST during IPR as evidenced by the large effect size (.83), standardized response mean (1.04), and index of responsiveness (1.07).ConclusionsIn this study, the FIST correlated well with balance and function measures (concurrent validity) and was responsive to change during IPR. A clinically meaningful change was indicated by an increase in score of ≥6.5 points.     

An experimental basis for revising the graphic rating scale for pain

Seven subjects judged the differences between electrocutaneous shocks and words from two category rating lists describing those sensations in each of two difference estimation experiments. The electrocutaneous shocks used for the two experiments were 10 suprathreshold shock intensities determined separately for each subject. There were two distinct 7-word category rating lists. Both lists shared 6 common words; however, the seventh word made the rational ordering of the two lists different.Magnitude scales of meaning for the category rating words and sensory scales for the electrocutaneous shock intensities were determined for each of the two experiments for each subject using conjoint measurement analysis. Comparisons of the sensory scales for electrocutaneous shock between the two difference estimation experiments for each subject showed that they judged the electrocutaneous shocks similarly with the two word lists. This allowed for comparisons between the scales of meaning for the words from the category rating lists. The two word lists were not equivalent. There was substantial agreement among the subjects on characteristic spacings of quantitative values for the category rating items. These results suggest that clinical rating scales used for analgesimetry should not assume homogeneity of spacing of category items. A scale incorporating our subjects' common understanding is presented.     

Gait and Balance Measures Can Identify Change From a Cerebrospinal Fluid Tap Test in Idiopathic Normal Pressure Hydrocephalus

Objectives

To identify in patients with idiopathic normal pressure hydrocephalus (iNPH) undergoing a cerebrospinal fluid (CSF) tap test (TT) for consideration of a ventricular peritoneal (VP) shunt: (1) gait and balance measures, which identify symptom change; (2) differences present between pre– and post–CSF TT scores between patients classified as responders and nonresponder; (3) ability of patients with iNPH to accurately quantify change in their gait and balance symptoms from a CSF TT.

Cutting-edge Science and Coffee: Auditory System Gordon Research Conference and Seminar 2012 Report

At the third Gordon Research Conference and Gordon Research Seminar on the Auditory System (2012), investigators from all career stages reported on emerging research in a broad range of sub-fields. A distinguishing feature of these conferences is their attention to junior investigators, and their experience is the focus of this conference report.     

Influence of Natural Weather Conditions in the Long-Term Fracture Energy of Glass Fibre Reinforced Cement (GRC) Modified with Chemical Additions

The use of glass fibre-reinforced cement (GRC) in structural elements has been limited due to the reduction in the mechanical properties of the material with aging. Chemical additions have been used to modify the cement mortar formulation in order to minimise such loss, but no conclusive results have been obtained yet. Moreover, the application of accelerated aging methods in such modified GRC formulations still poses several uncertainties. An experimental campaign seeking to assess the reduction in the fracture energy of two GRCs manufactured with modified matrixes after five years of exposure to natural environment was performed. Furthermore, a comparison with results from the literature that used accelerated aging methods was performed. The results show that the use of the chemical additives might be capable of maintaining to a notable extent the mechanical properties of GRC after five years of natural aging. Regarding the accelerated aging method by means of immersion in hot water tanks, it seemed that the equivalences applied in previous research accurately match the degradation of the material after natural exposure to weather. Additionally, a digital image correlation analysis showed that aged GRCs seemed to distribute damage in a smaller area than young GRCs.     

GRC5 and NMD3 function in translational control of gene expression and interact genetically

The yeast gene, GRC5 (growth control), is a member of the highly conserved QM gene family, the human member of which has been associated with the suppression of Wilms' tumor. GRC5 encodes ribosomal protein L10, which is thought to play a regulatory role in the translational control of gene expression. A revertant screen identified four spontaneous revertants of the mutant grc5-1 ^ts allele. Genetic and phenotypic analysis showed that these represent one gene, NMD3, and that the interaction of NMD3 and GRC5 is gene-specific. NMD3 was previously identified as a component of the nonsense-mediated mRNA decay pathway. The point mutations within NMD3 reported here may define a domain important for the functional interaction of Grc5p and Nmd3p. Received: 17 August / 10 November 1998     

The minimal important difference of the ICU mobility scale

Background

The intensive care unit mobility scale (IMS) is reliable, valid and responsive. Establishing the minimal important difference (MID) of the IMS is important in order to detect clinically significant changes in mobilization.