Test-retest Reliability of EMG β-Band Intermuscular Coherence of Non-specific Chronic Low Back Pain During Flexion-extension Task

Introduction: This study aimed to investigate the reliability and agreement of the Beta-band Intermuscular Coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low Back Pain (NS-CLBP) patients and healthy subjects by studying four phases of the Flexion-Extension Task (F-ET): standing, flexion, relaxation, and extension phases. Materials and Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All subjects performed three trials of F-ET while the surface electromyography was recorded from the lumbar erector spinal, gluteus maximus,  and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) for four phases of F-ET were used to analyze the intra- rater reliability and agreement of the measurements. Results: The investigation of ICC, SEM, and MDC showed that the reliability was moderate to a high level for pool and pairwise coherence of Bb-IMC in all mentioned muscles for   four phases of the flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: So far, no studies have used the Bb-IMC method to study low back pain, which is carried out in our research to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET have moderate to a high level of reliability for using Bb-IMC and could be considered a tool for the NS-CLBP patients’ assessment. Despite the small sample size investigated, in clinical practice the using Bb-IMC measure  can help to study the interaction of corticospinal in NS-CLBP and also in healthy subjects. This measure requires larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Further, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

BACKGROUND

Proprioceptive training in the aquatic environment is more beneficial owing to water properties. The primary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquatic proprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and joint position sense in male athletes after anterior cruciate ligament reconstruction (ACLR).

METHODS

A total of 38 athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. The conventional therapy group (CT) (n=19) received conventional rehabilitation for 6 weeks, while the hydrotherapy group (HT) (n=19) received the same conventional rehabilitation, in addition to 12 sessions of innovative aquatic proprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), and international knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was used to compare the means between the two groups. Cohen's d from an independent t-test was used to calculate the effect sizes for all variables after the intervention for both groups.

RESULTS

Base on the results, there were a significant difference in absolute errors (AE) (FAE=56.231, P<0.001) and variable errors (VE) (FVE=60.245, P<0.001) between the two groups. No significant differences were detected in constant error (CE), VAS, and IKDC between the two groups (P>0.05). Both groups displayed a significant difference in terms of AE, VE, VAS, and IKDC after the intervention (P<0.05). Percent changes after the intervention for AE(69.19%), VE (68.20%), CE (65.20%), VAS37.50%, and IKDC (38.61%) were greater in the HT group, compared to the CT group.

CONCLUSION

As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into the conventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individuals with ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensure the optimal engagement of proprioception.

Test-Retest Reliability of Surface Electromyographic Measurements in Athletes With Anterior Cruciate Ligament Reconstruction: A Voluntary Response Index Analysis

Introduction: Voluntary Response Index (VRI) is used as a measure of motor control to study abnormalities of voluntary movements. This study aimed to evaluate the reliability of voluntary response index analysis in subjects with Anterior Cruciate Ligament Reconstruction (ACLR).Materials and Methods: Using surface electromyography, the VRI components of both groups of 15 ACLR and 15 healthy controls were assessed during the functional task (sit-stand-sit). The outcome variables of VRI included the magnitude and similarity index.Results: In sit to stand phase, high reliability was found (ICC=0.80-0.89) for the magnitude and similarity index in both groups. In the standing phase, high to very high reliability was found for the magnitude and similarity index in both groups (ICC=0.75-0.91). In stand to sit phase, high to very high reliability was found (ICC=0.78-0.92) for the magnitude and similarity index in both groups.Conclusion: Surface electromyographic measurements of VRI analysis demonstrated high to very high reliability in athletes with ACLR during the functional task (sit-stand-sit). The results of the current study showed that the VRI analysis in athletes after ACLR was a reliable method and can be used to evaluate motor control before and after ligament injury in these patients.

The epidemiology of Candida species in the Middle East and North Africa

In recent decades, the epidemiology of invasive candidiasis (IC) has progressively changed worldwide. This notably includes emergence of several Candida species. Although some surveillance programs provided global trends in IC epidemiology, data from countries from the Middle East and North Africa (MENA) remain scarce. In this manuscript, we reviewed the existing available data on the epidemiology of Candida species associated with IC, particularly candidemia, in MENA region regarding species distribution. As witnessed worldwide, an evident shift of Candidaalbicans towards non-albicansCandida (NAC) has been observed in the MENA region. The worrying emergence of multi-drug resistant Candida species in MENA calls for a better understanding of their epidemiology. This represents an essential prerequisite for the implementation of effective infection control strategies and surveillance systems to prevent IC among high-risk patients.

Prognostic scores for sorafenib-treated hepatocellular carcinoma patients: A new application for the hepatoma arterial embolisation prognostic score

BACKGROUND

No prognostic classification is currently used for patients treated with systemic therapies for Hepatocellular Carcinoma (HCC).

METHODS

We retrospectively analysed data from patients treated with sorafenib for HCC from five centres in France and in the United Kingdom (UK). The training set comprised data from two centres and the validation set from three. Variables independently associated with Overall Survival (OS) in the training set were used to build the SAP (Sorafenib Advanced HCC Prognosis) score. The score was tested in the validation set, then compared with other prognostication systems.

RESULTS

The training set and validation set included 370 and 468 patients respectively. In the training set, variables independently associated with OS in multivariable analysis were: performance status (PS) >0, alpha-fetoprotein (AFP) >400 ng/ml, tumour size >7 cm, bilirubin >17 μmol/l and albumin <36 g/l. The SAP score was built giving one point to each abnormal variable, and three classes were constructed. The SAP score was significantly associated with OS in the training set, with median OS of 14.9 months for SAP A, 7.2 months for SAP B and 2.5 months for SAP C (P < 0.001). In the validation set, the SAP score was significantly associated with OS, and showed greater discriminative abilities than Barcelona Clinic Liver Cancer (BCLC) and albumin-bilirubin (ALBI) scores. However, the hepatoma arterial embolisation prognostic (HAP) score showed greater discriminative abilities than the SAP score.

CONCLUSION

In European patients treated with sorafenib, the HAP was the most discriminant prognostic score and may facilitate stratification in trials and inform clinical decision making.

Effect of Different Doses of Oral Cholecalciferol on Serum 1,25(OH)2D in Vitamin D Deficient Schoolchildren

Data regarding 1,25-dihydroxycholecalciferol in adolescents are limited. We aimed to determine serum levels of this active metabolite of vitamin D and the effects of different doses of vitamin D on its concentration in schoolchildren with high prevalence of vitamin D deficiency. In a previously published randomized double-blind, placebo-controlled trial, 210 subjects, aged 14-20 years, were assigned to 3 regimens of vitamin D treatment: group A (n=70) received 50 000 U oral cholecalciferol monthly, group B (n=70), 50 000 U bimonthly, and group C (n=70), placebo. Serum 25(OH)D, calcium, parathyroid hormone, and bone markers were measured at baseline and after 2 and 5 months of treatment. In the present study, serum levels of 1,25(OH)2D were measured in 97 boys and 95 girls. At baseline, girls had significantly higher concentrations of 1,25(OH)2D than boys (36, IQR: 24, 63 vs. 30, IQR: 15, 57.5 pmol/l; p<0.01). There was no significant correlation between serum levels of 25(OH)D and 1,25(OH)2D in the total population (Spearman rho=- 0.111; p=0.126), boys (Spearman rho=0.008; p=0.941), and girls (Spearman rho=0.036; p=0.729). Also, 1,25(OH)2D values did not change over time in different study groups. Moreover, total and sex-stratified analysis did not show any significant difference between different groups at different times of the study period. In an adolescent population with high prevalence of hypovitaminosis D especially in girls, 1,25(OH)2D values were higher in girls than boys. There was no significant change in 1,25(OH)2D concentrations with different doses of vitamin D.

Interest of external photoprotection by means of clothing and sunscreen products in young children

BACKGROUND

Protecting young children is a major public health issue.

OBJECTIVE

We tested children's clothing and sunscreen products that are specially designed for children.

METHODS

The effectiveness of the different types of clothing and sunscreen products was determined using spectrophotometer equipped with an integrating sphere A measure of transmittance carried out, respectively, between 290 and 400 nm and between 320 and 400 nm, allowed us to assess the photoprotective properties in the UVB and UVA range respectively.

RESULTS

Although the photoprotective effect varies according to the type of clothing (UV-protection factor [UPF] of approximately 10 for a cotton T-shirt and 500 for a pair of jeans), the effect is constant for any one type of clothing. Placing fabrics in layers is essential and this enables the protective effect to be greatly increased. Moreover, the authors wished to answer the question, 'what makes a good sun cream?' by analysing the formula of each product tested. It turns out that only creams containing both organic filters and inorganic filters have an sun protection factor (SPF) that is the same as the one stated on the product.

CONCLUSION

Concerning townwear, the jeans, tracksuits, sweatshirts, pullovers and tights turned out to be very photoprotective. They enable, in effect, to reach a UPF higher than 500. The mere presence of titanium dioxide and/or zinc dioxide does not mean that the product will have a high SPF. Products containing alcohol can be eliminated from the possible choices by carefully reading the label.

Preoperative concomitant chemoradiotherapy with oxaliplatin and 5-fluorouracil in locally advanced rectal carcinoma

e15108

Background: Preoperative concomitant chemoradiotherapy has shown to improve local control and sphincter preservation with decreased acute toxicity compared with postoperative treatment in locally advanced rectal carcinoma. The primary endpoint of this phase II trial was pathologic tumor response. Secondary endpoint was sphincter preservation and toxicity Methods: Inclusion criteria: rectal adenocarcinoma <12 cms from anal verge, clinical stage T3–4, adequate renal, hematological and liver function. Planned sample for this trial was 40 patients. Treatment schedule: Pelvic radiotherapy (25 Gy/ 5 fractions: 5 Gy on day 1 to day 5) and chemotherapy: Oxaliplatin 85 mg/m2 on 2 hours, day 1 and 15, folinic acid 20 mg/m2 and 5 fluoro-uracil bolus 500 mg/m2 on day 1, 8 and 15 (cycle repeated every 4 weeks). Surgery with TME was performed after the end of the second cycle of chemotherapy. Adjuvant chemotherapy with 5FULV2 was administered after surgery Results: 15 patients have been recruited between January and October 2006: 10 males/5 females. Median age: 45 years (range 26–62). Clinical stage (determined by CT or RMI): T3: 66.6% and T4: 33.3%. Tumor location (from anal verge): < 6 cm in 10pts, >6 cm in 5pts. Surgery (performed in 14 patients) consisted of low anterior resection in 5pts and abdominal-perineal resection in 10p. Tumor down-staging was observed in 10pts (66.6%), including 5pts with complete pathological response (33.3%). Main adverse effects (NCI-CTC): diarrhea G3–4: 14.2%, sensitive peripheral neurotoxicity G1: 26.6%, nausea/vomiting G3–4: 11%, Anemia G3–4: 7.1%, neutropenia G3–4: 14.2% Conclusions: Preliminary results show that preoperative concomitant chemoradiotherapy with oxaliplatin and 5FU-folinic acid is an effective regimen with an acceptable safety profile for locally advanced rectal cancer, leading to a high probability of tumor downstaging. This interim analysis has to be confirmed by the final analysis.

No significant financial relationships to disclose.

Improvement of the nutritive value of soybean meal by protease and alpha-galactosidase treatment in broiler cockerels and broiler chicks

1. Tube-fed broiler cockerels were used in three experiments to measure the effect of different enzyme treatments on true metabolisable energy (TME) and true nitrogen digestibility (TND) of commercial solvent-extracted, heat-treated soybean meal (SBM). 2. In experiment 1, proteases P2 and P3 (from Aspergillus niger) and alpha-galactosidase (from A. oryzae) improved TME and TND while protease P1 (from Bacillus subtilis) had little effect. The effects of enzyme treatment were similar whether treatment was applied by pre-incubation of enzymes (proteases P1, P2 and P3, 1.0 g/kg; alpha-galactosidase, 0.1 g/kg) with SBM for 2 h at 50 degrees C or by simple mixing of enzymes (proteases P1, P2 and P3, 0.25 g/kg; alpha-galactosidase, 0.1 g/kg) with SBM prior to feeding. 3. In experiment 2, the effects of mixing SBM with each of protease P1 (0 or 0.25 g/kg), protease P3 (0 or 0.25 g/kg) or alpha-galactosidase (0 or 0.1 g/kg) alone or in all possible combinations were studied. Effects of protease P1 were limited, but protease P3 and alpha-galactosidase improved TME and TND. There were significant interactions between protease P3 and alpha-galactosidase for both TME and TND; the response when enzymes were applied together was less than that expected from application of the enzyme preparations individually. 4. In experiment 3, the effect of varying the concentration of protease P3 (0, 0.1, 0.25 and 1.0 g/kg SBM dry matter) and alpha-galactosidase (0, 0.025, 0.0625 and 0.25 g/kg SBM dry matter) mixed with SBM alone or in all possible combinations of protease P3 and alpha-galactosidase were assessed. Increases in TME and TND for both enzymes were non-linear with the greatest response occurring at the lowest concentration of each enzyme. There were also interactions between the two enzyme preparations. 5. Finally, either protease P3 (0, 0.1 and 1.0 g/kg SBM dry matter) or alpha-galactosidase (0, 0.025 and 0.25 g/kg SBM dry matter) were mixed with SBM alone or in all possible combinations and treated SBMs incorporated into semi-purified diets containing 450 g SBM/kg as the sole source of dietary N and offered to growing broiler chicks for 21 d. Similar patterns of increases in chick growth rate and diet digestibility to those recorded in experiment 3 were obtained when protease P3 and alpha-galactosidase where included in the diets. 6. It is concluded that responses measured by tube-feeding SBM treated with protease P3 and alpha-galactosidase were similar to responses obtained with growing broiler chicks. Further, these responses were obtained by simple addition of enzymes to diets and nutritive value of SBM was improved by both protease and alpha-galactosidase treatment.

The potential for the improvement of the nutritive value of soya-bean meal by different proteases in broiler chicks and broiler cockerels

1. The potential for improving the nutritive value of commercial solvent-extracted, heat-treated soya-bean meal (SBM) by protease treatment was measured using growing broiler chicks and tube-fed broiler cockerels. 2. SBM was pre-treated (50 degrees C for 2 h) with water alone; at alkaline pH (initial pH 8.25) with and without protease P1 (isolated from a Bacillus species) or at acid pH (initial pH 4.5) with and without protease P2 (isolated from an Aspergillus species) and incorporated into diets (290 g SBM/kg diet) for broiler chicks (20 chicks/treatment). Only protease P2 treatment improved chick performance; from 7 to 28 d of age, chicks fed on treated SBM had greater feed intakes and gained more weight than chicks fed on untreated SBM. Both proteases P1 and P2 significantly reduced chick serum anti-soya antibodies while protease P2 treatment increased apparent ileal nitrogen (N) digestibility and apparent N retention across the whole digestive tract. 3. Two tube-feeding experiments established that, of the treated SBMs used in experiment 1, only protease P2 treatment improved apparent N digestibility and true metabolisable energy. Also it was shown that increasing the temperature at which treated SBM was dried to 60 degrees C, compared with freeze-drying or drying at 50 degrees C reduced apparent N digestibility and true metabolisable energy of SBM with no significant interactions between enzyme treatment and drying temperature for both apparent N digestibility and TME. 4. It is concluded that, overall, the nutritional value of SBM assayed in a growth trial and by tube feeding was improved by treatment with protease P2 and not by treatment with protease P1.