Interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults: A randomized controlled trial

BACKGROUND

Frailty is common among older adults, often associated with activity limitations during physical and walking tasks. The interactive boxing-cycling combination has the potential to be an innovative and efficient training method, and our hypothesis was that interactive boxing-cycling would be superior to stationary cycling in improving frailty and activity limitations in frail and prefrail older adults.

OBJECTIVE

To examine the impact of interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults compared to stationary cycling.

MATERIALS AND METHODS

A single-blinded randomized controlled trial. Forty-five participants who met at least one frailty phenotype criteria were randomly assigned to receive either interactive boxing-cycling (n = 23) or stationary-cycling (n = 22) for 36 sessions over 12 weeks. The interactive boxing-cycling was performed on a cycle boxer bike with an interactive boxing panel fixed in front of the bike. The primary outcomes were frailty status, including score and phenotypes. Secondary outcomes included activity limitations during physical and walking tasks. The pre- and post-intervention data of both groups were analyzed using a repeated measures two-way ANOVA.

RESULTS

Both types of cycling significantly improved frailty scores (p<0.001). Interactive boxing-cycling was more effective than stationary cycling in reversing the frailty phenotype of muscle weakness (p = 0.03, odds ratio 9.19) and demonstrated greater improvements than stationary cycling in arm curl (p = 0.002, η2=0.20), functional reach (p = 0.001, η2=0.22), and grip strength (p = 0.02, η2=0.12) tests. Additionally, interactive boxing-cycling exhibited a greater effect on gait speed (p = 0.02, η2=0.13) and gait variability (p = 0.01, η2=0.14) during dual-task walking.

CONCLUSION

In frail and prefrail older adults, interactive boxing-cycling effectively improves frailty but is not superior to stationary cycling. However, it is more effective at improving certain activity limitations.

REGISTRATION NUMBER

TCTR20220328001.

Effectiveness of tisagenlecleucel versus real-world standard of care in relapsed/refractory follicular lymphoma

Aim: To contextualize the effectiveness of tisagenlecleucel versus real-world standard of care (SoC) in relapsed/refractory follicular lymphoma. Materials & methods: A retrospective indirect matched comparison study using data from the phase II ELARA trial and the US Flatiron Health Research Database. Results: Complete response rate was 69.1 versus 17.7% and the overall response rate was 85.6 versus 58.1% in tisagenlecleucel versus SoC, post weighting by odds. For overall survival, an estimated reduction in the risk of death was observed in favor of tisagenlecleucel over SoC. The hazard ratio for progression-free survival was 0.45 (95% CI: 0.26, 0.88), and for time-to-next treatment was 0.34 (95% CI: 0.15, 0.78) with tisagenlecleucel versus SoC. Conclusion: A consistent trend toward improved efficacy end points was observed in favor of tisagenlecleucel versus SoC.

Using Arterial Pulse and Laser Doppler Analyses to Discriminate between the Cardiovascular Effects of Different Running Levels

BACKGROUND AND AIMS

Running can induce advantageous cardiovascular effects such as improved arterial stiffness and blood-supply perfusion. However, the differences between the vascular and blood-flow perfusion conditions under different levels of endurance-running performance remains unclear. The present study aimed to assess the vascular and blood-flow perfusion conditions among 3 groups (44 male volunteers) according to the time taken to run 3 km: Level 1, Level 2, and Level 3.

METHODS

The radial blood pressure waveform (BPW), finger photoplethygraphy (PPG), and skin-surface laser-Doppler flowmetry (LDF) signals of the subjects were measured. Frequency-domain analysis was applied to BPW and PPG signals; time- and frequency-domain analyses were applied to LDF signals.

RESULTS

Pulse waveform and LDF indices differed significantly among the three groups. These could be used to evaluate the advantageous cardiovascular effects provided by long-term endurance-running training, such as vessel relaxation (pulse waveform indices), improvement in blood supply perfusion (LDF indices), and changes in cardiovascular regulation activities (pulse and LDF variability indices). Using the relative changes in pulse-effect indices, we achieved almost perfect discrimination between Level 3 and Level 2 (AUC = 0.878). Furthermore, the present pulse waveform analysis could also be used to discriminate between the Level-1 and Level-2 groups.

CONCLUSIONS

The present findings contribute to the development of a noninvasive, easy-to-use, and objective evaluation technique for the cardiovascular benefits of prolonged endurance-running training.

Increased hip adductor activation during sit-to-stand improves muscle activation timing and rising-up mechanics in individuals with hemiparesis

Long sit-to-stand (STS) time has been identified as a feature of impaired functional mobility. The changes in biomechanics of STS performance with simultaneous hip adductor contraction have not been studied, which may limit indications for use of hip adductor activation during STS training. Ten individuals with hemiplegia (mean age 61.8 years, injury time 29.8 ± 15.2 months) performed the STS with and without squeezing a ball between two legs. The joint moments, ground reaction force (GRF), chair reaction force and movement durations and temporal index of electromyography were calculated from the control condition for comparison with those from the ball squeezing condition. Under the squeeze condition, reduced peak vertical GRF during the ascension phase with increased loading rate was observed in the nonparetic limb, and the peak knee extensor moment occurred earlier in the paretic. Earlier activation of tibialis anterior and gluteus maximus, and gluteus medius were found in squeeze STS. Squeezing a ball between limbs during STS increased the contraction timing of tibialis anterior, gluteus maximus, gluteus medius, and soleus as well as a more symmetric rising mechanics encourage the use of squeezing a ball between limbs during STS for individuals with hemiparesis.

Comparison of the effects of ultrasound- guided needle puncture, radial shock wave therapy, and combined treatments on calcific tendinitis of the shoulder: A single-blind randomized controlled trial

BACKGROUND

Calcific tendinitis of the shoulder is a common disorder resulting in restricted motion and pain.

OBJECTIVE

This study compared the effects of ultrasound-guided fine-needle puncture (USNP), radial shock wave therapy (RSWT), and the combination of both treatments (COMB) on calcific tendinitis of the shoulder.

METHODS

We enrolled 62 patients who had unilateral shoulder pain for more than 3 months. The patients were randomly divided into three groups: USNP, RSWT, and COMB. All USNP needle punctures were guided with ultrasound (US), and RSWT was delivered at 2 Hz (2000 shock waves; 0.26 mJ/mm2) once a week for 3 weeks. The COMB group received three weekly rounds of RSWT after a single US-guided needle puncture. The primary outcome was the pain visual analog scale (VAS), and secondary outcomes were the Constant scores, 36-Item Short-Form Health Survey, and range of motion.

RESULTS

A within-group comparison at 3 months revealed significant improvements in the pain VAS (p< 0.05, during activity) and Constant (p< 0.05) scores, but between-group comparisons revealed no statistically significant differences in the pain VAS (p> 0.05) or Constant (p= 0.089) scores. Only improvement differences in role-emotional (SF-36; p= 0.01) and active external rotation (p= 0.035) were determined over time, which favored the USNP and COMB groups.

CONCLUSIONS

Although no significant differences were observed among the groups in the treatment of calcific tendinitis of the shoulder, more satisfactory outcomes were noted in the USNP and COMB groups than in the RSWT group. Larger samples, longer follow-up times, and other treatment protocols are suggested for future studies.

Insights into the genetic spatial structure of Nicaraguan weedy rice and control of its seed spread

BACKGROUND

The genetic backgrounds and occurrence patterns of weedy rice (WR, Oryza sativa) are highly diverse, and so are the challenges facing its control among countries. WR control is difficult because it is similar to cultivated rice and manual removal is one of the few options for control. Understanding the ecology of WR will aid efforts to break its life cycle and establish long-term management strategies under both irrigated and rainfed systems.

RESULTS

Nicaraguan WR (NWR) plants were genetically closer to the AUS and Indica pools in terms of to genetic distance. A map of admixture coefficients suggested a pattern of long-distance dispersal and spread of NWR across Nicaragua, which has likely been facilitated by commercial activities and sharing of harvesting equipment between border cities or important trading ports and inland regions. Moreover, the NWR plants from the soil seedbank in irrigated regions showed different habitats and lower grain number per panicle compared with plants spread by seed-mediated contamination. In addition, grain indexes showed that length-to-width ratio was a better indicator than awn length for distinguishing between NWR and Nicaraguan Indica cultivars.

CONCLUSION

Analysis of the population structure and habitats of NWR revealed five clusters derived from seed-mediated contamination in rainfed upland regions, plants from the soil seedbank in irrigated double-cropping regions, and pollen-mediated contamination across both regions. Field weed management before harvesting and seed purification based on the length-to-width ratio can be conducted to improve the efficiency of long-term control of WR in Nicaragua. © 2022 Society of Chemical Industry.

Do harder midsoles facilitate propulsion and do softer midsoles increase shock attenuation during taking-off and landing of scissor jump?

To determine the influence of midsole hardness on ground reaction force (GRF) features during badminton scissor jump takeoff and landing and the interactive effect of midsole hardness with playing and nonplaying limbs, data were collected from badminton athletes who performed scissor jumps while wearing shoes with two levels of midsole hardness. Temporal-spatial and GRF variables were calculated. Measurements of the soft and hard midsole conditions for playing versus non-playing sides were compared using two-way repeated measure analyses of variance. The playing and non-playing limbs showed different GRF features while performing scissor jump. During takeoff, no significant differences between the soft and hard midsole conditions were identified for the jump height in any of the GRF variables. During landing, the cushioning capacity might be affected by harder midsole indicated by higher vertical impact peak (p = 0.008). Meanwhile, the longer time-to-vertical impact peak (p = 0.007) and the lower loading rate of the vertical impact peak (p = 0.013) may be plausible indicators for cushioning. Current study indicated the playing-limb consistently showed dominance on both the propulsion and shock attenuation behaviours during scissor jump and that, for the footwear selection between 62C and 68C midsoles, expectation would be more on effects on landing characteristics than on propulsion performance.

The effect of giving verbal feedback during neck stabilisation exercise as an addition to physical therapy in patients with chronic neck pain: A randomised controlled trial

OBJECTIVES

To study the addition of feedback-guided neck strength home exercise to physical therapy as an enhanced rehabilitation programme in the treatment of patients with chronic neck pain.

DESIGN

A prospective randomised controlled trial.

SETTING

Rehabilitation department of an academic hospital.

SUBJECTS

Patients with chronic neck pain.

INTERVENTIONS

The patients in both groups received supervised physical therapy sessions 3 times a week for 12 weeks. Patients in Group A (N = 38) used the neck strengthening exerciser device for 20 min daily at home for 6 weeks and patients in Group B (N = 20) performed 20 min of daily regular neck exercise at home for 6 weeks.

OUTCOME MEASURES

Neck disability index, pain visual analogue scale, active range of motion of the neck, Patient Global Assessment and patient evaluation of treatment effect. All subjects were assessed at baseline as well as at 6- and 12-week follow-ups.

RESULTS

At the 6-week follow-up, Group A exhibited significantly greater improvements (P < 0.05) in pain Visual Analogue Scale (Group A: 2.97 ± 1.57; Group B: 4.20 ± 1.82), neck disability index (Group A: 13.95 ± 8.07; Group B: 20.07 ± 9.14) and active cervical extension (Group A: 65.26 ± 12.76; Group B: 51.45 ± 11.78). At 12-week follow-up, Group A also exhibited significantly greater active cervical extension (Group A: 67.74 ± 11.94; Group B: 53.85 ± 14.09; P < 0.05).

CONCLUSION

Adding neck strengthening exerciser home training to physical therapy was demonstrated to be more effective than physical therapy alone for patients with chronic neck pain.

Effect of exergaming versus combined exercise on cognitive function and brain activation in frail older adults: A randomised controlled trial

BACKGROUND

Cognitive impairment is prevalent among frail older adults. Traditional exercise and exergaming positively affect cognition in healthy older people. However, few studies have investigated the effects of exergaming on cognition and brain activation in frail older adults.

OBJECTIVE

This study compared the effect of Kinect based exergaming (EXER) and combined physical exercise (CPE) training on cognitive function and brain activation in frail older adults in Taiwan. We hypothesised that EXER would be superior to CPE in this population.

METHODS

We randomised 46 community-dwelling frail older adults to the EXER or CPE group for 36 sessions (three 60-min training sessions per week) over 12 weeks. Outcome measures for cognitive function included global cognition measured by the Montreal Cognitive Assessment, executive function measured by the Executive Interview 25, verbal memory measured by the Chinese version of the California Verbal Learning Test, attention measured by the Stroop Colour and Word Test and Trail Making Test (part B), and working memory measured by spatial n-back tests. Prefrontal cortex activation during the global cognition test was documented with functional near-infrared spectroscopy (fNIRS).

RESULTS

Both groups improved significantly in global cognition (P<0.05), executive function (P<0.05), and attention (P<0.05) after the 12-week intervention. The group×time interaction indicated that EXER training significantly enhanced global cognition more than CPE training (F(1,44)=5.277, P=0.026). Moreover, only the EXER group showed significant improvements in verbal (P<0.05) and working (P<0.05) memory after the intervention. The fNIRS hemodynamics data revealed decreased activation in prefrontal cortices of both groups (P<0.05) during the post-training cognitive assessment, thereby suggesting greater neural efficiency; however, we found no significant group difference.

CONCLUSION

In frail older adults, exergaming and CPE could improve cognitive function, most likely by increasing neural efficiency. Moreover, exergaming may be superior to CPE, particularly in improving global cognition.

Effectiveness of Alpelisib + Fulvestrant Compared with Real-World Standard Treatment Among Patients with HR+, HER2-, PIK3CA-Mutated Breast Cancer

BACKGROUND

The BYLieve trial (NCT03056755) confirmed efficacy and safety of alpelisib with fulvestrant for hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-), PIK3CA-mutated advanced breast cancer (ABC), after cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) with an aromatase inhibitor (AI) as immediate prior therapy. Further analyses were performed to compare efficacy from BYLieve with effectiveness of standard treatment in the real-world setting.

MATERIALS AND METHODS

Patients who progressed on a CDK4/6i plus AI and were treated with alpelisib with fulvestrant in BYLieve were matched with a real-world patient cohort who received standard-of-care from a deidentified clinico-genomics database (CGDB). Primary and secondary endpoints were to compare progression-free survival (PFS), estimated by the Kaplan-Meier method, and the proportion of patients remaining progression-free at 6 months, respectively, between the two cohorts.

RESULTS

A total of 855 patients with PIK3CA-mutant disease who had prior CDK4/6i plus hormone therapy were selected from the CGDB; further matching to 120 patients from BYLieve selected 95 patients without exposure to HER2-targeting agents, clinical study drug, or alpelisib. In unadjusted and postmatching results, primary and secondary endpoints favored treatment with alpelisib with fulvestrant in BYLieve more than standard treatments in the real-world cohort. Postadjustment, median PFS for patients treated with alpelisib in BYLieve was 7.3 versus 3.7 months in the real-world cohort, and 6-month PFS was 54.6% versus 40.1%, respectively.

CONCLUSION

Matched/weighted analysis comparing BYLieve with the real-world setting further supports the clinical benefit of alpelisib with fulvestrant for treatment of HR+, HER2-, PIK3CA-mutant ABC after CDK4/6i treatment.

IMPLICATIONS FOR PRACTICE

Approximately 40% of patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer (ABC) have PIK3CA-mutated tumors, which have been associated with endocrine therapy resistance. Alpelisib, an α-selective phosphatidylinositol-3-kinase inhibitor, demonstrated significantly improved progression-free survival in SOLAR-1 and demonstrated clinical efficacy in BYLieve when combined with fulvestrant. Data are limited in comparing the efficacy of alpelisib combined with fulvestrant with effectiveness of standard therapy after CDK4/6i treatment. Using real-world data, this is the first analysis comparing alpelisib combined with fulvestrant with standard treatments for HR+, HER2-, PIK3CA-mutant ABC in the post-CDK4/6i setting.

Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial

OBJECTIVE

To analyse the effectiveness of corticosteroid (CS) and hyaluronic acid (HA) subacromial - subdeltoid (SASD) injection compared with normal saline (NS) in patients with chronic subacromial bursitis (CSB).

DESIGN

A prospective three-arm double-blinded randomised controlled trial.

SETTING

Rehabilitation department of two teaching hospitals.

SUBJECTS

Patients with CSB (N = 186) divided into CS (N = 68), HA (N = 60), and NS (N = 58) groups.

INTERVENTIONS

Three SASD injections under ultrasound guidance: group A, 20 mg of triamcinolone; group B, 2.5 mL of HA; and group C, 2.5 mL of NS.

OUTCOME MEASURES

The primary outcome measures were the pain visual analogue scale (VAS) score at eight weeks. The secondary outcomes were scores on the Shoulder Pain and Disability Index (SPADI) and Shoulder Disability Questionnaire.

RESULTS

At eight weeks, the pain VAS scores during activity were 2.56 ± 2.29, 3.65 ± 2.50, and 4.71 ± 2.83 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.013; CS vs HA, P = 0.010). SPADI scores were 40.83 ± 21.75, 36.92 ± 22.78, and 33.35 ± 23.38 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.197; CS vs HA, P = 0.004).

CONCLUSION

Ultrasound-guided corticosteroid injection into the subacromial - subdeltoid bursa was proven to be effective and superior to hyaluronic acid and normal saline injection for treating CSB. Hyaluronic acid injection was only marginally more effective than normal saline injection.Trial Registration: ClinicalTrials.gov: NCT02702206.

Alpelisib plus fulvestrant in PIK3CA-mutated, hormone receptor-positive advanced breast cancer after a CDK4/6 inhibitor (BYLieve): one cohort of a phase 2, multicentre, open-label, non-comparative study

BACKGROUND

Alpelisib, a PI3Kα-selective inhibitor and degrader, plus fulvestrant showed efficacy in hormone receptor-positive, HER2-negative, PIK3CA-mutated advanced breast cancer in SOLAR-1; limited data are available in the post-cyclin-dependent kinase 4/6 inhibitor setting. BYLieve aimed to assess alpelisib plus endocrine therapy in this setting in three cohorts defined by immediate previous treatment; here, we report results from cohort A.

METHODS

This ongoing, phase 2, multicentre, open-label, non-comparative study enrolled patients with hormone receptor-positive, HER2-negative, advanced breast cancer with tumour PIK3CA mutation, following progression on or after previous therapy, including CDK4/6 inhibitors, from 114 study locations (cancer centres, medical centres, university hospitals, and hospitals) in 18 countries worldwide. Participants aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 2 or less, with no more than two previous anticancer treatments and no more than one previous chemotherapy regimen, were enrolled in three cohorts. In cohort A, patients must have had progression on or after a CDK4/6 inhibitor plus an aromatase inhibitor as the immediate previous treatment. Patients received oral alpelisib 300 mg/day (continuously) plus fulvestrant 500 mg intramuscularly on day 1 of each 28-day cycle and on day 15 of cycle 1. The primary endpoint was the proportion of patients alive without disease progression at 6 months per local assessment using Response Evaluation Criteria in Solid Tumors, version 1.1, in patients with a centrally confirmed PIK3CA mutation. This trial is registered with ClinicalTrials.gov, NCT03056755.

FINDINGS

Between Aug 14, 2017, and Dec 17, 2019 (data cutoff), 127 patients with at least 6 months' follow-up were enrolled into cohort A. 121 patients had a centrally confirmed PIK3CA mutation. At data cutoff, median follow-up was 11·7 months (IQR 8·5-15·9). 61 (50·4%; 95% CI 41·2-59·6) of 121 patients were alive without disease progression at 6 months. The most frequent grade 3 or worse adverse events were hyperglycaemia (36 [28%] of 127 patients), rash (12 [9%]), and rash maculopapular (12 [9%]). Serious adverse events occurred in 33 (26%) of 127 patients. No treatment-related deaths were reported.

INTERPRETATION

BYLieve showed activity of alpelisib plus fulvestrant with manageable toxicity in patients with PIK3CA-mutated, hormone receptor-positive, HER2-negative advanced breast cancer, after progression on a CDK4/6 inhibitor plus an aromatase inhibitor.

FUNDING

Novartis Pharmaceuticals.

Effects of compression garments on surface EMG and physiological responses during and after distance running

BACKGROUND

The few previous studies that focused on the effects of compression garments (CG) on distance running performance have simultaneously measured electromyogram, physiological, and perceptual parameters. Therefore, this study investigated the effects of CG on muscle activation and median frequency during and after distance running, as well as blood-lactate concentration and rating of perceived exertion (RPE) during distance running.

METHODS

Eight healthy male recreational runners were recruited to randomly perform two 40 min treadmill running trials, one with CG, and the other with control garment made of normal cloth. The RPE and the surface electromyography (EMG) of 5 lower extremity muscles including gluteus maximus (GM), rectus femoris (RF), semitendinosus (ST), tibialis anterior (TA), and gastrocnemius (GAS) were measured during the running trial. The blood-lactate levels before and after the running trial were measured.

RESULTS

Wearing CG led to significant lower muscle activation (p  <  0.05) in the GM (decreased 7.40%-14.31%), RF (decreased 4.39%-4.76%), and ST (decreased 3.42%-7.20%) muscles; moreover, significant higher median frequency (p< 0.05) in the GM (increased 5.57%) and ST (increased 10.58%) muscles. Wearing CG did not alter the RPE values or the blood-lactate levels (p > 0.05).

CONCLUSION

Wearing CG was associated with significantly lower muscle activation and higher median frequency in the running-related key muscles during distance running. This finding suggested that wearing CG may improve muscle function, which might enhance running performance and prevent muscle fatigue.

Impact of Incremental Delays in Appropriate Therapy on the Outcomes of Hospitalized Adult Patients with Gram-negative Bloodstream Infections: "Every day matters"

BACKGROUND

Serious bloodstream infections (BSIs) are often caused by Gram-negative (GN) bacteria in hospitalized patients. Treatment of these infections has been further complicated by the continued rise and spread of drug-resistant pathogens, including carbapenem resistant (CR) strains of Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa.

METHODS

This retrospective cohort analysis used real-world data from a large United States hospital-based database to examine the association between key clinical outcomes and different lengths of time to appropriate treatment between October 2010 and September 2015.

RESULTS

Of 40,549 patients with GN-BSIs who were identified, 1117 (2.8%) had a CR GN-BSI. Overall, outcomes of hospitalized adult patients with GN-BSIs incrementally worsened the longer appropriate therapy was delayed. Patients with CR GN-BSIs had a median infection-associated length of stay (LOS) of 8, 9, 10, and 13 days, whereas patients with CS GN-BSIs had a median infection-associated LOS of 6, 7, 8, and 11 days for patients with days to appropriate therapy of 0, 1-2, 3-4, and ≥ 5 days, respectively. Among patients with CR GN-BSIs, the percentage of patients discharged home was 38%, 33%, 35%, and 31%, whereas in patients with CS GN-BSIs, the percentage of patients discharged home was 58%, 53%, 48%, and 43% for patients with days to appropriate therapy of 0, 1-2, 3-4, and ≥ 5 days, respectively.

CONCLUSION

The findings from this study highlight the clear need to deliver appropriate therapy more expeditiously in patients with CS and CR GN-BSIs.

Biomechanical comparison of four tibial fixation techniques for meniscal root sutures in posterior medial meniscus root repair: A porcine study

Objective

This study hypothesized that the suture anchor of tibial fixation method of PMMR repair technique is the main factor which reduce the gap formation or over displacement of tear site in initial healing, and then investigated the fixation stability of 4 different tibial fixations through cyclic and ultimate failure load testing of meniscal root sutures.

Methods

Twenty-four porcine tibiae with intact medial meniscus roots were randomly assigned into 4 groups: transosseous suture, washer, suture anchor, or screw with washer. Each sample underwent cyclic loading followed by a load-to-failure test. Displacement, maximum load to failure, stiffness, and elongation at failure load were recorded.

Results

The maximum average load and displacement at failure for each of the repair groups were as follows: transosseous suture, 232.8 N and 12.16 mm; washer, 189.9 N and 21.5 mm; suture anchor, 140.6 N and 13.8 mm; and screw with washer, 167.9 N and 18.9 mm. The maximum stiffness values for each of the repair groups were as follows: transosseous suture, 19.5 ± 0.7 N/mm; washer, 21.5 ± 1.4 N/mm; suture anchor, 13.8 ± 0.7 N/mm; and screw with washer, 18.9 ± 3.9 N/mm. The mean elongation across the repairs for each of the repair groups after 1000 loading cycles was: transosseous suture, 3.74 ± 0.28 mm; washer, 3.04 ± 0.13 mm; suture anchor, 2.25 ± 0.33 mm; and screw with washer, 2.43 ± 0.19 mm. The mean elongation was significantly less with the suture anchor than with the other techniques (p < .05).

Conclusion

Under physiological loading, our results indicate that a slower rehabilitation program with limited flexion and only partial weight bearing is advised when using a suture anchor because of the lower maximum load and stiffness.

The translational potential of this article

Tibial fixation using a washer or a screw with a washer is an effective and cost-saving technique when an option is required with high stiffness and low displacement at failure.

Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait

Background

Precise evaluation of the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait.

Methods

Ten unilateral THA patients received CT scans and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait.

Results

The adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P < 0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased.

Conclusions

Results suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.

216. Association Between Days to Initiate Appropriate Therapy and Hospital Length of Stay Among Adult Hospitalized Patients With Gram-negative Bloodstream Infections (GN-BSI)

Background

The deleterious outcomes associated with delay receipt of appropriate therapy are well documented. However, scant data exists on the consequences of each day delay of appropriate therapy and subsequent outcomes among adult hospitalized patients with GN-BSIs.

Methods

Study design: a retrospective cohort analysis. Study population: consecutive adult, hospitalized patients with a GN-BSI (11 most prevalent pathogens) in 1 of 181 institutions contributing microbiology data to the Premier Healthcare Database (October 2010–Sep 2015). Exclusion criteria: age < 18 years; diagnosis of pregnancy or cystic fibrosis, died or discharged within 2 days of index GN-BSI culture, lack of sufficient antibiotic susceptibility or treatment data to determine appropriateness. Day of initiating appropriate therapy was defined as the first day when the patient received an antibiotic with in vitro activity against the GN-BSI post index culture. Results were summarized by Kaplan–Meier estimates, and Cox Proportional-Hazards (CPH) analyses modeling discharge to home were conducted. Time to initiate appropriate therapy (0, 1–2 days, 3–4 days, ≥5 days) was included in the CPH model as an ordinal variable.

Results

A total of 40,549 patients met selection criteria. Mean (SD) age was 67.5 (16.1) years and 54% were female. E. coli and K. pneumoniae were the most common GN-BSI (58.0% and 18.3%, respectively). Approximately 30% of patients were in the ICU at index GN-BSI and in-hospital mortality was 6.8%. The mean (SD) time to receive appropriate therapy post index GN-BSI culture was 0.6 (2.7) days, and 69.7%, 22.5%, 5.7% and 2.1% received appropriate therapy in 0, 1–2, 3–4, and ≥5 days of index GN-BSI, respectively. The mean/median LOS post index GN-BSI by 0, 1–2, 3–4, and ≥5 days delays in appropriate treatment were 8.3/6, 9.8/7, 11.5/8, and 19.2/11 days respectively. Kaplan–Meier plots are shown in Figure 1. In the CPH model, each interval delay in appropriate therapy was associated with a 21% decrease in the likelihood of being discharged home for patients with GB-BSIs.

Conclusion

Hospital length of stay was found to increase when appropriate therapy was delayed. These findings highlight the critical need for early appropriate therapy among patients with GN-BSIs.

Disclosures

All authors: No reported disclosures.

164. Analysis of Adult, Hospitalized Patients With Carbapenem-resistant (CR) Gram-Negative Bloodstream Infections (GN-BSIs) due to Lactose Fermenters (LFs) and Non-lactose Fermenters (NLFs): Is There a Difference in Outcomes?

Background

The deleterious consequences of BSIs due to CR-GN bacteria among hospitalized adult patients are well described in the literature. However, scant data exist that compares the baseline features and outcomes of patients with CR-GN-BSIs due to LFs relative to those caused by NLFs.

Methods

We performed a retrospective cohort analysis of consecutive hospitalized adult patients (age ≥18 years) in the Premier Healthcare Database (January 2014–June 2018) with GN-BSI due to select LFs (E. coli, Klebsiella spp., Citrobacter spp., Enterobacter spp., and Serratia spp.) and NLFs (Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas spp.). Patients with a diagnosis of cystic fibrosis or who had both LF and NLF GNB on index BSI culture were excluded. Baseline demographics, medical history, comorbidities, hospitalization history, and outcomes were compared between patients with CR-GNB due to LFs and NLFs. Outcomes assessed included composite death (in-hospital death or discharge to hospice), in-hospital mortality, discharge to home, and hospital length of stay post index GNB-BSI culture collection.

Results

Of the 1749 patients with a CR-GNB-BSI due to an LF or NLF, 1505 met study criteria. Of the 1505, 418 (27.8%) were LFs and 1087 (72.2%) were NLFs. The most common LFs were Klebsiella spp. (55.7%) and Enterobacter spp. (25.7%), while Stenotrophomonas spp. (45.2%) was the most common NLF. Overall, groups were highly similar at baseline but patients with CR-GNB-BSIs due to an LF were slightly older and more likely to be in the ICU at index BSI culture collection (table). Outcomes were also comparable between patients with CR-GNB-BSIs due to LFs and NLFs but there were a few notable differences. Composite mortality was higher in patients with GNB-BSIs due to an LF and these patients were also less likely to be discharged home.

Conclusion

The findings indicate that CR-GNB-BSIs result in considerable morbidity and mortality irrespective of whether the GNB is an LF or NLF. One in five patients died during their hospitalization and less than half were discharged home. This highlights the need for better and more preventive and therapeutic strategies aimed at combating CR-GNB-BSIs.

Disclosures

All authors: No reported disclosures.

Definitive and sustained increase in prostate cancer metastases in the United States

INTRODUCTION

We examined the most recent Surveillance, Epidemiology, and End Results release to corroborate temporal trends in nonmetastatic and distant prostate cancer metastases in the United States.

METHODS

Surveillance, Epidemiology, and End Results was analyzed for the incidence of nonmetastatic and distant metastasis for men with prostate cancer aged 50-74 and ≥75 years during 2004-2015. Incidence ratios (IR) were calculated relative to the year prior.

RESULTS

The incidence of distant metastasis significantly increased from 451.0 to 504.0 per million (IR:1.12, 95% CI:1.01-1.24) from 2011 to 2012 and 532.3 to 586.1 per million (IR:1.10, 95% CI:1.00-1.21) from 2014 to 2015 in men aged ≥75 years. The incidence of distant metastasis did not significantly increase in men aged 55-74 over the study period.

CONCLUSION

We demonstrate a sustained and definitive increase in prostate cancer distant metastases in men aged ≥75 years. Although our observational study design cannot pinpoint the exact cause of this increase, which is likely multifactorial, this shift reverses declines in metastases at diagnoses that followed the advent of prostate-specific antigen screening.

Effects of Virtual Reality-Based Physical and Cognitive Training on Executive Function and Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Control Trial

Background: Walking while performing cognitive and motor tasks simultaneously interferes with gait performance and may lead to falls in older adults with mild cognitive impairment (MCI). Executive function, which seems to play a key role in dual-task gait performance, can be improved by combined physical and cognitive training. Virtual reality (VR) has the potential to assist rehabilitation, and its effect on physical and cognitive function requires further investigation. The purpose of this study was to assess the effects of VR-based physical and cognitive training on executive function and dual-task gait performance in older adults with MCI, as well as to compare VR-based physical and cognitive training with traditional combined physical and cognitive training.

Method: Thirty-four community-dwelling older adults with MCI were randomly assigned into either a VR-based physical and cognitive training (VR) group or a combined traditional physical and cognitive training (CPC) group for 36 sessions over 12 weeks. Outcome measures included executive function [Stroop Color and Word Test (SCWT) and trail making test (TMT) A and B], gait performance (gait speed, stride length, and cadence) and dual-task costs (DTCs). Walking tasks were performed during single-task walking, walking while performing serial subtraction (cognitive dual task), and walking while carrying a tray (motor dual task). The GAIT Up system was used to evaluate gait parameters including speed, stride length, cadence and DTCs. DTC were defined as 100 * (single-task gait parameters − dual-task gait parameters)/single-task gait parameters.

Results: Both groups showed significant improvements in the SCWT and single-task and motor dual-task gait performance measures. However, only the VR group showed improvements in cognitive dual-task gait performance and the DTC of cadence. Moreover, the VR group showed more improvements than the CPC group in the TMT-B and DTC of cadence with borderline significances.

Conclusion: A 12-week VR-based physical and cognitive training program led to significant improvements in dual-task gait performance in older adults with MCI, which may be attributed to improvements in executive function.

Multiple-Wearable-Sensor-Based Gait Classification and Analysis in Patients with Neurological Disorders

The aim of this study was to conduct a comprehensive analysis of the placement of multiple wearable sensors for the purpose of analyzing and classifying the gaits of patients with neurological disorders. Seven inertial measurement unit (IMU) sensors were placed at seven locations: the lower back (L5) and both sides of the thigh, distal tibia (shank), and foot. The 20 subjects selected to participate in this study were separated into two groups: stroke patients (11) and patients with neurological disorders other than stroke (brain concussion, spinal injury, or brain hemorrhage) (9). The temporal parameters of gait were calculated using a wearable device, and various features and sensor configurations were examined to establish the ideal accuracy for classifying different groups. A comparison of the various methods and features for classifying the three groups revealed that a combination of time domain and gait temporal feature-based classification with the Multilayer Perceptron (MLP) algorithm outperformed the other methods of feature-based classification. The classification results of different sensor placements revealed that the sensor placed on the shank achieved higher accuracy than the other sensor placements (L5, foot, and thigh). The placement-based classification of the shank sensor achieved 89.13% testing accuracy with the Decision Tree (DT) classifier algorithm. The results of this study indicate that the wearable IMU device is capable of differentiating between the gait patterns of healthy patients, patients with stroke, and patients with other neurological disorders. Moreover, the most favorable results were reported for the classification that used the combination of time domain and gait temporal features as the model input and the shank location for sensor placement.

Surgeon Annual and Cumulative Volumes Predict Early Postoperative Outcomes After Brain Tumor Resection

OBJECTIVE

Surgeon volume has been previously shown to affect patient outcomes. However, data related to neuro-oncologic surgery are limited and do not include neurologic morbidities as an outcomes measure. In this study, we aimed to determine if 5-year surgeon cumulative and annual volumes predict early postoperative outcomes in patients after brain tumor surgery.

METHODS

A population-based cohort of patients (n = 10,258) undergoing brain tumor resection between 2005 and 2014 were included for study using the New York Statewide Planning and Research Cooperation System. Surgeons were categorized by their cumulative and annual surgical volume.

RESULTS

Patients treated by high cumulative/high annual (HC/HA) volume surgeons had shorter length of stay (median, 5 days vs. 8 days vs. 8 days vs. 6 days, respectively; P < 0.01), lower charges (median, 70,025 vs. $77,043 vs. $93,715 vs. $77,018 respectively; P < 0.01) and less nonroutine discharge (41% vs. 48% vs. 50.9% vs. 43.9% respectively; P < 0.01) compared with patients treated by surgeons from the low cumulative/low annual (LC/LA), LC/HA, HC/LA groups. Similarly, HC/HA volume surgeons also had lower rate of hydrocephalus (9.9% vs. 10.4% vs. 13.7% respectively; P = 0.02), medical complications (6.9% vs. 11.2% vs. 11.5% respectively; P < 0.01), neurologic complications (44.1% vs. 46.8% vs. 48.1% respectively; P = 0.03), 30-day reoperation (5.1% vs. 6.9% vs. 7.1% respectively; P < 0.01) and 30-day death (3.3% vs. 5.4% vs. 5.2%; P < 0.01) compared with LC/LA and LC/HA volume surgeons.

CONCLUSIONS

There is some evidence for improved postoperative outcomes when surgery is performed by HC and HA volume surgeons. This finding suggests that subspecialization in surgical neuro-oncology should be considered.

Contemporary Incidence and Outcomes of Prostate Cancer Lymph Node Metastases

PURPOSE

The incidence of localized prostate cancer has decreased with shifts in prostate cancer screening. While recent population based studies demonstrated a stable incidence of locoregional prostate cancer, they categorized organ confined, extraprostatic and lymph node positive disease together. However, to our knowledge the contemporary incidence of prostate cancer with pelvic lymph node metastases remains unknown.

MATERIALS AND METHODS

We used SEER (Surveillance, Epidemiology and End Results) data from 2004 to 2014 to identify men diagnosed with prostate cancer. We analyzed trends in the age standardized prostate cancer incidence by stage. The impact of disease extent on mortality was assessed by adjusted Cox proportional hazard analysis.

RESULTS

During the study period the annual incidence of nonmetastatic prostate cancer decreased from 5,119.1 to 2,931.9 per million men (IR 0.57, 95% CI 0.56-0.58, p <0.01) while the incidence of pelvic lymph node metastases increased from 54.1 to 79.5 per million men (IR 1.47, 95% CI 1.33-1.62, p <0.01). The incidence of distant metastases in men 75 years old or older reached a nadir in 2011 compared to 2004 (IR 0.81, 95% CI 0.74-0.90, p <0.01) and it increased in 2012 compared to 2011 (IR 1.13, 95% CI 1.02-1.24, p <0.05). The risk of cancer specific mortality significantly increased in men diagnosed with pelvic lymph node metastases (HR 4.5, 95% CI 4.2-4.9, p <0.01) and distant metastases (HR 21.9, 95% CI 21.2-22.7, p <0.01) compared to men with nonmetastatic disease.

CONCLUSIONS

The incidence of pelvic lymph node metastases is increasing coincident with a decline in the detection of localized disease. Whether this portends an increase in the burden of advanced disease or simply reflects decreased lead time remains unclear. However, this should be monitored closely as the increase in N1 disease reflects an increase in incurable prostate cancer at diagnosis.

Predictors of acupuncture use among children and adolescents with cancer

BACKGROUND

Evidence for the application of acupuncture in pediatric oncology is limited. We investigated the acceptance of acupuncture and factors associated with its use among children and adolescents with cancer.

METHODS

Ninety acupuncture-naïve children receiving cancer treatment at Columbia University Medical Center (CUMC) provided consent/assent for participation. Participants could choose to receive or refuse integrative services offered at CUMC. Symptoms were collected for a 6-month period with the Memorial Symptom Assessment Scale (MSAS). Acute and delayed adverse events among participants who received acupuncture were recorded.

RESULTS

Fifty-four percent of the participants elected to receive acupuncture. In total, 252 acupuncture sessions were administered with a median of four sessions per patient (range 1-13 sessions). Pain (56%), nausea (51%), lack of energy (50%), and irritability (43%) were the most frequently reported symptoms in the whole cohort. Determinants of acupuncture use included older age and ethnicity. Acupuncture was more likely than other integrative modalities to be used for gastrointestinal and constitutional symptoms including drowsiness (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.98-5.66; P < 0.0001), lack of energy (OR, 3.23; 95% CI, 1.78-5.87; P = 0.0001), and pain (OR, 2.63; 95% CI, 1.46-4.72; P = 0.001). Adverse events were reported by 3% of the participants. There was no increased incidence of adverse events in children with thrombocytopenia (P = 0.189) or neutropenia (P = 0.497).

CONCLUSION

Our results highlight the potential use of acupuncture as a safe, adjunctive therapy for symptom management within existing supportive care regimens in pediatric oncology and potential areas to focus research initiatives.

Feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke: a randomized controlled pilot study

BACKGROUND

Wearable devices based on inertial measurement units through wireless sensor networks have many applications such as real-time motion monitoring and functional outcome assessment of stroke rehabilitation. However, additional investigations are warranted to validate their clinical value, particularly in detecting the synergy patterns of movements after stroke.

AIM

The aim of this study was to explore the feasibility and efficacy of wearable devices for upper limb rehabilitation in patients with chronic stroke and to compare the intervention effects (e.g., neurological recovery, active range of motion, and deviation angle) with those in a control group.

DESIGN

A single-blind, randomized-controlled pilot study.

SETTING

Rehabilitation ward.

METHODS

A total of 18 patients with chronic stroke were randomly distributed into a device group and control group. Both groups received conventional rehabilitation; nevertheless, the device group was additionally subjected to 15 daily sessions at least three times a week for 5 weeks. The outcome measures included the upper extremity subscores of the Fugl-Meyer assessment, active range of motion, and deviation angle. These measurements were performed pre- and post-treatment.

RESULTS

All five Fugl-Meyer assessment subscores improved in both the device and control groups after intervention; in particular, the "shoulder/elbow/forearm" subscore (P=0.02, 0.03) and "total score" (P=0.03, 0.03) substantially improved. The active range of motion of shoulder flexion and abduction substantially improved at pre-post treatment in both the device (P=0.02, 0.03) and control (P=0.02, 0.03) groups. The deviation angle of shoulder external rotation during shoulder abduction substantially improved in the device group (P=0.02), but not in the control group.

CONCLUSIONS

The designed wearable devices are practical and efficient for use in chronic patients with stroke.

CLINICAL REHABILITATION IMPACT

Wearable devices are expected to be useful for future internet-of-things rehabilitation clinical trials at home and in long-term care institutions.

Indications, Utilization and Complications Following Prostate Biopsy: New York State Analysis

PURPOSE

Uptake of active surveillance and changes in prostate cancer care may affect the utilization of and complications following prostate needle biopsy. We characterized recent trends and risk factors for prostate needle biopsy complications using a statewide, all-payer cohort.

MATERIALS AND METHODS

We used SPARCS (New York Statewide Planning and Research Cooperative System) to identify prostate needle biopsies performed between 2011 and 2014 via the transrectal and the transperineal approach (9,472 and 421 patients, respectively). We characterized trends in utilization and complications using Poisson regression and the Cochrane-Armitage test. We applied logistic regression to examine predictors of complications within 30 days of prostate needle biopsy.

RESULTS

Ambulatory use of prostate needle biopsy decreased with time (p <0.01). The most common indication for prostate needle biopsy was elevated prostate specific antigen in 53.2% of patients, followed by active surveillance for cancer in 26.7%, abnormal digital rectal examination in 2.6% and atypia in 1.6%. The prostate needle biopsy associated infection rate increased from 2.6% to 3.5% during the study period (p = 0.02). Among the 777 repeat prostate needle biopsies, the complication rate was comparable to that of initial prostate needle biopsy. Preprocedural rectal swab was done in less than 1% of prostate needle biopsies. On multivariable analysis, patient race, procedure year, diabetes (OR 1.92, 95% CI 1.29-2.86, p <0.01), transrectal approach (OR 3.48, 95% CI 1.27-9.54, p = 0.02) and recent hospitalization (OR 2.03, 95% CI 1.43-2.89, p <0.01) were significantly associated with infection. The median total charge for infectious complications was $4,129 (IQR 711-19,185).

CONCLUSIONS

Across New York State, infectious complications after prostate needle biopsy have increased over time. With higher complications using the transrectal approach and minimal utilization of targeted antibiotic prophylaxis, further efforts should focus on the evaluation and implementation of these strategies to reduce post-prostate needle biopsy complications nationally.

Entropic and Near-Field Improvements of Thermoradiative Cells

A p-n junction maintained at above ambient temperature can work as a heat engine, converting some of the supplied heat into electricity and rejecting entropy by interband emission. Such thermoradiative cells have potential to harvest low-grade heat into electricity. By analyzing the entropy content of different spectral components of thermal radiation, we identify an approach to increase the efficiency of thermoradiative cells via spectrally selecting long-wavelength photons for radiative exchange. Furthermore, we predict that the near-field photon extraction by coupling photons generated from interband electronic transition to phonon polariton modes on the surface of a heat sink can increase the conversion efficiency as well as the power generation density, providing more opportunities to efficiently utilize terrestrial emission for clean energy. An ideal InSb thermoradiative cell can achieve a maximum efficiency and power density up to 20.4% and 327 Wm⁻², respectively, between a hot source at 500 K and a cold sink at 300 K. However, sub-bandgap and non-radiative losses will significantly degrade the cell performance.

A robotic gait training system integrating split-belt treadmill, footprint sensing and synchronous EEG recording for neuro-motor recovery

This paper presents a robotic gait training system for neuro-motor rehabilitation of hemiplegic stroke survivors. The system is composed of a treadmill consisting of two separated belts, footprint array sensor attached below each belt for gait data acquisition, and an electroencephalography (EEG) device for monitoring brain activities during gait training. The split belt treadmill allow physical therapists to set different treadmill belt velocities to modify physical workload of the patients during walking, thus being able to better improve the symmetry of gait phases between affected and unaffected (sound) legs in comparison with conventional treadmills where there is only one single belt. In contrast to in-shoe pressure sensors, the under-belt footprint sensor array designed in this study not only reduces the preparation complexity of gait training but also collects more gait data for motion analysis. Recorded EEG is segmented synchronously with gait-related events. The processed EEG data can be used for monitoring brain-activities during gait training, providing a neurological approach for motion assessment. One subject with simulated stroke using an ankle-foot orthosis participated in this study. Preliminary results indicate the feasibility of the proposed system to improve gait function and monitor neuro-motor recovery.

Use, complications, and costs of stereotactic body radiotherapy for localized prostate cancer

BACKGROUND

Stereotactic body radiotherapy (SBRT) for localized prostate cancer has potential advantages over traditional radiotherapies. Herein, the authors compared national trends in use, complications, and costs of SBRT with those of traditional radiotherapies.

METHODS

The authors identified men who underwent SBRT, intensity-modulated radiotherapy (IMRT), brachytherapy, and proton beam therapy as primary treatment of prostate cancer between 2004 and 2011 from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare linked data. Temporal trend of therapy use was assessed using the Cochran-Armitage test. Two-year outcomes were compared using the chi-square test. Median treatment costs were compared using the Kruskal-Wallis test.

RESULTS

A total of 542 men received SBRT, 9647 received brachytherapy, 23,408 received IMRT, and 800 men were treated with proton beam therapy. There was a significant increase in the use of SBRT and proton beam therapy (P<.001), whereas brachytherapy use decreased (P<.001). A higher percentage of patients treated with SBRT and brachytherapy had low-grade cancer (Gleason score ≤ 6 vs ≥ 7) compared with individuals treated with IMRT and proton beam therapy (54.0% and 64.2% vs 35.2% and 49.6%, respectively; P<.001). SBRT compared with brachytherapy and IMRT was associated with equivalent gastrointestinal toxicity but more erectile dysfunction at 2-year follow-up (P<.001). SBRT was associated with more urinary incontinence compared with IMRT and proton beam therapy but less compared with brachytherapy (P<.001, respectively). The median cost of SBRT was $27,145 compared with $17,183 for brachytherapy, $37,090 for IMRT, and $54,706 for proton beam therapy (P<.001).

CONCLUSIONS

The use of SBRT and proton beam therapy for localized prostate cancer has increased over time. Despite men of lower disease stage undergoing SBRT, SBRT was found to be associated with greater toxicity but lower health care costs compared with IMRT and proton beam therapy. Cancer 2016;122:2496-504. © 2016 American Cancer Society.

Effects of Botulinum Toxin Landmark-Guided Intra-articular Injection in Subjects With Knee Osteoarthritis

BACKGROUND

Increasing evidence has suggested that botulinum toxin A (BoNT/A) can inhibit the release of selected neuropeptide transmitters from primary sensory neurons. Thus, intra-articular (IA) injection therapies with BoNT/A may reduce pain in patients with knee osteoarthritis (OA).

OBJECTIVE

To investigate the effects of landmark-guided IA injection of BoNT/A on patients with knee OA.

DESIGN

A prospective randomized controlled trial.

SETTING

A rehabilitation clinic of a private teaching hospital.

PATIENTS

A total of 46 patients with symptomatic knee OA (mostly Kellgren-Lawrence grade 2-3).

METHODS

The patients were randomly assigned to 1 of the following groups: BoNT/A group (BoNT/A injection; n = 21) or control group (education only; n = 20). The patients in the BoNT/A group received an IA injection of 100 units of BoNT/A into the affected knee.

MAIN OUTCOME MEASURES

The short-term (1 week posttreatment) and long-term (6 months posttreatment) effects were evaluated using a pain visual analogue scale (VAS) and questionnaires concerning functional status, including the Lequesne and Western Ontario and McMaster Universities (WOMAC) indexes.

RESULTS

The between-group comparison revealed significant differences with regard to the pain VAS score at 1 week (P < .001) and at 6 months (P = .001) posttreatment. Similar findings for the between-group comparison were observed for the WOMAC and Lequesne indexes at 6 months (P < .05) posttreatment. The pain VAS score in the BoNT/A group significantly decreased from 5.05 ± 1.12 (pretreatment) to 2.89 ± 1.04 at 1 week (P < .001) and 3.45 ± 1.70 at 6 months posttreatment (P < .001) but not in the control group (P = .476).

CONCLUSIONS

The IA injection of BoNT/A provided pain relief and improved functional abilities in patients with knee OA in both the short- and long-term follow-up.

LEVEL OF EVIDENCE

I.

Biomechanical risk factors for tripping during obstacle--Crossing with the trailing limb in patients with type II diabetes mellitus

People with type II diabetes mellitus (DM) are at a high risk of falling especially during more challenging locomotor tasks such as obstacle-crossing. The current study aimed to identify the risk factors for tripping in these patients during trailing-limb obstacle-crossing. Fourteen patients with type II DM with or without mild peripheral neuropathy (PN) and 14 healthy controls walked and crossed obstacles of three different heights while their motion data were measured using a motion capture system and two forceplates. The DM group was found to cross obstacles with significantly reduced trailing toe clearance (p<0.05), increasing the probability of the foot hitting the obstacle, and thus the risk of tripping. This altered end-point control was associated with significantly reduced knee flexion and hip adduction of the trailing swing limb (p<0.05), as well as significantly increased ankle plantarflexor moments in the leading stance limb (p<0.05). Therefore, reduced knee flexion and hip adduction of the swing limb are identified as risk factors for tripping during obstacle-crossing. Increased mechanical demands on the ankle plantarflexors suggest that weakness of these muscles may further reduce the already compromised performance of obstacle-crossing in these patients. The current results showed that obstacle-crossing can be used to detect gait deviations and to identify the associated risk of tripping in patients with type II DM without or at an early stage of PN.

Emergence of a sylvatic enzootic formosan ferret badger-associated rabies in Taiwan and the geographical separation of two phylogenetic groups of rabies viruses

Taiwan had been declared rabies-free in humans and domestic animals for five decades until July 2013, when surprisingly, three Formosan ferret badgers (FB) were diagnosed with rabies. Since then, a variety of wild carnivores and other wildlife species have been found dead, neurologically ill, or exhibiting aggressive behaviors around the island. To determine the affected animal species, geographic areas, and environments, animal bodies were examined for rabies by direct fluorescent antibody test (FAT). The viral genomes from the brains of selected rabid animals were sequenced for the phylogeny of rabies viruses (RABV). Out of a total of 1016 wild carnivores, 276/831 (33.2%) Formosan FBs were FAT positive, with occasional biting incidents in 1 dog and suspected spillover in 1 house shrew. All other animals tested, including dogs, cats, bats, mice, house shrews, and squirrels, were rabies-negative. The rabies was badger-associated and confined to nine counties/cities in sylvatic environments. Phylogeny of nucleoprotein and glycoprotein genes from 59 Formosan FB-associated RABV revealed them to be clustered in two distinct groups, TWI and TWII, consistent with the geographic segregation into western and eastern Taiwan provided by the Central Mountain Range and into northern rabies-free and central-southern rabies-affected regions by a river bisecting western Taiwan. The unique features of geographic and genetic segregation, sylvatic enzooticity, and FB-association of RABV suggest a logical strategy for the control of rabies in this nation.

Thin-film 'Thermal Well' Emitters and Absorbers for High-Efficiency Thermophotovoltaics

A new approach is introduced to significantly improve the performance of thermophotovoltaic (TPV) systems using low-dimensional thermal emitters and photovoltaic (PV) cells. By reducing the thickness of both the emitter and the PV cell, strong spectral selectivity in thermal emission and absorption can be achieved by confining photons in trapped waveguide modes inside the thin-films that act as thermal analogs to quantum wells. Simultaneously, photo-excited carriers travel shorter distances across the thin-films reducing bulk recombination losses resulting in a lower saturation current in the PV cell. We predict a TPV efficiency enhancement with near-field coupling between the thermal emitter and the PV cell up to 38.7% using a thin-film germanium (Ge) emitter at 1000 K and an ultra-thin gallium antimonide (GaSb) cell supported by perfect back reflectors separated by 100 nm. Even in the far-field limit, the efficiency is predicted to reach 31.5%, which is over an order of magnitude higher than the Shockley Queisser limit of 1.6% for a bulk GaSb cell and a blackbody emitter at 1000 K. The proposed design approach does not require nanoscale patterning of the emitter and PV cell surfaces, but instead offers a simple low-cost solution to improve the performance of thermophotovoltaic systems.

Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking

Background

The current study aimed to investigate the immediate and long-term effects of laterally-wedged (LW) insoles on the knee loadings, the knee abductor moment (KAM) in particular, and the compensatory changes at other lower limb joints in patients with bilateral medial knee osteoarthritis during level walking with and without LW insoles.

Methods

Older adults with bilateral medial knee OA (age 66 ± 5.3 years; height 156 ± 4.9 cm; mass 60 ± 5.1 kg; leg length 83.72 ± 3.64 cm) were studied using computerized gait analysis initially (Baseline) and 6 weeks after using LW insoles (Follow-up) during barefoot walking and walking with LW insoles (7° of lateral inclination, with medial arch support). The three-dimensional angles and internal moments at the lower limb joints, as well as the ground reaction forces, were obtained using a motion analysis system and two forceplates. Key features of all the variables were compared using paired t tests for immediate effects (barefoot vs. LW) and for long-term effects (Baseline vs. Follow-up). The symptomatic severity (WOMAC Index) was also evaluated (Baseline vs. Follow-up).

Results

The KAM with LW insoles at Baseline was significantly reduced when compared to the barefoot condition (p < 0.05), suggesting that the LW insoles were effective in reducing unfavorable loadings at the knee immediately upon wearing the insoles. After 6 weeks of wearing LW insoles (Follow-up), no significant changes were found in most of the biomechanical variables, including KAM (p > 0.05), when compared to Baseline with LW insoles. However, a specific gait adaptation with reduced knee loading was revealed when walking without LW insoles, i.e., for the barefoot condition (p < 0.05).

Conclusions

After long-term use of LW insoles, the pain and physical function were improved with decreased peak KAM. A specific gait adaptation with reduced KAM was also found when walking without LW insoles. These results indicate a positive long-term effect in persons with bilateral medial knee OA, both as an orthosis to assist walking, and as a treatment intervention to facilitate gait adaptations in favor of reduced KAM.

15.7% Efficient 10-μm-thick crystalline silicon solar cells using periodic nanostructures

Only ten micrometer thick crystalline silicon solar cells deliver a short-circuit current of 34.5 mA cm(-2) and power conversion efficiency of 15.7%. The record performance for a crystalline silicon solar cell of such thinness is enabled by an advanced light-trapping design incorporating a 2D inverted pyramid photonic crystal and a rear dielectric/reflector stack.

Anticipatory changes in control of swing foot and lower limb joints when walking onto a moving surface traveling at constant speed

Adapting to a predictable moving surface such as an escalator is a crucial part of daily locomotor tasks in modern cities. However, the associated biomechanics have remained unexplored. In a gait laboratory, fifteen young adults walked from the ground onto a moving or a static surface while their kinematic and kinetic data were obtained for calculating foot and pelvis motions, as well as the angles and moments of the lower limb joints. Between-surface-condition comparisons were performed using a paired t-test (α = 0.05). The results showed that anticipatory locomotor adjustments occurred at least a stride before successfully walking onto the moving surface, including increasing step length and speed in the trailing step (p < 0.05), but the opposite in the leading step (p < 0.05). These modifications reduced the plantarflexor moment of the trailing ankle needed for stabilizing the body, while placing increased demand on the knee extensors of the trailing stance limb. For a smooth landing and to reduce the risk of instability, the subjects adopted a flat foot contact pattern with reduced leading toe-clearance (p < 0.05) at an instantaneous speed matching that of the moving surface (p > 0.05), mainly through reduced extension of the trailing hip but increased pelvic anterior tilt and leading swing ankle plantarflexion (p < 0.05). The current results provide baseline data for future studies on other populations, which will contribute to the design and development of strategies to address falls while transferring onto moving surfaces such as escalators.

Five-day, low-level laser therapy for sports-related lower extremity periostitis in adult men: a randomized, controlled trial

Periostitis in the lower leg caused by overexercise is a universal problem in athletes and runners. The purpose of this study was to observe the functional improvement of the lower limbs upon rehabilitation low-level laser therapy (LLLT). All medical data were gathered from enrolled adults with sports-related lower leg pain. A total of 54 patients underwent triple-phase bone scans using skeletal nuclear scintigraphy, which confirmed periostitis in their lower limbs. The patients were then randomly divided into two groups: one group received laser therapy (N = 29) and the other group (N = 25) received an equivalent placebo treatment (a drug or physical therapy). Treatment protocol commenced with rehabilitation intervention and LLLT was performed three times daily for 5 days at a dosage of 1.4 J/cm(2). A Likert-type pain scale was used to evaluate the severity of pain. Balance function, including postural stability testing (PST) and limits of stability (LOS), was also performed to evaluate the function outcome. Patients experienced a significant improvement in pain by day 2 or day 5 after starting LLLT, but here was no significant difference in pain scale between the measurements before (baseline) and after LLLT. Comparing the PST, the group differences of dynamic vs. static testings ranged from -18.54 to -50.22 (compared 12, 8, 4, 3, 2, 1 to 0, all p < 0.0001), and the PST after LLLT were 3.73 units (p = 0.0258) lower than those of before LLLT. Comparing the LOS, the group differences of dynamic vs. static testing were similar to those in PST, and the relationship between LOS and groups only varied with the direction control during dynamic testing in direction at backward/right vs. right (p < 0.0001). LLLT had a positive effect on proprioception in patients with lower limb periostitis. Larger, better controlled studies are needed to determine what specific effects LLLT has on the function of proprioception.

Decoupled cantilever arms for highly versatile and sensitive temperature and heat flux measurements

Microfabricated cantilever beams have been used in microelectromechanical systems for a variety of sensor and actuator applications. Bimorph cantilevers accurately measure temperature change and heat flux with resolutions several orders of magnitude higher than those of conventional sensors such as thermocouples, semiconductor diodes, as well as resistance and infrared thermometers. The use of traditional cantilevers, however, entails a series of important measurement limitations, because their interactions with the sample and surroundings often create parasitic deflection forces and the typical metal layer degrades the thermal sensitivity of the cantilever. The paper introduces a design to address these issues by decoupling the sample and detector section of the cantilever, along with a thermomechanical model, the fabrication, system integration, and characterization. The custom-designed bi-arm cantilever is over one order of magnitude more sensitive than current commercial cantilevers due to the significantly reduced thermal conductance of the cantilever sample arm. The rigid and immobile sample section offers measurement versatility ranging from photothermal absorption, near-field thermal radiation down to contact, conduction, and material thermal characterization measurements in nearly identical configurations.