Ertl and Non-Ertl amputees exhibit functional biomechanical differences during the sit-to-stand task

BACKGROUND

People with transtibial amputation stand ~50times/day. There are two general approaches to transtibial amputation: 1) distal tibia and fibula union using a "bone-bridge" (Ertl), 2) non-union of the tibia and fibula (Non-Ertl). The Ertl technique may improve functional outcomes by increasing the end-bearing ability of the residual limb. We hypothesized individuals with an Ertl would perform a five-time sit-to-stand task faster through greater involvement/end-bearing of the affected limb.

METHODS

Ertl (n=11) and Non-Ertl (n=7) participants sat on a chair with each foot on separate force plates and performed the five-time sit-to-stand task. A symmetry index (intact vs affected limbs) was calculated using peak ground reaction forces.

FINDINGS

The Ertl group performed the task significantly faster (9.33s (2.66) vs 13.27 (2.83)s). Symmetry index (23.33 (23.83)% Ertl, 36.53 (13.51)% Non-Ertl) indicated the intact limb for both groups produced more force than the affected limb. Ertl affected limb peak ground reaction forces were significantly larger than the Non-Ertl affected limb. Peak knee power and net work of the affected limb were smaller than their respective intact limb for both groups. The Ertl intact limb produced significantly greater peak knee power and net work than the Non-Ertl intact knee.

INTERPRETATION

Although loading asymmetries existed between the intact and affected limb of both groups, the Ertl group performed the task ~30% faster. This was driven by greater power and work production of the Ertl intact limb knee. Our results suggest that functional differences exist between the procedures.

Belatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report

Thrombotic microangiopathy (TMA) after kidney transplantation is an uncommon and challenging cause of graft dysfunction and is associated with early graft loss. An idiosyncratic endothelial reaction to calcineurin inhibitors (CNIs) has been implicated as a frequent cause of TMA. This reaction is marked by uncontrolled activation of complement and subsequent cellular destruction. Usual therapy consists of withdrawal of the inciting drug and plasmapheresis to minimize levels of circulating complement. Recently, eculizumab, a monoclonal antibody to complement component C5, has been used for the treatment of atypical hemolytic uremic syndrome. Belatacept, an inhibitor of T cell costimulatory protein CTLA-4 has been used in immunosuppression strategies aimed at minimization of CNI. Here we report the first case of treatment of CNI-associated TMA/hemolytic uremic syndrome with withdrawal of tacrolimus and initiation of both belatacept and eculizumab. The case describes a favorable clinical course for both graft and patient, and is accompanied by a review of the literature.

Effects of load carriage and footwear on lower extremity kinetics and kinematics during overground walking

Kinetic and kinematic responses during walking vary by footwear condition. Load carriage also influences gait patterns, but it is unclear how an external load influences barefoot walking. Twelve healthy adults (5 women, 7 men) with no known gait abnormalities participated in this study (age=23±3years, height=1.73±0.11m, and mass=70.90±12.67kg). Ground reaction forces and 3D motion were simultaneously collected during overground walking at 1.5ms^-1 in four conditions: Barefoot Unloaded, Shod Unloaded, Barefoot Loaded, and Shod Loaded. Barefoot walking reduced knee and hip joint ranges of motion, as well as stride length, stance time, swing time, and double support time. Load carriage increased stance and double support times. The 15% body weight load increased GRFs ∼15%. Walking barefoot reduced peak anteroposterior GRFs but not peak vertical GRFs. Load carriage increased hip, knee, and ankle joint moments and powers, while walking barefoot increased knee and hip moments and powers. Thus, spatiotemporal and kinematic adjustments to walking barefoot decrease GRFs but increase knee and hip kinetic measures during overground walking. The ankle seems to be less affected by these footwear conditions. Regardless of footwear, loading requires larger GRFs, joint loads, and joint powers.

Practical Rotary Encoder Accuracy Limits for Transmission Error Measurement

Errors of angular position on encoders used for transmission error measurement were investigated to determine the practical limits of accuracy. Computer correction can be used to eliminate consistent errors on the encoders but errors remain, attributable to electrical noise, bearing errors and friction effects. Practical limits on the calibration and usage of the encoders for individual harmonics of once per revolution frequency and for a given angular position were established.

Alias Errors in Precision Rotary Encoder Calibration

Discrepancies between errors measured by back-to-back tests on rotary encoders and the errors quoted by the manufacturers led to investigation of the causes for the difference. An error that was apparently at 96 cycles per revolution was found to be due to a much higher frequency which was well outside the normal operating range for transmission error work.

Statin-induced expression change of INSIG1 in lymphoblastoid cell lines correlates with plasma triglyceride statin response in a sex-specific manner

Statins are widely prescribed to lower plasma low-density lipoprotein (LDL) cholesterol levels. They also modestly reduce plasma triglyceride (TG), an independent cardiovascular disease risk factor, in most people. The mechanism and inter-individual variability of TG statin response is poorly understood. We measured statin-induced gene expression changes in lymphoblastoid cell lines derived from 150 participants of a simvastatin clinical trial and identified 23 genes (false discovery rate, FDR=15%) with expression changes correlated with plasma TG response. The correlation of insulin-induced gene 1 (INSIG1) expression changes with TG response (rho=0.32, q=0.11) was driven by men (interaction P=0.0055). rs73161338 was associated with INSIG1 expression changes (P=5.4 × 10⁻⁵) and TG response in two statin clinical trials (P=0.0048), predominantly in men. A combined model including INSIG1 expression level and splicing changes accounted for 29.5% of plasma TG statin response variance in men (P=5.6 × 10⁻⁶). Our results suggest that INSIG1 variation may contribute to statin-induced changes in plasma TG in a sex-specific manner.

Boundary-Layer Effects on Acoustic Transmission Through Narrow Slit Cavities

We explore the slit-width dependence of the resonant transmission of sound in air through both a slit array formed of aluminum slats and a single open-ended slit cavity in an aluminum plate. Our experimental results accord well with Lord Rayleigh's theory concerning how thin viscous and thermal boundary layers at a slit's walls affect the acoustic wave across the whole slit cavity. By measuring accurately the frequencies of the Fabry-Perot-like cavity resonances, we find a significant 5% reduction in the effective speed of sound through the slits when an individual viscous boundary layer occupies only 5% of the total slit width. Importantly, this effect is true for any airborne slit cavity, with the reduction being achieved despite the slit width being on a far larger scale than an individual boundary layer's thickness. This work demonstrates that the recent prevalent loss-free treatment of narrow slit cavities within acoustic metamaterials is unrealistic.

Effects of load carriage and footwear on spatiotemporal parameters, kinematics, and metabolic cost of walking

Gait patterns are commonly altered when walking or running barefoot compared to shod conditions. Although controversy exists as to whether barefoot conditions result in lower metabolic costs, it is clear that adding load to the body results in increased metabolic costs. The effects of footwear and backpack loading have been investigated separately, but it is unclear whether manipulating both simultaneously would cause similar outcomes. Twelve healthy individuals (7 female, 5 male) with no obvious gait abnormalities participated in this study (age=24±2 years, height=1.73±0.13 m, and mass=71.1±16.9 kg). Steady state metabolic data and 3D motion capture were collected during treadmill walking at 1.5 ms(-1) in four conditions: Barefoot Unloaded, Shod Unloaded, Barefoot Loaded, and Shod Loaded. Barefoot walking elicited shorter stride lengths, stance and double support times, as well as a slight (≈1%), but not significant, decrease in metabolic cost. Loading increased metabolic costs of walking but did not elicit spatiotemporal changes in either footwear condition. Lower limb kinematic differences were noted in response to both loading and footwear. Changes in spatiotemporal parameters observed when walking barefoot were not exacerbated by the addition of a backpack load. This suggests that the increased metabolic demand associated with the load is met with a similar spatiotemporal pattern whether a person wears a supportive shoe or not. Thus, the discomfort associated with foot strike while barefoot that promotes spatiotemporal changes seems to be independent of load.

Nosocomial Mycobacterial Pseudoinfection in a Georgia Hospital

Nosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.

Aqueous benzene-diols react with an organic triplet excited state and hydroxyl radical to form secondary organic aerosol

Benzene-diols are oxidized rapidly by hydroxyl radical and the triplet excited state of an aromatic carbonyl to efficiently form SOA in the aqueous phase.

Oscillation and reaction board techniques for estimating inertial properties of a below-knee prosthesis

The purpose of this study was two-fold: (1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee prosthesis, and (2) contrast the effects of the proposed technique and that of using intact limb inertial properties on joint kinetic estimates during walking in unilateral, transtibial amputees. An oscillation and reaction board system was validated and shown to be reliable when measuring inertial properties of known geometrical solids. When direct measurements of inertial properties of the prosthesis were used in inverse dynamics modeling of the lower extremity compared with inertial estimates based on an intact shank and foot, joint kinetics at the hip and knee were significantly lower during the swing phase of walking. Differences in joint kinetics during stance, however, were smaller than those observed during swing. Therefore, researchers focusing on the swing phase of walking should consider the impact of prosthesis inertia property estimates on study outcomes. For stance, either one of the two inertial models investigated in our study would likely lead to similar outcomes with an inverse dynamics assessment.

Secondary organic aerosol production from aqueous reactions of atmospheric phenols with an organic triplet excited state

Condensed-phase chemistry plays a significant role in the formation and evolution of atmospheric organic aerosols. Past studies of the aqueous photoformation of secondary organic aerosol (SOA) have largely focused on hydroxyl radical oxidation, but here we show that triplet excited states of organic compounds ((3)C*) can also be important aqueous oxidants. We studied the aqueous photoreactions of three phenols (phenol, guaiacol, and syringol) with the aromatic carbonyl 3,4-dimethoxybenzaldehyde (DMB); all of these species are emitted by biomass burning. Under simulated sunlight, DMB forms a triplet excited state that rapidly oxidizes phenols to form low-volatility SOA. Rate constants for these reactions are fast and increase with decreasing pH and increasing methoxy substitution of the phenols. Mass yields of aqueous SOA are near 100% for all three phenols. For typical ambient conditions in areas with biomass combustion, the aqueous oxidation of phenols by (3)C* is faster than by hydroxyl radical, although rates depend strongly on pH, oxidant concentrations, and the identity of the phenol. Our results suggest that (3)C* can be the dominant aqueous oxidant of phenols in areas impacted by biomass combustion and that this is a significant pathway for forming SOA.

Pediatric inflammatory diseases. Part I: multiple sclerosis

Multiple sclerosis (MS) is an inflammatory CNS disease characterized by multifocal areas of demyelination; usually it arises in young adults, but can also occur in children (under the age of 10) and adolescents (under the age of 18). As in adult, pediatric MS (PMS) diagnosis is based on the demonstration of multiple demyelination episodes separated in time and spaces. Diagnostic criteria realized for childhood are similar to those employed for adults. Although clinical and imaging features of PMS can be similar to those of adults, the disease is often characterized by a more aggressive course and atypical imaging findings, with giant and pseudotumoral plaques. Differential diagnosis between PMS and ADEM could be difficult: clinical findings and MRI are necessary; sometimes MRI follow-up is required for definitive diagnosis.