Relative phase measures of intersegmental coordination describe motor control impairments in children with cerebral palsy who exhibit stiff-knee gait

BACKGROUND

The purpose of this retrospective study was to explore lower limb intersegmental coordination as a clinically important indicator of motor control mechanisms in individuals with cerebral palsy exhibiting stiff-knee gait. We used the relative phase of thigh and foot segments around foot-off to describe motor control, given the relevance of the pre-swing phase of gait to the existence of stiff-knee gait.

METHODS

Traditional gait parameters and thigh/foot intersegmental coordination were calculated using pre-and postoperative kinematic data from a cohort of 54 subjects (92 legs) with spastic cerebral palsy. All participants had stiff-knee gait, walked without assistive devices, and underwent rectus femoris transfer surgery to improve swing period knee flexion. Analyses included correlations between a) preoperative intersegmental coordination and gait variables (knee flexion range, rate and gait performance) and b) pre-to-postoperative intersegmental coordination change and change in gait variables.

FINDINGS

Thigh/foot intersegmental coordination significantly (P < 0.001) correlated with knee flexion range, rate and walking speed. Postoperative intersegmental coordination was significantly more uncoupled than preoperative. Pre-to-postoperative intersegmental coordination improvement also significantly correlated with improvements in knee flexion range, rate and walking speed. Pre-to-postoperative changes in intersegmental coordination accounted for 43% and 36% of variance in knee flexion range change and knee flexion rate change respectively.

INTERPRETATION

Intersegmental coordination is a clinically important factor in knee flexion limitations associated with stiff-knee gait for individuals with cerebral palsy. These findings are a foundation for further study of intersegmental coordination measures as complements to traditional instrumented gait analysis.

[Adenoid cystic carcinoma of external auditory canal which pain as the first symptom：a case report]

Adenoid cystic carcinoma of external auditory canal is the relatively rare malignant tumor in head and neck surgery.As the signs and symptoms of this tumour do not always correlate with the histopathologic diagnosis and subsequent clinical behavior，it is easily to be ignored. Aggressive surgical resection with adjuvant radiotherapy seems effective for local disease control.

Clinical Efficacy of Combination Intravenous and Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer With Peritoneal Carcinomatosis

Background: Gastric cancer (GC) is prone to metastasis that typically resulted in peritoneal carcinomatosis (PC). GC patients with PC have an extremely poor clinic prognosis. Although GC is sensitive to chemotherapy, PC causes chemotherapy failure. Recent studies showed the combination of intravenous and intraperitoneal chemotherapy can significantly improve the survival rates in GC patients with PC. Aim: To identify the clinical and adverse effects of intravenous chemotherapy combined with intraperitoneal perfusion chemotherapy in the treatment of abdominal peritoneal carcinomatosis arising from gastric cancer. Methods: Retrospective analysis was performed on 49 patients with abdominal peritoneal carcinomatosis from gastric cancer who were treated at the Fujian Medical University Union Hospital between September 2010 and September 2015. The patients were divided into 2 groups based on treatment method: patients subjected to intravenous chemotherapy (n = 27), referred to as the simple group and patients subjected to combined intravenous and intraperitoneal chemotherapy (n = 22), referred to as the combination group. The short-term effects and adverse effects were evaluated based on treatment method, in conjunction with a related review of the results. The long-term effect was evaluated based on the survival rate and median survival time of both groups of patients at 12, 18, 24, 30, 36, and 60 months, as determined through follow-up. Results: Gender, age, ECOG scores before treatment, clinical stages, and the pathologic data of advanced GC patients of the 2 groups were equally distributed. The objective efficacy evaluation results showed that the objective response rate (ORR) and disease control rate (DCR) of the simple group after treatment were significantly lower than in the combination group. The median survival time (MST) of the simple group was (6.57 ± 0.75) months, which was significantly shorter than in the combination group (15.03 ± 2.31) months ( P < 0.05). In addition, the 12-, 18-, 24-, 30-, 36-, and 60-month survival rates of the simple group were all significantly lower than those of the combination group. Furthermore, combined therapy improved the physical condition of the patients. The incidence of adverse reactions in the 2 groups was not statistically significant; neither of the treatments resulted in severe complications. Conclusion: Compared with intravenous chemotherapy alone, the combined intravenous and intraperitoneal perfusion chemotherapy was more effective in improving quality of life and extending survival in time patients with abdominal peritoneal carcinomatosis from gastric cancer. In addition, the treatment produced only mild adverse effects, showing that it is tolerable and therefore worth further clinical study.

No consistent evidence of a disproportionately low resting energy expenditure in long-term successful weight-loss maintainers

Background

Evidence in humans is equivocal in regards to whether resting energy expenditure (REE) decreases to a greater extent than predicted for the loss of body mass with weight loss, and whether this disproportionate decrease in REE persists with weight-loss maintenance.

Objectives

We aimed to1) determine if a lower-than-predicted REE is present in a sample of successful weight-loss maintainers (WLMs) and 2) determine if amount of weight loss or duration of weight-loss maintenance are correlated with a lower-than-predicted REE in WLMs.

Design

Participants (18-65 y old) were recruited in 3 groups: WLMs (maintaining ≥13.6 kg weight loss for ≥1 y, n = 34), normal-weight controls [NCs, body mass index (BMI; in kg/m2) similar to current BMI of WLMs, n = 35], and controls with overweight/obesity (OCs, BMI similar to pre-weight-loss maximum BMI of WLMs, n = 33). REE was measured (REEm) with indirect calorimetry. Predicted REE (REEp) was determined via 1) a best-fit linear regression developed with the use of REEm, age, sex, fat-free mass, and fat mass from our control groups and 2) three standard predictive equations.

Results

REEm in WLMs was accurately predicted by equations developed from NCs and OCs (±1%) and by 3 standard predictive equations (±3%). In WLMs, individual differences between REEm and REEp ranged from -257 to +163 kcal/d. A lower REEm compared with REEp was correlated with amount of weight lost (r = 0.36, P < 0.05) but was not correlated with duration of weight-loss maintenance (r = 0.04, P = 0.81).

Conclusions

We found no consistent evidence of a significantly lower REE than predicted in a sample of long-term WLMs based on predictive equations developed from NCs and OCs as well as 3 standard predictive equations. Results suggest that sustained weight loss may not always result in a substantial, disproportionately low REE. This trial was registered at clinicaltrials.gov as NCT03422380.

Gene transcription through activation of G-protein-coupled chemoattractant receptors

Receptors for leukocyte chemoattractants, including chemokines, are traditionally considered to be responsible for the activation of special leukocyte functions such as chemotaxis, degranulation, and the release of superoxide anions. Recently, these G-protein-coupled serpentine receptors have been found to transduce signals leading to gene transcription and translation in leukocytes. Transcription factors, such as NF kappa B and AP-1, are activated upon stimulation of the cells with several chemoattractants at physiologically relevant concentrations. Activation of transcription factors through these receptors involves G-protein coupling and the activation of protein kinases. The underlying signaling pathways appear to be different from those utilized by TNF-alpha, a better characterized cytokine that induces the transcription of immediate-early genes. Chemoattractants stimulate the expression of several inflammatory cytokines and chemokines, which in turn may activate their respective receptors and initiate an autocrine regulatory mechanism for persistent cytokine and chemokine gene expression.

Effects of consuming a high-protein diet with or without soy protein during weight loss and maintenance: a non-inferiority, randomized clinical efficacy trial

OBJECTIVE

This 12-month randomized, non-inferiority clinical trial sought to determine the impact of consuming soy protein as part of an energy-restricted, high-protein diet on weight loss, body composition and cardiometabolic health.

METHODS

Seventy-one adults (58 female) with overweight or obesity (body mass index: 32.9 ± 3.6 kg m-2) were randomly assigned to consume three servings of soy (S) or non-soy (NS) protein foods per day for 12 months. All participants completed a group-based behavioural weight loss program lasting 4 months (M4), and follow-up assessments were completed at month 12 (M12).

RESULTS

Body weight was reduced in both groups at M4 (S: -7.0% ± 5.2%, NS: -7.1% ± 5.7%) and M12 (S: 3.6% ± 5.1%, NS: -4.8% ± 7.3%). Body weight reductions (mean difference [90% confidence interval]) were not different between S and NS at either time point (M4: -0.16% [-1.4, 3.6], P = 0.90; M12: 1.1% [-1.4, 3.6], P = 0.44). Differences in body fat mass loss were not different between S and NS at M4 (0.29 ± 0.84 kg, P = 0.73) or M12 (0.78 ± 1.5 kg, P = 0.59). Weight loss-induced improvements in cholesterol, triglycerides and blood pressure did not differ between S and NS.

CONCLUSION

These results indicate that soy-based protein foods can be effectively incorporated into an energy-restricted, high-protein diet for improving body weight, body composition and cardiometabolic health.

Long-Term Effect of Therapeutic Horseback Riding in Youth With Autism Spectrum Disorder: A Randomized Trial

This paper presents 6-month follow-up data of 44% (N = 64/116) of participants (ages 6-16 years) with a diagnosis of autism spectrum disorder, who participated in a previously-published randomized controlled trial of therapeutic horseback riding (THR) compared to a no-horse contact active control. The objective of this study was to examine whether significant improvements of irritability, hyperactivity, social, and communication behaviors observed in participants randomized to receive a 10-week manual-based THR intervention were sustained 6 months after the intervention conclusion. Participants' caregivers from both the THR (n = 36) and active control (n = 28) groups completed a measure of irritability and hyperactivity behaviors (primary outcome variables). Additionally, only the THR group participants completed the full battery of study outcomes assessments. Between group comparisons examining the extended interval from baseline (1-month pre-intervention assessment) to 6-months after the intervention revealed that the THR group maintained reductions in irritability behavior at a 0.1 level (effect size = 0.32, p = 0.07). (Effect size = 0.32, p = 0.07), which was 73% of efficacy preserved from the primary post-intervention endpoint (within 1-month post-intervention). Hyperactivity behaviors did not sustain this same trend. Comparisons from baseline and 6-months after the intervention revealed that the THR group sustained significant initial improvements made in social and communication behaviors, along with number of words and different words spoken during a standard language sample. This is the first known study to examine and demonstrate the longer-term effects of THR for individuals with ASD and warrants a more thorough evaluation of whether the effects of THR are maintained for at least 6-months after the intervention compared to a control.

CLINICAL TRIAL REGISTRATION INFORMATION

Trial of Therapeutic Horseback Riding in Children and Adolescents with Autism Spectrum Disorder; http://clinicaltrials.gov; NCT02301195.

Hunger, Food Cravings, and Diet Satisfaction are Related to Changes in Body Weight During a 6-Month Behavioral Weight Loss Intervention: The Beef WISE Study

Previously published findings from the Beef WISE Study (Beef's Role in Weight Improvement, Satisfaction, and Energy) indicated equivalent weight loss between two energy-restricted higher protein (HP) diets: A HP diet with ≥4 weekly servings of lean beef (B; n = 60) and a HP diet restricted in all red meats (NB; n = 60). Long-term adherence to dietary prescriptions is critical for weight management but may be adversely affected by changes in appetite, food cravings, and diet satisfaction that often accompany weight loss. A secondary a priori aim of the Beef WISE Study was to compare subjective ratings of appetite (hunger and fullness), food cravings, and diet satisfaction (compliance, satisfaction, and deprivation) between the diets and determine whether these factors influenced weight loss. Subjective appetite, food cravings, and diet satisfaction ratings were collected throughout the intervention, and body weight was measured at the baseline, after the weight loss intervention (week 16), and after an eight-week follow-up period (week 24). Hunger and cravings were reduced during weight loss compared to the baseline, while fullness was not different from the baseline. The reduction in cravings was greater for B vs. NB at week 16 only. Higher deprivation ratings during weight loss were reported in NB vs. B at weeks 16 and 24, but participants in both groups reported high levels of compliance and diet satisfaction with no difference between groups. Independent of group assignment, higher baseline hunger and cravings were associated with less weight loss, and greater diet compliance, diet satisfaction, and lower feelings of deprivation were associated with greater weight loss. Strategies to promote reduced feelings of hunger, cravings, and deprivation may increase adherence to dietary prescriptions and improve behavioral weight loss outcomes.

Continuous local bupivacaine wound infusion with neuraxial morphine reduces opioid consumption after cesarean delivery

Background: As a part of a quality improvement program, maternal postoperative opioid use and pain scores were compared between those receiving continuous infusion of bupivacaine for local incisional pain control with multimodal pain management and neuraxial morphine versus multimodal pain management with neuraxial morphine alone. Objective: We compared postoperative opioid use and pain scores between the multimodal pain management group with neuraxial morphine and the group receiving multimodal pain management, neuraxial morphine, and continuous infusion of bupivacaine for local incisional pain control. Study design: A retrospective cohort analysis of cesarean deliveries from January of 2015 through March of 2016 was undertaken. Deliveries were grouped by utilization of continuous infusion of bupivacaine for local incisional pain control. For each postoperative day, the average daily opioid use, antiemetic use and pain scores were determined. Patients received 1-2 tablets oxycodone-acetaminophen (5-325 mg) every 4 h as needed with oxycodone 5-10 mg immediate release tablets every 4 h as needed for breakthrough pain in addition to acetaminophen and ibuprofen. Total dose of narcotic, antiemetic use, and pain scores was compared between groups utilizing t-test for continuous variables and chi square for categorical data. A linear mixed model with unstructured covariance was utilized to analyze the daily dose of narcotic and pain scores from postoperative day 1 through day 4. Results: Patients in the standard multimodal group with neuraxial morphine used more opioids versus those receiving continuous wound infusion of bupivacaine in total postoperative dosing (122.79 ± 61.92 mg versus 89.88 ± 51.38 mg, p = .0063). There was a statistically significant difference between the standard group and local infusion of bupivacaine group on postoperative days 1 and 2 (32.79 ± 15.56 mg versus 22.13 ± 15.73 mg, p = .0011 and 40.25 ± 19.84 mg versus 29.13 ± 14.58 mg, p = .0018, respectively). There was no difference in narcotic use for postoperative days 3 and 4. There was a higher mean number of antiemetic doses in the standard group (0.31 ± 0.70 versus 0.10 ± 0.30, p = .0396). Pain scores did not differ between groups, although there was a correlation between opioid dosing and pain scores. The standard group received more IV ketorolac (87.72 ± 42.01 mg versus 64.50 ± 53.3 mg, p = .0165) and more IV acetaminophen (634.89 ± 706.42 mg versus 375.0 ± 490.29 mg, p = .0315) within the first 24 h postoperatively. In addition, the standard group received more oral acetaminophen (6969.67 ± 3230.14 mg versus 5248.75 ± 2711.71 mg, p = .0064). No difference was seen in regard to ibuprofen between groups. These results remained constant when adjusted for differences in gestational age, variation in intraoperative opioid dosing, as well as differences in uterine incision type. Conclusion: We found a significant reduction in postoperative opioid use when continuous infusion of bupivacaine for local incisional pain control was added to our standard pain management with neuraxial morphine after cesarean delivery. As a result of this quality improvement initiative, we have implemented this intervention universally as a part of our multimodal postoperative pain management strategy.

Alignment of parent- and child-reported outcomes and histology in eosinophilic esophagitis across multiple CEGIR sites

BACKGROUND

Patient-reported outcome metrics for eosinophilic esophagitis (EoE) have been developed and validated but not used in a multicenter pediatric population or systematically aligned with histology.

OBJECTIVE

We sought to understand (1) the potential of caregiver report to predict patient self-reported symptoms and (2) the correlation of patient-reported outcome domains with histology.

METHODS

Patients with EoE (n = 310) and their parents participating in the Consortium of Gastrointestinal Eosinophilic Disease Researchers (CEGIR) observational clinical trial were queried for baseline patient symptoms and quality of life (QOL) by using the Pediatric Eosinophilic Esophagitis Symptom Score, version 2 (PEESSv2.0), and the Pediatric QOL EoE module (PedsQL-EoE), and biopsy specimens were analyzed by using the EoE Histology Scoring System.

RESULTS

PEESSv2.0 parental and child reports aligned across all domains (r = 0.68-0.73, P < .001). PedsQL-EoE reports correlated between parents and children across ages and multiple domains (r = 0.48-0.79, P < .001). There was a tight correlation between symptoms on PEESSv2.0 and their effects on QOL both on self-report and parental report (P < .001). Self-reported symptoms on PEESSv2.0 (positively) and PedsQL-EoE (inversely) showed a weak correlation with proximal, but not distal, peak eosinophil counts and features and architectural tissue changes on the EoE Histology Scoring System (P < .05).

CONCLUSIONS

Parents of children with EoE aged 3 to 18 years accurately reflected their children's disease symptoms and QOL. Self- and parent-reported symptoms correlate with proximal esophageal histology. Our data suggest that parental report in young children can function as an adequate marker for self-reported symptoms and that self-reported symptoms can reflect changes in tissue histology in the proximal esophagus. These findings should be considered during clinical trials for drug development.

The Influence of Adding Spices to Reduced Sugar Foods on Overall Liking

Abstract

Reducing sugar intake is a major public health goal but many consumers are reluctant to use low calorie sweeteners. Two studies were conducted in healthy adults aged 18 to 65 to investigate whether addition of culinary spices to foods reduced in sugar could preserve hedonic liking. Test foods, black tea, oatmeal, and apple crisp, were prepared in full sugar (FS), reduced sugar (RS), and reduced sugar with spice (RSS) versions. Sugar reductions were 100%, 35%, and 37% for tea, oatmeal, and apple crisp, respectively. In Study 1, 160 subjects rated absolute liking of FS, RS, and RSS versions of a breakfast of oatmeal and tea and an afternoon snack of apple crisp on consecutive weeks. In Study 2, 150 subjects rated relative liking of all 3 versions of one food at the same seating, with different foods tested 1 wk apart. Liking was assessed using a 9‐point Likert scale. Both studies yielded similar results. For all 3 test items, liking was significantly higher for FS than for RS (P < 0.03). For tea, addition of spices did not significantly improve liking in either study. For oatmeal, addition of spices did not consistently improve liking compared to RS. For apple crisp, relative liking of RSS was not different then FS. These results indicate that it is possible to preserve the hedonic pleasure of a reduced sugar version of a dessert food, apple crisp, by addition of culinary spices. This may be a promising strategy to reduce sugar in some foods without using low calorie sweeteners.

Practical Application

Reducing sugar consumption is an important public health goal. Many consumers are reluctant to use low calorie sweeteners and alternative approaches are needed. Using culinary spices to enhance the flavor of foods may allow sugar reduction while still preserving acceptable overall liking.

Objectively Measured Physical Activity and Sedentary Behavior in Successful Weight Loss Maintainers

OBJECTIVE

The objective of this study was to compare patterns of objectively measured moderate-to-vigorous physical activity (MVPA, ≥ 3.00 metabolic equivalents [METs]), light-intensity physical activity (LPA, 1.50-2.99 METs), and sedentary behavior (SB, < 1.50 METs) in successful weight loss maintainers (WLMs), normal weight controls (NC), and controls with overweight/obesity (OC).

METHODS

Participants (18-65 y) were recruited in three groups: WLM (maintaining ≥ 13.6-kg weight loss for ≥ 1 year, n = 30), NC (BMI matched to current BMI of WLM, n = 33), and OC (BMI matched to pre-weight loss BMI of WLM, n = 27). All participants wore the activPAL for 1 week.

RESULTS

Compared with OC and NC, WLM spent more awake time in total MVPA (WLM: 9.6 ± 3.9%, NC: 7.1 ± 2.1%, OC: 5.9 ± 2.0%; P < 0.01) and more time in sustained (≥ 10 min) bouts of MVPA (WLM: 39 ± 33, NC: 17 ± 14, OC: 9 ± 11 min/d; P < 0.01). Compared with OC, WLM and NC spent more awake time in LPA (WLM: 29.6 ± 7.9%, NC: 29.1 ± 8.3%, OC: 24.8 ± 6.7%; P = 0.04) and less awake time sedentary (WLM: 60.8 ± 9.3%, NC: 63.8 ± 9.5%, OC: 69.3 ± 7.5%; P < 0.01).

CONCLUSIONS

Results provide additional data supporting the important role of MVPA in weight loss maintenance and suggest notable differences in LPA and SB between normal weight individuals and those with overweight/obesity. Increasing LPA and/or decreasing SB may be additional potential targets for weight management interventions.

Analysis of Reach-to-Grasp by School-Aged Children with Down Syndrome Elucidates Limitations in Upper Extremity Motor Control

AIMS

To identify limitations in preparatory planning (PP) and movement execution that constrain performance of reach-to-grasp (RTG) movements in school-aged children with Down syndrome (DS) and examine the effect of chronological age (CA) on performance.

METHODS

Nine children with DS ages 6 to 12 years and nine with typical development (TD) participated in this pilot descriptive study. Three-dimensional kinematic analysis was applied to RTG movements performed in the context of two functional tasks.

RESULTS

PP variables focused on the coordination of reach and grasp. Compared to the group with TD, the group with DS demonstrated significant limitations in anticipatory slowing down of hand transport and orientation of the hand in preparation for object contact. There was also relatively late onset of preparatory grip formation in the group with DS. In regard to movement execution, reach trajectories of the group with DS showed significantly greater deviation from the straight path. Correlations of study variables with CA were low and insignificant in both groups.

CONCLUSIONS

Motor control mechanisms that mediate both PP and execution of the fundamental RTG movement are potential factors limiting upper extremity activity in school-aged children with DS. They should be addressed in future intervention-based research.