Digital Measures of Postural Sway Quantify Balance Deficits in Spinocerebellar Ataxia

BACKGROUND

Maintaining balance is crucial for independence and quality of life. Loss of balance is a hallmark of spinocerebellar ataxia (SCA).

OBJECTIVE

The aim of this study was to identify which standing balance conditions and digital measures of body sway were most discriminative, reliable, and valid for quantifying balance in SCA.

METHODS

Fifty-three people with SCA (13 SCA1, 13 SCA2, 14 SCA3, and 13 SCA6) and Scale for Assessment and Rating of Ataxia (SARA) scores 9.28 ± 4.36 and 31 healthy controls were recruited. Subjects stood in six test conditions (natural stance, feet together and tandem, each with eyes open [EO] and eyes closed [EC]) with an inertial sensor on their lower back for 30 seconds (×2). We compared test completion rate, test-retest reliability, and areas under the receiver operating characteristic curve (AUC) for seven digital sway measures. Pearson's correlations related sway with the SARA and the Patient-Reported Outcome Measure of Ataxia (PROM ataxia).

RESULTS

Most individuals with SCA (85%-100%) could stand for 30 seconds with natural stance EO or EC, and with feet together EO. The most discriminative digital sway measures (path length, range, area, and root mean square) from the two most reliable and discriminative conditions (natural stance EC and feet together EO) showed intraclass correlation coefficients from 0.70 to 0.91 and AUCs from 0.83 to 0.93. Correlations of sway with SARA were significant (maximum r = 0.65 and 0.73). Correlations with PROM ataxia were mild to moderate (maximum r = 0.56 and 0.34).

CONCLUSION

Inertial sensor measures of extent of postural sway in conditions of natural stance EC and feet together stance EO were discriminative, reliable, and valid for monitoring SCA. © 2024 International Parkinson and Movement Disorder Society.

Standing Balance Conditions and Digital Sway Measures for Clinical Trials of Friedreich's Ataxia

BACKGROUND

Progressive loss of standing balance is a feature of Friedreich's ataxia (FRDA).

OBJECTIVES

This study aimed to identify standing balance conditions and digital postural sway measures that best discriminate between FRDA and healthy controls (HC). We assessed test-retest reliability and correlations between sway measures and clinical scores.

METHODS

Twenty-eight subjects with FRDA and 20 HC completed six standing conditions: feet apart, feet together, and feet tandem, both with eyes opened (EO) and eyes closed. Sway was measured using a wearable sensor on the lumbar spine for 30 seconds. Test completion rate, test-retest reliability with intraclass correlation coefficients, and areas under the receiver operating characteristic curves (AUCs) for each measure were compared to identify distinguishable FRDA sway characteristics from HC. Pearson correlations were used to evaluate the relationships between discriminative measures and clinical scores.

RESULTS

Three of the six standing conditions had completion rates over 70%. Of these three conditions, natural stance and feet together with EO showed the greatest completion rates. All six of the sway measures' mean values were significantly different between FRDA and HC. Four of these six measures discriminated between groups with >0.9 AUC in all three conditions. The Friedreich Ataxia Rating Scale Upright Stability and Total scores correlated with sway measures with P-values <0.05 and r-values (0.63-0.86) and (0.65-0.81), respectively.

CONCLUSION

Digital postural sway measures using wearable sensors are discriminative and reliable for assessing standing balance in individuals with FRDA. Natural stance and feet together stance with EO conditions suggest use in clinical trials for FRDA. © 2024 International Parkinson and Movement Disorder Society.

Аntibiotic resistance of bacterial cultures isolated from the feral pigeon (Columba livia) and starling (Sturnus vulgaris) at a solid waste landfill

Resistance to antibiotics is well-known global phenomenon. There are places contributing to the development of antibiotic resistance such as waste landfills, especially ones that accept medical waste which did not undergo disinfection and livestock waste with bacteria not sensitive to antibiotics. An extensive system of transfer of antibiotic resistant microorganisms is formed on these territories (zoochory, groundwater, transport etc.). The aim of the research was to determine the species composition of bacteria isolated from birds of Derhachi municipal solid waste landfills in Kharkiv city, Ukraine. Also, we determine the sensitivity of bacterial isolates to a number of standard antibiotic drugs. We collected droppings of feral pigeons (Columba livia Gmelin, 1789; Columbidae) and starlings (Sturnus vulgaris Linnaeus, 1758; Sturnidae) during the winter period in 2020/2021; both species are dominants of waste landfills. We isolated 15 bacteria species of 4 families by bacteriological methods (growing on simple and selective media and identification by biochemical properties): Enterobacteriaceae (Enterobacter asburiae, E. dissolvens, E. cancerogenus, E. cloacae, E. sakazakii, Escherichia coli, Klebsiella terrigena, K. ornithinolytica, Citrobacter freundii, Proteus mirabilis), Yersiniaceae (Serratia ficaria, S. rubidaea, S. entomophila), Morganellaceae (Providencia stuartii) and Pseudomonadaceaе (Pseudomonas aeruginosa). Sensitivity was determined by the disk-diffusion method to 18 antibiotics. Ten isolates turned out to be multiresistant-resistant to three or more classes of antimicrobial drugs. A promising direction for future research is the determination of the pathogenicity of the isolates and checking the roles of birds of Derhachi solid waste landfills as reservoirs of pathogens. Currently, it can be assumed that large concentrations of synanthropic birds (especially those that forage on solid waste landfills) with a high probability are reservoirs of many bacteria, in particular those that have developed resistance to drugs.

Pharmacokinetics of three doses of epidural ropivacaine during hysterectomy and comparison with bupivacaine

PURPOSE

Ropivacaine is a new long-acting aminoamide local anaesthetic, structurally related to bupivacaine. The clinical efficacy of 125 mg, 187.5 mg and 250 mg ropivacaine have been reported and compared with 125 mg bupivacaine for epidural analgesia during hysterectomy. In the pharmacokinetic part of this study the objectives were to 1) determine the dose proportionality in the pharmacokinetics of epidural ropivacaine, and 2) compare the pharmacokinetics of 125 mg ropivacaine and 125 mg bupivacaine.

METHODS

In a randomized, double-blind controlled study, patients received one of four treatment regimens with ropivacaine (125, 187.5 or 250 mg) or bupivacaine (125 mg) as a 25 ml epidural bolus administered over three minutes. Peripheral venous blood samples were collected over 24 hr for ropivacaine or bupivacaine quantification using gas chromatography with nitrogen sensitive detection. Pharmacokinetic variables were derived from plasma concentration-time curve data.

RESULTS

Fifty two women entered the study. Demographic characteristics were similar among groups. Six patients were excluded due to inadequate sensory block or an insufficient number of plasma samples. The peak plasma concentration (Cmax) of ropivacaine and the total area under the plasma concentration-time curve (AUC) increased proportionally with the dose. Apparent plasma clearance (CL) and the terminal half-life (t1/2) were similar in the three ropivacaine groups. When compared with the 125 mg ropivacaine group, the bupivacaine group had a longer terminal half life (P < 0.05).

CONCLUSIONS

Epidural ropivacaine displays dose-proportional pharmacokinetic behaviour for doses of 125 mg to 250 mg. Ropivacaine has a shorter terminal half-life than bupivacaine.

A double-blind comparison of ropivacaine 0.5%, 0.75%, 1.0% and bupivacaine 0.5%, injected epidurally, in patients undergoing abdominal hysterectomy

PURPOSE

Ropivacaine is a new long-acting, injectable local anaesthetic currently undergoing clinical investigation world wide. It is structurally very similar to bupivacaine, but with less potential for central nervous system or cardiac toxicity. The purpose of this double-blind study was: to investigate the dose-response relationship of increasing doses of ropivacaine on the quality of anaesthesia and the duration of both motor and sensory blockade, and to compare these results with an established local anaesthetic, bupivacaine.

METHODS

One hundred and twenty five patients were randomly assigned to one of four treatment groups and 116 completed the study. Epidural anaesthesia was established using 25 ml test solution, injected over three minutes following a satisfactory test dose. Sensory onset, spread and duration, using the pin prick method, and motor scores using a modified Bromage scoring system were compared.

RESULTS

A dose/response relationship was observed with increasing doses of ropivacaine for all variables tested except analgesia and muscle relaxation (P < 0.01). There were differences in: (i) motor onset (Levels 1 and 2), when ropivacaine 1.0% was compared with ropivacaine 0.75% and 0.5% (P < 0.05); (ii) in sensory duration at all levels except T6 when ropivacaine was compared with ropivacaine 0.5% (P < 0.05); (iii) differences in sensory duration at T12 and S1 when ropivacaine 1.0% was compared with bupivacaine 0.5% (P < 0.05); (iv) differences in motor duration at all levels when ropivacaine 1.0% was compared with ropivacaine 0.5% (P < 0.05). No serious adverse events were reported in this study.

CONCLUSION

Increasing doses of ropivacaine were associated with an increased clinical effect. The most consistent differences occurred when ropivacaine 1.0% was compared with 0.5% and the least consistent between ropivacaine 0.5%, 0.75% and bupivacaine 0.5%. The main difference between ropivacaine 1.0% and bupivacaine was in sensory duration. No serious adverse events were reported.

Flexible endoscopic intubation of the neonate

The development of the ultrathin bronchoscope has provided a means of providing flexible endoscopic intubation for the neonate and small infant. We report our experience of 26 such endoscopic intubations in 23 neonates with birth weights from 1,200 to 4,600 g and post-conceptional ages varying from 31.5 to 60 weeks. The most common indications for the procedure were dysmorphic airways with variable degrees of micrognathia, acquired airway lesions, and severe degrees of hydrocephalus. With the use of the current 2.2 mm and 2.7 mm diameter instruments, it is now possible to utilize this technique with 2.5 mm endotracheal tubes. There were no failed procedures and no evidence of laryngospasm, the most frequent adverse effect being a transient fall in oxygen saturation. The procedure as practiced by experienced individuals is well tolerated and is an important adjunct for intubation of neonates with dysmorphic upper airways or other disorders that prevent adequate visualization of the larynx.