Validation of a measure of smoothness of walking

BACKGROUND

Altered biomechanics and/or neural control disrupt the timing of postures and muscle patterns necessary for smooth and regular stepping. Harmonic ratio of trunk accelerations has been proposed as a measure of smoothness of walking. We sought to validate this measure of smoothness by examining the measure in groups expected to differ in smoothness (ie, young and old) and across walking conditions expected to affect smoothness (ie, straight path, curved path, and dual task).

METHODS

Thirty young (mean age = 24.4 ± 4.3 years) and 30 older adults (mean age = 77.5 ± 5.1 years) who could ambulate independently participated. We measured linear acceleration of the body along vertical, anterior-posterior, and medial-lateral axes using a triaxial accelerometer firmly attached to the skin over the L3 segment of the lumbar spine during straight path, curved path, and dual task (reciting every other letter of the alphabet) walking.

RESULTS

Older adults had lower harmonic ratio anterior-posterior (HR(AP)), that is, were less smooth in the direction of motion and walked more slowly than young adults for all walking conditions. Once the analyses were adjusted for walking speed, only HR(AP) differed between young and old participants for all walking conditions. For the most part, both young and old participants were less smooth for slow pace walking, curved path walking, and dual task walking compared with usual pace straight path walking.

CONCLUSIONS

The harmonic ratio, calculated from trunk acceleration, is a valid measure of smoothness of walking, which may be thought of as a measure of the motor control of walking.

The oligomeric structure of high molecular weight adiponectin

There is great interest in the structure of adiponectin as its oligomeric state may specify its biological activities. It occurs as a trimer, a hexamer and a high molecular weight complex. Epidemiological data indicate that the high molecular weight form is significant with low serum levels in type 2 diabetics but to date, has not been well-defined. To resolve this issue, characterization of this oligomer from bovine serum and 3T3-L1 adipocytes by sedimentation equilibrium centrifugation and gel electrophoresis respectively, was carried out, revealing that it is octadecameric. Further studies by dynamic light scattering and electron microscopy established that bovine and possibly mouse high molecular weight adiponectin is C1q-like in structure.

Microinjection of calpastatin inhibits fusion in myoblasts

Rat satellite cells (RSC) were microinjected with purified calpastatin or m-calpain, and myoblasts from a C2C12 mouse line were microinjected with purified calpastatin. Microinjection with calpastatin completely prevented fusion of myoblasts from both sources, whereas microinjection with m-calpain significantly increased the rate of fusion of cultured RSC; 44% of the nuclei of RSC cultures were in multinucleated myotubes within 48 h after microinjection with m-calpain plus labeled dextran, whereas only 15% of the nuclei were in multinucleated myotubes after microinjection with dextran alone. Western analyses indicated that neither RSC nor C2C12 myoblasts contained detectable amounts of mu-calpain before fusion. The levels of calpastatin in C2C12 myoblasts increased as cells passed from the proliferative stage to the onset of fusion, and these levels increased substantially in both the C2C12 and the RSC cells as they progressed to the late or postfusion stage. Both RSC and C2C12 myoblasts contained an 80-kDa polypeptide that was labeled with an anti-m-calpain antibody in Western blots. The results are consistent with a role of the calpain system (m-calpain in these myoblast lines) in remodeling of the cytoskeletal/plasma membrane interactions during cell fusion.

Transitioning to a narrow path: the impact of fear of falling in older adults

BACKGROUND

Everyday ambulation requires navigation of variable terrain, transitions from wide to narrow pathways, and avoiding obstacles. While the effect of age on the transition to a narrow path has been examined briefly, little is known about the impact of fear of falling on gait during the transition to a narrow path. The purpose was to examine the effect of age and fear of falling on gait during transition to a narrow path.

METHODS

In 31 young, mean age=25.3 years, and 30 older adults, mean age=79.6 years, step length, step time, step width and gait speed were examined during usual and transition to narrow pathway using an instrumented walkway.

FINDINGS

During the transition to narrow walk condition, fearful older adults compared to young had a wider step width (0.06 m vs 0.04 m) prior to the narrow path and took shorter steps (0.53 m vs 0.72 m; p<0.001). Compared to non-fearful older adults, fearful older adults walked slower and took shorter steps during narrow path walking (gait speed: 1.1m/s vs 0.82 m/s; p=0.01; step length: 0.60 m vs 0.47 m; p=0.03). In young and non-fearful older adults narrow path gait was similar to usual gait. Whereas older adults who were fearful, walked slower (0.82 m/s vs 0.91 m/s; p=0.001) and took shorter steps (0.44 m vs 0.53 m; p=0.004) during narrow path walking compared to usual walking.

INTERPRETATION

Changes in gait characteristics with transitioning to a narrow pathway were greater for fear of falling than for age.

Use of stance time variability for predicting mobility disability in community-dwelling older persons: a prospective study

BACKGROUND AND PURPOSE

Mobility disability is a serious and frequent adverse health outcome associated with aging. Early identification of individuals at risk for mobility disability is important if interventions to prevent disability are to be instituted. The objectives of this prospective study were to (1) determine the magnitude of stance time variability (STV) that discriminates individuals who currently have mobility disability (prevalent mobility disability) and (2) determine the magnitude of STV that predicts a new onset of mobility disability at 1 year (incident mobility disability).

METHODS

A total of 552 community-dwelling older adults were evaluated as part of the Cardiovascular Health Study, a longitudinal cohort study. Stance time, in milliseconds, was determined from 2 passes on a 4-m computerized walkway at self-selected walking speed, and STV was defined as the standard deviation from approximately 12 individual steps. Mobility disability was defined as self-reported difficulty walking a one-half mile. Receiver operating characteristic (ROC) curves were plotted to determine an optimal cutoff value for STV for prevalent and incident mobility disability, and the area under the receiver operating characteristic curve (AUC) was computed.

RESULTS

The optimal cutoff score for STV (maximizing sensitivity and specificity) for prevalent mobility disability was 0.037 seconds (sensitivity = 65%, specificity = 65%, AUC = 0.70) and for incident 1-year mobility disability was 0.034 seconds (sensitivity = 61%, specificity = 60%, AUC = 0.65). The use of likelihood ratios demonstrated a gradient of risk across values of STV, with mobility risk increasing as values of STV increased.

DISCUSSION AND CONCLUSION

Values of STV may be useful in identifying older adults with mobility disability and at risk for future disability. We recommend the more conservative estimate for identifying risk, STV = 0.034 seconds, which maximizes the sensitivity and minimizes false negatives. The relatively modest values on the validity indices could possibly be improved by increasing the reliability of the measurement of STV. Clinicians should interpret the cutoff values liberally and use STV in conjunction with other measures until further work is completed to validate STV as an indicator of mobility disability.

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the "On the Move" group exercise program in community-dwelling older adults

BACKGROUND

Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises.

METHODS

The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the "On the Move" group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12weeks delivered by study exercise leaders and facility activity staff personnel.

OUTCOMES

The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed.

STAKEHOLDERS

Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations.

SUMMARY

A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice.

EphrinA1-Fc attenuates myocardial ischemia/reperfusion injury in mice

EphrinA1, a membrane-bound receptor tyrosine kinase ligand expressed in healthy cardiomyocytes, is lost in injured cells following myocardial infarction. Previously, we have reported that a single intramyocardial injection of chimeric ephrinA1-Fc at the time of ischemia reduced injury in the nonreperfused myocardium by 50% at 4 days post-MI by reducing apoptosis and inflammatory cell infiltration. In a clinically relevant model of acute ischemia (30min)/reperfusion (24hr or 4 days) injury, we now demonstrate that ephrinA1-Fc reduces infarct size by 46% and completely preserves cardiac function (ejection fraction, fractional shortening, and chamber dimensions) in the short-term (24hrs post-MI) as well as long-term (4 days). At 24 hours post-MI, diminished serum inflammatory cell chemoattractants in ephrinA1-Fc-treated mice reduces recruitment of neutrophils and leukocytes into the myocardium. Differences in relative expression levels of EphA-Rs are described in the context of their putative role in mediating cardioprotection. Validation by Western blotting of selected targets from mass spectrometry analyses of pooled samples of left ventricular tissue homogenates from mice that underwent 30min ischemia and 24hr of reperfusion (I/R) indicates that ephrinA1-Fc administration alters several regulators of signaling pathways that attenuate apoptosis, promote autophagy, and shift from FA metabolism in favor of increased glycolysis to optimize anaerobic ATP production. Taken together, reduced injury is due a combination of adaptive metabolic reprogramming, improved cell survival, and decreased inflammatory cell recruitment, suggesting that ephrinA1-Fc enhances the capacity of the heart to withstand an ischemic insult.

Serial diffusion MRI to monitor and model treatment response of the targeted nanotherapy CRLX101

PURPOSE

Targeted nanotherapies are being developed to improve tumor drug delivery and enhance therapeutic response. Techniques that can predict response will facilitate clinical translation and may help define optimal treatment strategies. We evaluated the efficacy of diffusion-weighted magnetic resonance imaging to monitor early response to CRLX101 (a cyclodextrin-based polymer particle containing the DNA topoisomerase I inhibitor camptothecin) nanotherapy (formerly IT-101), and explored its potential as a therapeutic response predictor using a mechanistic model of tumor cell proliferation.

EXPERIMENTAL DESIGN

Diffusion MRI was serially conducted following CRLX101 administration in a mouse lymphoma model. Apparent diffusion coefficients (ADCs) extracted from the data were used as treatment response biomarkers. Animals treated with irinotecan (CPT-11) and saline were imaged for comparison. ADC data were also input into a mathematical model of tumor growth. Histological analysis using cleaved-caspase 3, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, Ki-67, and hematoxylin and eosin (H&E) were conducted on tumor samples for correlation with imaging results.

RESULTS

CRLX101-treated tumors at day 2, 4, and 7 posttreatment exhibited changes in mean ADC = 16 ± 9%, 24 ± 10%, 49 ± 17%, and size (TV) = -5 ± 3%, -30 ± 4%, and -45 ± 13%, respectively. Both parameters were statistically greater than controls [p(ADC) ≤ 0.02, and p(TV) ≤ 0.01 at day 4 and 7], and noticeably greater than CPT-11-treated tumors (ADC = 5 ± 5%, 14 ± 7%, and 18 ± 6%; TV = -15 ± 5%, -22 ± 13%, and -26 ± 8%). Model-derived parameters for cell proliferation obtained using ADC data distinguished CRLX101-treated tumors from controls (P = 0.02).

CONCLUSIONS

Temporal changes in ADC specified early CRLX101 treatment response and could be used to model image-derived cell proliferation rates following treatment. Comparisons of targeted and nontargeted treatments highlight the utility of noninvasive imaging and modeling to evaluate, monitor, and predict responses to targeted nanotherapeutics.

Intraclass Correlation Coefficients for Planning Cluster Randomized Trials in Community-Dwelling Older Adults

Objectives: With the emerging trends, more cluster randomized trials will be conducted in older adults, where facilities are randomized rather than individuals. Similarity of individuals from a facility (intraclass correlation coefficient/ICC) plays a critical role, but not readily available. We document ICCs for measures commonly used in community-dwelling older adults and discuss implications. Method: Secondary analysis of a range of baseline measures from the On the Move cluster randomized trial, whose ICCs were computed using a linear mixed model. Results: Self-reported disability measures related to facility characteristics and sense of community had the greatest ICCs (>0.10), while mobility performance measures had 0.05 to 0.10, and cognitive measure 0.11. Discussion: The ICCs for measures commonly used in older adults are of a sufficient magnitude to have a substantial impact on planned sample size of a study and credibility of results, and should be taken into consideration in study planning and data analysis.

Identification and management of ocular lipid deposition in association with hyperlipidaemia in captive moray eels, Gymnothorax funebris Ranzani, Gymnothorax moringa (Cuvier) and Muraena retifera Goode and Bean

Ocular lipid deposition and its surgical management and possible association with systemic hyperlipidaemia in captive moray eels are described. Ophthalmologic examinations, haematology and plasma biochemistry analyses were performed on an initial population of captive moray eels (n=10): green moray, Gymnothorax funebris Ranzani; spotted moray, Gymnothorax morninga (Cuvier) and reticulated moray, Muraena retifera Goode and Bean. Recently captured green moray eels comprised the control group (n=9). Clinical signs compatible with ocular lipid deposition were identified in six of ten captive eels (60%) vs. none of the controls. Green moray eels in the initial captive population (n=5) had significantly higher total protein, triglyceride, cholesterol and aspartate amino transferase values than the control eels. Dietary management was attempted in all captive eels, and surgical intervention was performed in three eels, including two from a separate population, with improved ocular clarity within 1month post-operatively. Histopathological evaluation of surgical specimens and two eyes from an additional affected eel that died suggested ocular lipid deposition. Eels in captivity have an apparent predisposition for hyperlipidaemia and ocular lipid deposition. Although limited in this study and complicated by exhibit restraints, dietary management was minimally effective, while surgery improved ocular clarity.