Nevin Manimala

Eur J Phys Rehabil Med. 2021 May 5. doi: 10.23736/S1973-9087.21.06621-1. Online ahead of print.

ABSTRACT

BACKGROUND: Fatigue in Parkinson’s Disease (PD) compromises patients’ physical activity and poses questions on how to plan correct rehabilitation training. In addition, the relationship between subjective perceived fatigue and fatigue in motor performance is not yet entirely understood. As a consequence, a conclusive interpretation of muscular mechanisms of fatigue in PD has not yet been achieved. Among the various instrumental evaluations for fatigue, multichannel surface electromyography (sEMG) is a recognized tool that permits the study of myoelectric manifestations of fatigue.

AIM: To assess if muscles in PD show a different myoelectric fatigue pattern compared to the muscles of healthy age-matched subjects.

DESIGN: Observational controlled study.

POPULATION: Idiopathic Parkinson’s Disease, Hohen &Yahr II and III stage, Parkinsonian Fatigue Scale average score ≥ 2.95, no therapy modification in the 4 weeks preceding the study; exclusion criteria: Mini Mental State Examination ≤ 24, upper limb disease/symptoms that might interfere with sEMG analysis, presence of other fatiguerelated conditions. Twenty patients were selected according to these criteria. Twenty untrained healthy subjects were matched.

METHODS: All subjects underwent a muscle fatigue protocol and a sEMG analysis of the right biceps brachii muscle during electrically stimulated and voluntary contractions in order to obtain a myoelectric fatigue muscular pattern. The myoelectric pattern is characterized by the modifications of the following sEMG variables: reduction of mean frequency and muscle fibre conduction velocity, increase of average rectified value.

RESULTS: No statistical differences where observed between groups for sEMG variables and muscular electric behaviour in all contraction conditions (all p> .05).

CONCLUSIONS: Our results show that parkinsonian muscles does not differ from the muscles of healthy age-matched subjects in developing peripheral myoelectric fatigue. Nevertheless, the role of fatigue perception at rest and particularly during physical activity must be clearly understood in order to further target the rehabilitative approach for fatigued parkinsonian patients and to reduce hypomobility.

CLINICAL REHABILITATION IMPACT: In rehabilitative terms, these findings allow us to highlight the possibility of performing sustained training with isometric contractions in PD subjects; therefore, fatigue “per se” does not constitute a barrier for the execution of muscular exercises, likewise intensive.

PMID:33947826 | DOI:10.23736/S1973-9087.21.06621-1

Eur J Phys Rehabil Med. 2021 May 5. doi: 10.23736/S1973-9087.21.06595-3. Online ahead of print.

ABSTRACT

BACKGROUND: Physical Therapists may use the Graston technique to relieve soft-tissue restrictions and pain in the upper cervical region. However, no studies have tested the efficacy of the Graston technique in patients with cervicogenic headache.

AIM: To investigate the effect of adding the Graston technique to an exercise program on pain intensity, neck disability, cervical range of motion, headache frequency and duration, and medication intake in subjects with cervicogenic headache.

DESIGN: A single-blinded(assessor), randomized controlled trial.

SETTING: Outpatient rehabilitation clinic.

POPULATION: Sixty patients,35 to 50 years old, with cervicogenic headache have participated in the study. Patients were recruited from the outpatient clinics of Tala general hospital in Menoufia governorate.

METHODS: Patients were assigned randomly into two groups. Patients in the study group received the Graston technique in addition to an exercise program, while patients in the control group received the exercise program only. All patients received 3 sessions a week for 4 weeks. The primary outcome measure was the visual analogue scale(VAS), while the secondary outcome measures were neck disability index (NDI), cervical range of motion(CROM), headache frequency and duration, and medication intake. All outcomes were measured at baseline, after 2 weeks as well as after 4 weeks of intervention.

RESULTS: After 2 weeks of the treatment, statistically significant differences were found in all the measured outcomes (p< 0.05) in favor of the Graston group except for neck extension(p=0.08). After 4 weeks of the intervention, statistically significant differences were found in all the measured outcomes (p< 0.05) in favor of the Graston group.

CONCLUSIONS: Short-term effect of using the Graston technique in combination with an exercise program can reduce pain, decrease headache frequency and duration, and medication intake more than the exercise program alone in the medium-term. However, although the study results for NDI and neck ROM were statistically significant, it is neither clinically relevant change nor clearly outside the range of measurement error.

PMID:33947825 | DOI:10.23736/S1973-9087.21.06595-3

Med Sci Monit. 2021 Apr 24;27:e930435. doi: 10.12659/MSM.930435.

ABSTRACT

BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction. MATERIAL AND METHODS Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang’an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.Measurements of segments were taken as follows: ab – In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac – The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de – In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg – The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi – The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj – The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl – The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process. RESULTS The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes. CONCLUSIONS The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.

PMID:33947821 | DOI:10.12659/MSM.930435

Respir Care. 2021 May 4:respcare.08130. doi: 10.4187/respcare.08130. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric noninvasive ventilation (NIV) is used commonly in the acute care setting and is associated with high incidence of patient ventilator asynchrony.

METHODS: An ASL 5000 breathing simulator was used to model pediatric patients with varying patient efforts and lung conditions. For delivery of NIV, a commonly used acute care ventilator was used by connecting a nasal cannula interface to model nares produced with a 3-dimensional printer. The modes of ventilation were NIV pressure control continuous mandatory ventilation and NIV pressure control continuous spontaneous ventilation. Patient and ventilator waveforms were analyzed using the ASL 5000 software to assess for asynchrony events and determine the asynchrony index (AI).

RESULTS: Significant asynchrony (AI > 0.1) existed in the majority of scenarios for both pressure control continuous mandatory ventilation and pressure control continuous spontaneous ventilation (79% and 93%, respectively). The most common asynchrony event was ineffective trigger, accounting for 81.9% of events in pressure control continuous mandatory ventilation and 79.3% in pressure control continuous spontaneous ventilation. There were no statistically significant differences in the AI when comparing simulated patient effort or lung condition.

CONCLUSIONS: Significant asynchrony exists during NIV with a commonly used acute care ventilator and nasal cannula interface, which raises questions regarding its utility in clinical practice in the pediatric population.

PMID:33947794 | DOI:10.4187/respcare.08130

Neurology. 2021 May 4:10.1212/WNL.0000000000012142. doi: 10.1212/WNL.0000000000012142. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective of this study was to evaluate the correlation of large mitochondrial DNA deletions in skin samples of people with human immunodeficiency virus (PWH) with measures of neuropathy and prior exposure to therapy. We hypothesized that deletions would be associated with neuropathy. As secondary objectives we determined the correlation of deletion burden with demographic data and neuropathy measures.

METHODS: In this retrospective cohort study we measured the accumulation of large mtDNA deletions in skin biopsies from PWH recruited as part of the AIDS Clinical Trials Group (ACTG). Our cohort includes individuals with and without sensory neuropathy, as well as individuals with normal or abnormal skin biopsies. Skin biopsies, sural and peroneal nerve conduction studies, Total Neuropathy Score and deletion burden scores were measured along with baseline demographic data such as age, CD+4 cell count, viral counts and prior dNRTI exposures.

RESULTS: Sixty-seven PWH were enrolled in the study. The mean age of the cohort (n=67) was 44 years (SD 6.8, range 32-65 years) and 9 were female. The mean CD4+ T-cell count was 168 cells/mm3 (SD 97, range 1 – 416) and mean viral load was 51129 copies/mL (SD 114586, range 147 – 657775). We determined that there was a correlation between the total mtDNA deletion and intra-epidermal nerve fiber density (IENFD) (r=-0.344, p=0.04) and sural nerve amplitude (r=-0.359, p=0.004).

CONCLUSIONS: IENFD and sural nerve amplitude both statistically correlate with mitochondrial mutation burden in PWH, specifically in those with HIV-associated sensory neuropathy (HIV-SN) as assessed by skin biopsy.

PMID:33947785 | DOI:10.1212/WNL.0000000000012142

Neurology. 2021 May 4:10.1212/WNL.0000000000012153. doi: 10.1212/WNL.0000000000012153. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine whether the available operative techniques for thymectomy in myasthenia gravis (MG) confer variable chances for achieving complete stable remission (CSR), we performed a meta-analysis of comparative studies of surgical approaches to thymectomy.

METHODS: Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up.

RESULTS: 12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. At 3 years, CSR from MG was similar following VATS extended vs. both basic (RR 1.00, p=1.00, 95% CI 0.39-2.58) and extended (RR 0.96, p=0.74, CI: 0.72-1.27) transsternal approaches. CSR at 3 years was also similar following extended transsternal vs. combined transcervical-subxiphoid (RR 1.08, p=0.62, CI: 0.8-1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p=0.05, CI: 0.99-2.30). The only significant difference in CSR rate between a traditional open and a minimally invasive approach was seen at 10 years when comparing the now-abandoned basic (non-sternum-lifting) transcervical approach and the extended transsternal approach (RR 0.4, p=0.01, CI: 0.2-0.8).

CONCLUSIONS: A significant difference in the rate of CSR among various surgical approaches for thymectomy in MG was identified only at long-term follow-up, and only between what might be considered the most aggressive approach (extended transsternal thymectomy) and the least aggressive approach (basic transcervical thymectomy). Extended minimally invasive approaches appear to have equivalent CSR rates to extended transsternal approaches and are therefore appropriate in the hands of experienced surgeons.

PMID:33947783 | DOI:10.1212/WNL.0000000000012153

Neurology. 2021 May 4:10.1212/WNL.0000000000012145. doi: 10.1212/WNL.0000000000012145. Online ahead of print.

ABSTRACT

OBJECTIVE: To test the hypothesis that fundamental relationships along the amyloid, tau, and neurodegeneration (A/T/N) cascade depend on synaptic integrity in older adults in-vivo and postmortem.

METHODS: Two independent observational, cross-sectional cohorts: 1) in-vivo community-dwelling, clinically normal adults from the UCSF Memory and Aging Center completed lumbar puncture and MRI (exclusion criteria, CDR>0), and 2) postmortem decedents from the Rush Memory and Aging Project (exclusion criteria, inability to sign informed consent). In-vivo measures included cerebrospinal fluid (CSF) synaptic proteins (synaptotagmin-1, SNAP-25, neurogranin, and GAP-43), Aβ_42/40, ptau_181, and MRI gray matter volume (GMV). Postmortem measures captured brain tissue levels of presynaptic proteins (complexin-I, complexin-II, VAMP, and SNARE complex), and neuritic plaque and neurofibrillary tangle (NFT) counts. Regression models tested statistical moderation of synaptic protein levels along the A/T/N cascade (synaptic proteins*amyloid on tau, and synaptic proteins*tau on GMV).

RESULTS: 68 in-vivo older adults (age=71y, 43%F) and 633 decedents (age=90y, 68%F, 34% clinically normal) were included. Each in-vivo CSF synaptic protein moderated the relationship between Aβ_42/40 and ptau₁₈₁ (-0.23<𝛽s<-0.12, ps<0.05) and the relationship between ptau and GMV (-0.49<𝛽s<-0.32, ps<0.05). Individuals with more abnormal CSF synaptic protein demonstrated expected relationships between Aβ-ptau and ptau-brain volume, effects that were absent or reversed in those with more normal CSF synaptic protein. Postmortem analyses recapitulated CSF models. More normal brain tissue levels of complexin-I, VAMP, and SNARE moderated the adverse relationship between neuritic plaque and NFT counts (-0.10<𝛽s<-0.08, ps<0.05).

CONCLUSIONS: Pathogenic relationships of Aβ and tau may depend on synaptic state. Synaptic markers may help identify risk and/or resilience to AD proteinopathy.

PMID:33947778 | DOI:10.1212/WNL.0000000000012145

J Neurointerv Surg. 2021 May 4:neurintsurg-2021-017507. doi: 10.1136/neurintsurg-2021-017507. Online ahead of print.

ABSTRACT

BACKGROUND: First pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS.

METHODS: We used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models.

RESULTS: Of 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (-45% (95% CI: -65% to -12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: -14% (95% CI: -51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)).

CONCLUSIONS: FPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.

PMID:33947768 | DOI:10.1136/neurintsurg-2021-017507

BMJ Open. 2021 May 4;11(5):e045106. doi: 10.1136/bmjopen-2020-045106.

ABSTRACT

OBJECTIVE: To assess the effects and reliability of sham procedures in manual therapy (MT) trials in the treatment of back pain (BP) in order to provide methodological guidance for clinical trial development.

DESIGN: Systematic review and meta-analysis.

METHODS AND ANALYSIS: Different databases were screened up to 20 August 2020. Randomised controlled trials involving adults affected by BP (cervical and lumbar), acute or chronic, were included.Hand contact sham treatment (ST) was compared with different MT (physiotherapy, chiropractic, osteopathy, massage, kinesiology and reflexology) and to no treatment. Primary outcomes were BP improvement, success of blinding and adverse effect (AE). Secondary outcomes were number of drop-outs. Dichotomous outcomes were analysed using risk ratio (RR), continuous using mean difference (MD), 95% CIs. The minimal clinically important difference was 30 mm changes in pain score.

RESULTS: 24 trials were included involving 2019 participants. Very low evidence quality suggests clinically insignificant pain improvement in favour of MT compared with ST (MD 3.86, 95% CI 3.29 to 4.43) and no differences between ST and no treatment (MD -5.84, 95% CI -20.46 to 8.78).ST reliability shows a high percentage of correct detection by participants (ranged from 46.7% to 83.5%), spinal manipulation being the most recognised technique.Low quality of evidence suggests that AE and drop-out rates were similar between ST and MT (RR AE=0.84, 95% CI 0.55 to 1.28, RR drop-outs=0.98, 95% CI 0.77 to 1.25). A similar drop-out rate was reported for no treatment (RR=0.82, 95% 0.43 to 1.55).

CONCLUSIONS: MT does not seem to have clinically relevant effect compared with ST. Similar effects were found with no treatment. The heterogeneousness of sham MT studies and the very low quality of evidence render uncertain these review findings.Future trials should develop reliable kinds of ST, similar to active treatment, to ensure participant blinding and to guarantee a proper sample size for the reliable detection of clinically meaningful treatment effects.

PROSPERO REGISTRATION NUMBER: CRD42020198301.

PMID:33947735 | DOI:10.1136/bmjopen-2020-045106

BMJ Open. 2021 May 4;11(5):e044902. doi: 10.1136/bmjopen-2020-044902.

ABSTRACT

INTRODUCTION: Some empirical studies have identified an association between informal caregiving for adults and loneliness or social isolation. However, there is a lack of a review systematically synthesising empirical studies that have examined these associations. Hence, the aim of this systematic review is to provide an overview of evidence from observational studies.

METHODS AND ANALYSIS: Three electronic databases (Medline, PsycINFO, CINAHL) will be searched (presumably in May 2021), and reference lists of included studies will be searched manually. Cross-sectional and longitudinal observational studies examining the association between informal caregiving for adults and loneliness or social isolation will be included. Studies focusing on grandchildren care or private care for chronically ill children will be excluded. Data extraction will include information related to study design, definition and measurement of informal caregiving, loneliness and social isolation, sample characteristics, statistical analysis and main results. The quality of the studies will be evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers will perform the selection of studies, data extraction and assessment of study quality. Figures and tables will be used to summarise and report results. A narrative summary of the findings will be provided. If data permit, a meta-analysis will be conducted.

ETHICS AND DISSEMINATION: No primary data will be collected. Therefore, approval by an ethics committee is not required. We plan to publish our findings in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER: CRD42020193099.

PMID:33947734 | DOI:10.1136/bmjopen-2020-044902