Clinical Scores In Patients Research Articles

Association between Clinical Scores and Absence from Work after Knee Arthroscopy

(1) Background: To determine the association between patient-reported outcome measures and return to work after knee arthroscopy. (2) Material and Methods: Retrospective analysis of data on patients scheduled for knee arthroscopy in 2019 for which symptom severity was available using International Knee Documentation Committee subjective knee evaluation form (IKDC), Knee Disability And Osteoarthritis Outcome Score For Joint Replacement (KOOS JR), Tegner Lysholm scale and Euroqol EQ5D5L. Paid sick leave was retrieved from electronic patient records. (3) Results: 61 patients (mean age 46.44 ± 7.61 years, 28 (45.9%) males) met the inclusion criteria. All patients ultimately returned to work. Forty-six (75.41%) received a mean of 28.5 (range 7–68) days of paid medical leave after surgery. Of those, three patients were already on medical leave. There were no differences in demographics and clinical scores between patients who received paid sick leave and those who did not. No significant correlation was found between days of absence and clinical scores. (4) Conclusions: There was no association between absence from work and commonly used clinical scores in patients undergoing knee arthroscopy.

Improved prediction of mortality by combinations of inflammatory markers and standard clinical scores in patients with acute-on-chronic liver failure and acute decompensation.

Acute-on-chronic liver failure (ACLF) is a sinister prognosis, and there is a need for accurate biomarkers and scoring systems to better characterize ACLF patients and predict prognosis. Systemic inflammation and renal failure are hallmarks in ACLF disease development and progression. We hypothesized that the combination of specific inflammatory markers in combination with clinical scores are better predictors of survival than the originally developed CLIF-C acute decompensation (AD) and CLIF-C ACLF scores. We reevaluated all previously measured inflammatory markers in 522 patients from the CANONIC study, 342 without and 180 with ACLF. We used the Harrell's C-index to determine the best marker alone or in combination with the original scores and calculated new scores for prediction of mortality in the original CANONIC cohort. The best markers to predict 90-day mortality in patients without ACLF were the plasma macrophage activation markers soluble (s)CD163 and mannose receptor (sMR). Urinary neutrophil gelatinase associated lipocalin (UNGAL) and sCD163 were predictors for 28-day mortality in patients with ACLF. The newly developed CLIF-C AD+sMR score in patients without ACLF improved 90-day mortality prediction compared with the original CLIF-C AD score (C-index 0.82 [0.78-0.86] vs 0.74 [0.70-0.78, P=0.004]). Further, the new CLIF-C ACLF+sCD163+UNGAL improved the original CLIF-C ACLF score for 28-day mortality (0.85 [0.79-0.91] vs 0.75 [0.70-0.80], P=0.039). The capability of these inflammatory markers to improve the original prognostic scores in cirrhosis patients without and with ACLF points to a key role of macrophage activation and inflammation in the development and progression of AD and ACLF.

Structural white matter alterations as compensatory mechanisms in Parkinson's disease: A systematic review of diffusion tensor imaging studies.

Compensation is described as normal or near to normal performance in Parkinson's disease (PD), despite the ongoing neural loss. Functional compensation typically proceeds in an inverse U-shaped manner: compensation initiates in the prodromal phase, followed by an increasing episode until plateauing and diminishes in the advanced stages of the disease. The first evidence of the structural compensation was reported by functional magnetic resonance imaging studies. Recent studies, which have used diffusion tensor imaging (DTI) as the basis for their investigation, have shown improved white matter diffusional properties both in motor- and non-motor-related structures in association with improved clinical scores in patients with PD. The majority of DTI studies have demonstrated microstructural compensation in the prodromal/early stages of PD at the regional scale. However, there have been reports of compensation in later stages of the disease and the whole-brain/network scale that are probably due to the heterogeneous nature of PD. Although serving as a promising beginning to characterize compensation, lots remain to be clarified in understanding the underlying mechanisms of compensation and its structural pattern in PD. The existing knowledge gap necessitates studies that their main research questions are focused on structural compensation. This requirement becomes more apparent because structural compensation evidence has mostly emerged from the post hoc analysis of data and incidental findings of studies. Thus, future studies are required to investigate compensatory microstructural changes in PD to clarify the exact underlying mechanisms. These studies would also provide a basis to develop clinical improvements in the early diagnosis and management of PD.

Renal Function-Adjusted D-Dimer Levels in Critically Ill Patients With Suspected Thromboembolism.

Diagnosing thromboembolic disease typically includes D-dimer testing and use of clinical scores in patients with low to intermediate pretest probability. However, renal dysfunction is often observed in patients with thromboembolic disease and was previously shown to be associated with increased D-dimer levels. We seek to validate previously suggested estimated glomerular filtration rate-adjusted D-dimer cutoff levels. Furthermore, we strive to explore whether the type of renal dysfunction affects estimated glomerular filtration rate-adjusted D-dimer test characteristics. Single-center retrospective data analysis from electronic healthcare records of all emergency department patients admitted for suspected thromboembolic disease. Tertiary care academic hospital. Exclusion criteria were as follows: age less than 16 years old, patients with active bleeding, and/or incomplete records. Test characteristics of previously suggested that estimated glomerular filtration rate-adjusted D-dimer cutoff levels (> 333 µg/L [estimated glomerular filtration rate, > 60 mL/min/1.73 m], > 1,306 µg/L [30-60 mL/min/1.73 m], and > 1,663 µg/L [< 30 mL/min/1.73 m]) were validated and compared with the conventional D-dimer cutoff level of 500 µg/L. A total of 14,477 patients were included in the final analysis, with 467 patients (3.5%) diagnosed with thromboembolic disease. Renal dysfunction was observed in 1,364 (9.4%) of the total population. When adjusted D-dimer levels were applied, test characteristics remained stable: negative predictive value (> 99%), sensitivity (91.2% vs 93.4%), and specificity (42.7% vs 50.7%) when compared with the conventional D-dimer cutoff level to rule out thromboembolic disease (< 500 µg/L). Comparable characteristics were also observed when adjusted D-dimer cutoff levels were applied in patients with acute kidney injury (negative predictive value, 98.8%; sensitivity, 95.8%; specificity, 39.2%) and/or "acute on chronic" renal dysfunction (negative predictive value, 98.0%; sensitivity, 92.9%; specificity, 48.5%). D-Dimer cutoff levels adjusted for renal dysfunction appear feasible and safe assessing thromboembolic disease in critically ill patients. Furthermore, adjusted D-dimer cutoff levels seem reliable in patients with acute kidney injury and "acute on chronic" renal dysfunction. In patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m, the false-positive rate can be reduced when estimated glomerular filtration rate-adjusted D-dimer cutoff levels are applied.

Cross-cultural adaptation and validation of the Romanian knee disability and osteoarthritis outcome score for joint replacement (KOOSJR)

AimTo perform validation of the Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR).MethodNinety-six patients (101 knees) with advanced osteoarthritis (OA) scheduled for total knee replacement completed Romanian translations of KOOSJR and IKDC (International Knee Documentation Committee – subjective knee form) and Euroqol EQ-5D-5 L, and the treating physician completed the original knee society score (KSS).ResultsAverage age was 66.4 (range 50–83) years and male to female ratio 1:3.76. There was moderate correlation between the test-retest (average 4 days) KOOSJR (r = 0.618, n = 45) and IKDC (r = − 0.671, n = 99), weak between KOOSJR and EQ-5D-5 L Index (r = − 0.431, n = 100) and VAS (r = − 0.364, n = 99) and very weak to KSS score (r = − 0.133, n = 98) and function (r = − 0.072, n = 97) For the first KOOSJR, Cronbach’s alpha was 0.816 and intraclass correlation coefficient (ICC) 0.816 (95% CI 0.755–0.866) for average measures. For the retest, Cronbach’s alpha was 0.841 (95% CI 0.760–0.903) for averages.ConclusionThe Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) is a valid, reliable, consistent and reproducible clinical score for patients with OA requiring arthroplasty.

Clinical and pulmonary function changes in cough variant asthma with small airway disease

BackgroundIt is known that small airway disease is present across all asthma severities; however, its prevalence and clinical characteristics in cough variant asthma (CVA) have not been fully illuminated.MethodsA total of 77 CVA patients with preserved proximal airway function (FEV1/FVC > 70%) were enrolled in this study. The correlation between forced expiratory flow at 50% (FEF50%) and FEF25–75% in the CVA population was first evaluated. FEF50% was determined to be an easy and feasible parameter for identifying small airway disease. CVA with small airway disease is defined as FEF50% < 70%, whereas CVA with normal small airways is identified as FEF50% > 70%. Demographic features, clinical characteristics, lung function and induced sputum test results were determined at the initial visit and at the final visit 1 year later.ResultsFEF50% is a good marker for small airway disease. The cutoff value of 70% is more sensitive than the previously published 60% for identifying more patients with small airway problems early. Nearly half of the CVA population (45.4%) in our cohort had small airway disease. In both group, symptoms improved greatly after anti-asthmatic treatment. Interestingly, the changes in symptom scores [Asthma Control Test (ACT) and ACQ] were even greater in the CVA with small airway disease group than in the control group because of the higher medication usage in this subpopulation in real life. However anti-asthmatic therapy can not reverse small airway dysfunction. At last visit, FEF50% of CVA with small airway diseases was 57.2% ± 10.5%, still much lower than the control group (FEF50% = 92.6% ± 16.5%).ConclusionsIn our cohort, nearly half of the CVA population had small airway disease. Their demographic features, clinical characteristics, airway eosinophils and drug responsiveness were quite similar between two groups, which means these indices can not be used as markers to identify small airway obstruction. We found FEF50% is an easy and feasible marker for early identification. Regular anti-asthmatic medication helped to improve clinical scores in patients with small airway disease, but the obstruction could not be reversed over 1-year period.

Relationship between changes in resting-state spontaneous brain activity and cognitive impairment in patients with CADASIL

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) mainly manifests with cognitive impairment. Cognitive deficits in patients with CADASIL are correlated with structural brain changes such as lacunar lesion burden, normalized brain volume, and anterior thalamic radiation lesions, but changes in resting-state functional brain activity in patients with CADASIL have not been reported.MethodsThis study used resting-state functional magnetic resonance imaging (fMRI) to measure the amplitude of low-frequency fluctuation (ALFF) in 22 patients with CADASIL and 44 healthy matched controls. A seed-based functional connectivity (FC) analysis was used to investigate whether the dysfunctional areas identified by ALFF analysis exhibited abnormal FC with other brain areas. Pearson’s correlation analysis was used to detect correlations between the ALFF z-score of abnormal brain areas and clinical scores in patients with CADASIL.ResultsPatients with CADASIL exhibited significantly lower ALFF values in the right precuneus and cuneus (Pcu/CU) and higher ALFF values in the bilateral superior frontal gyrus (SFG) and left cerebellar anterior and posterior lobes compared with controls. Patients with CADASIL showed weaker FC between the areas with abnormal ALFF (using peaks in the left and right SFG and the right Pcu/CU) and other brain areas. Importantly, the ALFF z-scores for the left and right SFG were negatively associated with cognitive performance, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment scores (MoCA), respectively, whereas those of the right Pcu/CU were positively correlated with the MMSE score.ConclusionsThis preliminary study provides evidence for changes in ALFF of the right Pcu/CU, bilateral SFG and left cerebellar anterior and posterior lobes, and associations between ALFF values for abnormal brain areas and cognitive performance in patients with CADASIL. Therefore, spontaneous brain activity may be a novel imaging biomarker of cognitive impairment in this population.

GBR 830, an anti-OX40, improves skin gene signatures and clinical scores in patients with atopic dermatitis

GBR 830 is a humanized mAb against OX40, a costimulatory receptor on activated T cells. OX40 inhibition might have a therapeutic role in T cell-mediated diseases, including atopic dermatitis (AD). This exploratory phase 2a study investigated the safety, efficacy, and tissue effects of GBR 830 in patients with AD. Patients with moderate-to-severe AD (affected body surface area, ≥10%; Eczema Area and Severity Index score, ≥12; and inadequate response to topical treatments) were randomized 3:1 to 10mg/kg intravenous GBR 830 or placebo on day 1 (baseline) and day 29. Biopsy specimens were collected (n=40) at days 1, 29, and 71. Primary end points included treatment-emergent adverse events (TEAEs) and changes from baseline in biomarkers (epidermal hyperplasia/cytokines) at days 29 and 71. GBR 830 was well tolerated, with equal TEAE distribution (GBR 830, 63.0% [29/46]; placebo, 63.0% [10/16]). One serious TEAE in the GBR 830 group was deemed unrelated to study drug. At day 71, the proportion of intent-to-treat subjects achieving 50% or greater improvement in Eczema Area and Severity Index score was greater with GBR 830 (76.9% [20/26]) versus placebo (37.5% [3/8]). GBR 830 induced significant progressive reductions in TH1 (IFN-γ/CXCL10), TH2 (IL-31/CCL11/CCL17), and TH17/TH22 (IL-23p19/IL-8/S100A12) mRNA expression in lesional skin. Significant progressive reductions until day 71 in the drug group were seen in OX40+ T cells and OX40L+ dendritic cells (P<.001). Hyperplasia measures (thickness/keratin 16/Ki67) showed greater reductions with GBR 830 (P<.001). Two doses of GBR 830 administered 4weeks apart were well tolerated and induced significant progressive tissue and clinical changes until day 71 (42days after the last dose), highlighting the potential of OX40 targeting in patients with AD.

Long-term benefit and survival of knee joint distraction as treatment of severe knee osteoarthritis

Purpose: In relatively young patients with end-stage knee osteoarthritis (OA), total knee arthroplasty (TKA) comes with the risk of future revision surgery. Knee joint distraction (KJD) is joint preserving surgery, which has been shown to provide clinical and structural improvement for at least five years. The aim of this study was to evaluate long-term clinical and structural results and identify characteristics predicting survival of the native knee joint. Methods: Patients (n = 20; age <60 years) with end-stage tibiofemoral OA indicated for TKA were treated with KJD. WOMAC questionnaires (100 being best) and VAS pain scores (0 being best) were used for clinical evaluation before treatment (baseline) and every year after treatment, up to nine years. The minimum and mean joint space width (JSW) were measured using KIDA software on standardized radiographs to evaluate structural changes at baseline and one, two, five and seven years after treatment. Survival after treatment was analyzed using the Kaplan-Meier estimator, where failure was defined by TKA. Paired t-tests were used to evaluate clinical and structural changes compared to baseline for survivors and non-survivors. Nine-year survival of KJD was predicted using logistic regression analyses. Results: Three patients withdrew consent during follow-up. Nine years after treatment, survival was 48% and survivors reported clinical improvement compared to baseline: ΔWOMAC +29.9 points (95%CI +16.9 to +42.9; P = 0.001; Fig. 1A), ΔVAS -46.8 mm (95%CI −31.6 to −61.9; P<0.001). Survivors showed a significant remained increase of the minimum JSW (+0.62 mm; 95%CI +0.13 to +1.11; P = 0.020; Fig. 1B) and non-significant increase in mean JSW (+0.31; 95%CI −0.91 to +1.55; P = 0.562) after seven years. In patients whose treatment failed, last reported clinical scores were still improved compared to baseline: ΔWOMAC +20.5 points (95%CI −1.8 to +42.8; P = 0.067; Fig. 1A), ΔVAS −25.4 mm (95%CI −3.2 to −47.7; P = 0.030). At last measurement, the minimum JSW was still significantly increased (+0.37; 95%CI +0.02 to +0.73; P = 0.042; Fig. 1B) while the mean JSW was similar compared to baseline (−0.06; 95%CI −0.85 to +0.72; P = 0.854). Survival analysis showed a difference in survival percentage nine years after treatment for gender (women 14%, men 70%; P = 0.035; Fig. 2A) and for amount of increase in minimum JSW in the first year after treatment (<0.5 mm increase 0%, >0.5 mm increase 72%; P = 0.002; Fig. 2B). Gender and increase in minimum JSW after one year were shown to predict survival of the native knee joint after nine years. Conclusions: Long-term results of joint distraction for end-stage knee OA show long-lasting clinical and structural improvement with a survival of 48% after nine years of follow-up. The last reported clinical scores in patients failing treatment were still improved compared to baseline and cannot fully explain the subsequent TKA surgery. Positive predicting factors for survival of the native knee after nine years are male gender and a larger initial increase in minimum joint space width. The differences between genders may relate to different subchondral bone characteristics between men and (postmenopausal) women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A new scale measuring translation of the humeral head as a prognostic factor for the treatment of large and massive rotator cuff tears

Failure rates after rotator cuff repair remain high in patients with massive tears. Although superior translation of the humeral head has been used to assess the severity of rotator cuff tears, the relevance of anterior migration of the humeral head to clinical outcomes has not been established. The purpose of this study was to investigate the potential role of the T-scale, a measure of the anterolateral translation of the humeral head, as a prognostic factor for rotator cuff repair. One hundred twenty consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale and acromiohumeral interval (AHI) were measured preoperatively on axial computed tomography scans and radiographs, respectively. The correlations of the T-scale and AHI with previously published scores and active forward elevation (FE) were investigated. The outcome of rotator cuff repairs was compared between patients with positive and patients with negative preoperative T-scale values. The preoperative T-scale but not AHI correlated significantly with postoperative FE and clinical scores in patients with large to massive tears but not in those with small to medium tears. Postoperative FE and clinical scores were significantly higher in patients with positive T-scale values than in those with negative T-scale values. The relative risk of retear was 2.0 to 7.9 times greater in patients with negative T-scale values. Patients with large to massive tears and negative T-scale values had poorer clinical outcomes and higher retear rates. A negative T-scale value represents a useful prognostic factor for considering reverse shoulder arthroplasty in patients at greater risk of retear after rotator cuff repair.

Selective oral ROCK2 inhibitor reduces clinical scores in patients with Psoriasis Vulgaris and normalizes skin pathology via concurrent regulation of IL-17 and IL-10 levels

Abstract Targeted inhibition of Rho-associated kinase 2 (ROCK2) down-regulates pro-inflammatory T-cell response, while increasing the regulatory arm of immune response in animals models of autoimmunity and T helper 17 (Th17)-skewing human cell culture in vitro. We conducted a Phase 2, open-label, dose-finding study to evaluate the safety, tolerability, and activity of selective ROCK2 inhibitor, KD025, in subjects with Psoriasis Vulgaris who failed first-line therapy (NCT02317627 at ClinicalTrials.gov). Here, we report that oral administration of KD025 reduces Psoriasis Area and Severity Index (PASI) scores in 85% of patients completing the study, with minimal side effects. In the 400 mg QD and 200 mg BID cohorts 42% and 71% of patients respectively achieved at least a 50% decrease in PASI score (PASI 50) after three month of treatment. KD025 treatment reduced levels of both IL-17 and IL-23, but no IL-6 and TNF-a in the peripheral blood of clinical responders, whereas IL-10 levels were increased at the end of the study. The clinical improvement and changes in cytokine levels were associated with decreased epidermal thickness, T-cell infiltration and down-regulation of key molecules implicated in the regulation of the Th17 pathway, such as ROCK2, pSTAT3, RORgt and IRF4 in the skin. Collectively, these data demonstrate that orally available selective ROCK2 inhibitor down-regulates Th17-driven autoimmune response and improved clinical symptoms in psoriatic patients via defined molecular mechanism that involves concurrent modulation of cytokines without deleterious impact on the rest of the immune system.

Is there any potential or additive effect of anemia on hepatorenal syndrome?

Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis and is characterized by renal dysfunction and poor survival rates. Although anemia is a non-rare condition in advanced liver cirrhosis, there is no publication regarding the potential or additive effects of anemia on HRS and renal dysfunction in patients with cirrhosis. We investigated whether severe anemia is a precipitant factor for HRS. In this prospective study, consecutive patients with cirrhosis with and without renal dysfunction were enrolled. A total of 29 patients with cirrhosis with HRS meeting the HRS diagnostic criteria (9 patients with type 1 HRS and 20 with type 2 HRS) and 37 patients with cirrhosis without HRS were included. The demographic features, laboratory data (particularly anemic parameters), and clinical scores of patients with and without HRS were evaluated. Grades of ascites, Child-Turcotte-Pugh (CTP) scores, and Model of End Stage Liver Disease (MELD) scores were significantly higher in contrast to hemoglobin levels; hematocrit concentrations were significantly lower in patients with type 1 and 2 HRS than in those with non-HRS stable cirrhosis. There was a negative correlation between the hemoglobin-hematocrit and serum creatinine levels. In the logistic regression analysis, the hemoglobin levels and CTP and MELD scores were statistically significant for an onset of HRS. Anemia may contribute to HRS and deteriorated renal function in patients with HRS because anemic hypoxia can lead to microcirculatory renal ischemia in the kidneys and anemia can also activate sympathetic activity and hyperdynamic circulation in the pathogenesis of HRS.

Prediction of individual clinical scores in patients with Parkinson's disease using resting-state functional magnetic resonance imaging

Neuroimaging holds the promise that it may one day aid the clinical assessment. However, the vast majority of studies using resting-state functional magnetic resonance imaging (fMRI) have reported average differences between Parkinson's disease (PD) patients and healthy controls, which do not permit inferences at the level of individuals. This study was to develop a model for the prediction of PD illness severity ratings from individual fMRI brain scan. The resting-state fMRI scans were obtained from 84 patients with PD and the Unified Parkinson's Disease Rating Scale-III (UPDRS-III) scores were obtained before scanning. The RVR method was used to predict clinical scores (UPDRS-III) from fMRI scans. The application of RVR to whole-brain resting-state fMRI data allowed prediction of UPDRS-III scores with statistically significant accuracy (correlation=0.35, P-value=0.001; mean sum of squares=222.17, P-value=0.002). This prediction was informed strongly by negative weight areas including prefrontal lobe and medial occipital lobe, and positive weight areas including medial parietal lobe. It was suggested that fMRI scans contained sufficient information about neurobiological change in patients with PD to permit accurate prediction about illness severity, on an individual subject basis. Our results provided preliminary evidence, as proof-of-concept, to support that fMRI might be possible to be a clinically useful quantitative assessment aid in PD at individual level. This may enable clinicians to target those uncooperative patients and machines to replace human for a more efficient use of health care resources.

Neural correlates of clinical scores in patients with shoulder apprehension

Background Shoulder apprehension is a commonly reported complaint in shoulder instability, which may lead to patient morbidity and impede shoulder function. It is the result of a cognitively complex mechanism, which includes anxiety, salience, fear and anticipation. Purpose The primary aim of this study were to correlate 5 clinically established scores that assess these different aspects of apprehension to brain activation patterns from fMRI in patients with a positive apprehension. The second study aim was to correlated functional connectivity networks and task-related brain activation to these 5 different clinical scores. Study design Prospective case-control study. Methods This study includes 28 consecutive right-handed, male patients (26.8 ± 1.2 years) with positive shoulder apprehension test and 10 healthy matched control participants. Task-related and functional connectivity fMRI activation patterns during apprehension video cue stimulation were correlated to 5 clinical tests and scores: Visual Analog Scale (VAS), Rowe, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV) and Western Ontario Shoulder Instability (WOSI). Results Rowe, pain VAS and WOSI correlated with pre-frontal, dorsolateral/dorsomedial pre-frontal cortex, somatosensory areas and parieto-occipital and temporal areas (default mode network). Rowe additionally correlated with frontal pole, anterior mid-cingulate cortex and visual areas. Moreover, SSV correlated with task-related brain activity of bilateral pre- and post-central gyrus, and bilateral superior parietal lobe. Conclusion Overall, the Rowe score provides the strongest link between shoulder apprehension and brain level alterations as it correlated with the highest number of ICs involving areas responsible for both motor and cognitive functions, while the pain VAS and WOSI occupy an intermediately strong link recruiting less brain networks. Finally, SST and SSV have the weakest link at the brain level. Raising interest in this particular field may allow development of a whole new therapeutic approach to shoulder instability, as well as other joint instabilities or orthopedic conditions.

Lower extremity muscle activation and function in progressive task-oriented training on the supplementary tilt table during stepping-like movements in patients with acute stroke hemiparesis

An effective and standardized method for applying a tilt table as a supplementary treatment in the early rehabilitation of stroke patients is still missing. The aim of this study was to determine the influence of progressive task-oriented training on the tilt table on the improvement in lower extremity (LE) muscle activation and clinical function in subjects with hemiplegia due to stroke. Thirty-nine subjects with acute stroke were randomly allocated to three groups; control group, tilt table group, and task-oriented training group on the tilt table, with 13 patients, respectively. All of the subjects received the routine therapy for half an hour, and subjects in the experimental groups additionally received training on two different tilt table applications for 20min a day, five times a week for three weeks. The effect of tilt table applications was assessed using the surface electromyography (EMG) analysis during stepping-like movements on the tilt table for LE muscle activation and clinical scores for function. Our results showed that there was a significantly greater increase in the EMG patterns of the extensors and flexors of the affected leg muscles during flexion and extension movements of both legs and clinical scores in patients undergoing the progressive task-oriented training on the tilt table compared to the other groups. These findings suggest that progressive task-oriented training on the tilt table can improve LE muscle activation and clinical scores of functional performance for early rehabilitation of subjects with acute stroke.

Neural Correlates of Clinical Scores in Patients with Anterior Shoulder Apprehension.

Anterior shoulder apprehension is a commonly reported complaint in anterior shoulder instability, which may lead to patient morbidity and impede shoulder function. It is the result of a cognitively complex mechanism, which includes anxiety, salience, fear, and anticipation. The aim of this prospective case-control study was to correlate five clinically established scores using functional magnetic resonance imaging to assess brain activation patterns in patients with apprehension related to anterior shoulder instability. This study includes 28 consecutive male right-handed patients (mean ± SEM, 26.8 ± 1.2 yr) with positive shoulder apprehension test and 10 healthy matched control participants without apprehension or a history of instability. Task-related and functional connectivity functional magnetic resonance imaging activation patterns occurring during apprehension video cue stimulation were correlated with five clinical tests and scores: Visual Analog Scale (VAS), Rowe score for instability, Simple Shoulder Test, Subjective Shoulder Value (SSV), and Western Ontario Shoulder Instability (WOSI). Rowe, pain VAS, and WOSI scores correlated with prefrontal cortex, dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, somatosensory area, and parieto-occipital and temporal areas (default mode network). Rowe score additionally correlated with frontal pole, anterior midcingulate cortex, and visual areas. Moreover, SSV correlated with task-related brain activity in the bilateral precentral gyrus, bilateral postcentral gyrus, and bilateral superior parietal lobe. Overall, Rowe score provides the strongest link between shoulder apprehension and brain level alterations as it correlates with the highest number of independent components involving areas responsible for both motor and cognitive functions, whereas pain VAS and WOSI occupy an intermediately strong link recruiting less brain networks. Finally, Simple Shoulder Test and SSV have the weakest link at the brain level.

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography.

BackgroundMany shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath.MethodsA consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score.ResultsThe effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 ± 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease.ConclusionsThe effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.

Meniscal scaffolds.

There are two scaffold products designed for meniscal reconstruction or substitution of partial meniscal defects that are currently available in the Europe: the collagen meniscal implant (CMI; Ivy Sports Medicine, Gräfelfing, Germany) and the polymer scaffold (PS; Actifit, Orteq Bioengineering, London, United Kingdom). The CMI has demonstrated improved clinical outcomes compared with baseline in patients with chronic postmeniscectomy symptoms with follow-up ranging from 5 to more than 10 years. There are also several comparative studies that report improved clinical scores in patients with chronic medial meniscus symptoms treated with CMI versus repeat partial meniscectomy, and a lower reoperation rate. Recently, PS insertion was shown to result in improved clinical outcomes in patients with chronic postmeniscectomy symptoms of the medial or lateral meniscus at short-term follow-up. However, there is currently no medium- or long-term data available for the PS. The use of meniscal scaffolds in the acute setting has not been found to result in improved outcomes in most studies. The authors' surgical indications for meniscal scaffold implantation, preferred surgical technique, and postoperative rehabilitation protocol are described.

Do quantitative magnetic resonance imaging parameters correlate with the clinical presentation and functional outcomes after surgery in cervical spondylotic myelopathy? A prospective multicenter study.

A prospective multicenter cohort study. To establish the relationship between preoperative quantitative magnetic resonance imaging (MRI) parameters and clinical presentation and postoperative outcomes in patients with cervical spondylotic myelopathy. Correlation of magnetic resonance imaging with clinical presentation and outcomes in cervical spondylotic myelopathy is poorly understood. A total of 134 magnetic resonance imaging scans were reviewed from 12 sites across North America. The transverse area (TA) of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity (SI) changes on T1-/T2-weighted imaging (WI) were evaluated. Detailed clinical assessments--neurological signs, symptoms, Nurick grade, modified Japanese Orthopaedic Association, segmental-tract score, and long-tract score of modified Japanese Orthopaedic Association, 30-m walk test, Short-Form 36 questionnaire, and neck disability index were performed at admission, 6 months, and 12 months postoperatively. The total number of neurological signs in a patient correlated with TA (P = 0.01) and SI changes on T1-/T2WI (P = 0.05). Pre- and postoperative Nurick grade (P = 0.03, P = 0.02), modified Japanese Orthopaedic Association score (P = 0.005, P = 0.001), segmental-tract score (P = 0.05, P = 0.006), and long-tract score (P = 0.006, P = 0.002), 30-m walk test (P = 0.002, P = 0.01) correlated with TA. There was no significant difference in pre- and postoperative clinical scores in patients with/without SI changes. Patients with severe cord compression showed SI changes on T1-/T2WI more frequently (r =-0.27, r =-0.38). Pyramidal signs--plantar response, Hoffmann reflex and hyper-reflexia correlated with TA (P = 0.003, P = 0.0004, P = 0.024, respectively) and SI changes on T1/T2WI (P = 0.02). TA closely mirrors the clinical presentation of cervical spondylotic myelopathy and may be used in predicting surgical outcomes. Pyramidal signs correlated with TA and/or SI changes on T1-/T2WI. The total number of neurological signs in a patient correlated with TA. There was no significant relationship between TA, age and duration of symptoms. 3.

Tissuegene-C (TG-C) improved clinical scores in patients with osteoarthritis: a phase 2B study

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S194 333 TISSUEGENE-C (TG-C) IMPROVED CLINICAL SCORES IN PATIENTS WITH OSTEOARTHRITIS: A PHASE 2B STUDY B. Lee, J. Cho, T. Kim, Y. Park, E. Jeong, K.-H. Lee. Kolon Life Sci., Inc., Gwacheon-si, Republic of Korea Purpose: TG-C is a cell mediated gene therapy that contains nontransduced (hChonJ) and transduced (hChonJb#7) human allogeneic chondrocytes. The hChonJb#7 cells were transduced with TGF-b1 gene by using retroviral vector and irradiated with gamma-ray. TG-C has been proved its efficacy and safety in preclinical studies in vitro and in vivo. TG-C has been tested in Phase I and Phase IIa clinical studies in osteoarthritis (OA) patients and has proved its safety and efficacy in the patients. Methods: The current placebo controlled phase IIb study was conducted to determine both safety and efficacy of TG-C in patients with OA of the knee. Participants (n1⁄4 54) with a confirmed diagnosis of knee OA by X-ray and MRI were randomized into the treatment group (TG-C, 1.8 107 cells/knee, n 1⁄4 27) and the placebo group (saline, n 1⁄4 27). The primary evaluation parameter was International Knee Documentation Committee (IKDC) which measures pain, sports activities, and daily function. The secondary evaluation parameters were Western-Ontario and MacMaster University (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 100 mm Visual Analogue Scale (VAS). These parameters were assessed at 12 and 24 weeks post treatment. For TG-C treatment group, we also evaluated the all evaluation parameters at 48 weeks post treatment. Additionally, changes in biomarkers were assessed in serum and urine samples. Safety measures, including physical exams, complete blood count, and serum chemistry were included up to 6 months post treatment. Blood samples were screened to detect the replication competent retrovirus (RCR), retrovirally transduced cells, and TGF-b1 DNA and protein starting from 2 weeks up to 6 months post treatment. Results: TG-C treatmentgroup showed improvement in IKDC, WOMAC, KOOS and 100 mm VAS scores compared toplacebo group as shown in Table 1.