Clinical Function Tests Research Articles

A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait.

The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.

Multiple cross-frequency coupling analysis of resting-state EEG in patients with mild cognitive impairment and Alzheimer's disease.

Electroencephalographic (EEG) abnormalities are seen in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with characteristic features of cognitive impairment. The most common findings of EEG features in AD and MCI patients are increased relative power of slow oscillations (delta and theta rhythms) and decreased relative power of fast oscillations (alpha, beta and gamma rhythms). However, impairments in cognitive processes in AD and MCI are not sufficiently reflected by brain oscillatory activity in a particular frequency band. MCI patients are at high risk of progressing to AD. Cross-frequency coupling (CFC), which refers to coupling between different frequency bands, is a crucial tool for comprehending changes in brain oscillations and cognitive performance. CFC features exhibit some specificity in patients with AD and MCI, but a comparison between CFC features in individuals with these disorders is still lacking. The aim of this study was to explore changes in CFC properties in MCI and AD and to explore the relationship between CFC properties and multiple types of cognitive functional performance. We recorded resting-state EEG (rsEEG) signals in 46 MCI patients, 43 AD patients, and 43 cognitively healthy controls (HCs) and analyzed the changes in CFC as well as the relationship between CFC and scores on clinical tests of cognitive function. Multiple couplings between low-frequency oscillations and high-frequency oscillations were found to be significantly enhanced in AD patients compared to those of HCs and MCI, while delta-gamma as well as theta-gamma couplings in the right temporal and parietal lobes were significantly enhanced in MCI patients compared to HCs. Moreover, theta-gamma coupling in the right temporal lobe tended to be stronger in MCI patients than in HCs, and it was stronger in AD than in MCI. Multiple CFC properties were found to correlate significantly with various cognitive domains, especially the memory function domain. Overall, these findings suggest that AD and MCI patients must use more neural resources to maintain a resting brain state and that alterations in theta-gamma coupling in the temporal lobe become progressively obvious during disease progression and are likely to be a valuable indicator of MCI and AD pathology.

No Effect of Return to Sport Test Batteries with and without Psychological PROs on the Risk of a Second ACL Injury: A Critical Assessment of Four Different Test Batteries.

Patients report psychological barriers as important when returning to sport, however, psychological outcome measures are seldom included in return to sport (RTS) assessment. There is a need for clinical trials to integrate psychological patient-reported outcomes (PROs) in return to sport batteries assessing patients treated with ACL reconstruction. The aim of this study was to determine the association between passing clinical tests of muscle function and psychological PROs and sustaining a second ACL injury in patients who RTS after primary ACL reconstruction. Retrospective Cohort study. Patients' sex, age, height and weight, and the results of strength and hop tests, as well as answers to PRO's (including Tegner activity scale, the ACL Return to Sport after Injury scale (ACL-RSI) as well as the Quality of Life (QoL) subscale of the Knee injury and Osteoarthritis Outcome Score [KOOS]), were extracted from a rehabilitation-specific registry. Four different test batteries comprising muscle function tests and PROs were created to assess whether patients were ready to RTS. Passing each of the test batteries (yes/no) was used as an independent variable. A multivariable Cox proportional hazard model analysis was performed, with sustaining a second ACL injury (either ipsi- or contralateral; yes/no) within two years of RTS as the dependent variable. A total of 419 patients (male, n=214; 51%) were included, of which 51 (12.2%) suffered a second ACL injury within the first two years after RTS. There were no differences in passing rates in the different RTS test batteries comprising muscle function tests and PROs for patients who suffered a second ACL injury compared to patients who did not. No association between passing the RTS clinical tests batteries comprising muscle function and psychological PROs used, and the risk of a second ACL injury could be found. 3©The Author(s).

Olfactory dysfunction and its related molecular mechanisms in Parkinson's disease.

Changes in olfactory function are considered to be early biomarkers of Parkinson's disease. Olfactory dysfunction is one of the earliest non-motor features of Parkinson's disease, appearing in about 90% of patients with early-stage Parkinson's disease, and can often predate the diagnosis by years. Therefore, olfactory dysfunction should be considered a reliable marker of the disease. However, the mechanisms responsible for olfactory dysfunction are currently unknown. In this article, we clearly explain the pathology and medical definition of olfactory function as a biomarker for early-stage Parkinson's disease. On the basis of the findings of clinical olfactory function tests and animal model experiments as well as neurotransmitter expression levels, we further characterize the relationship between olfactory dysfunction and neurodegenerative diseases as well as the molecular mechanisms underlying olfactory dysfunction in the pathology of early-stage Parkinson's disease. The findings highlighted in this review suggest that olfactory dysfunction is an important biomarker for preclinical-stage Parkinson's disease. Therefore, therapeutic drugs targeting non-motor symptoms such as olfactory dysfunction in the early stage of Parkinson's disease may prevent or delay dopaminergic neurodegeneration and reduce motor symptoms, highlighting the potential of identifying effective targets for treating Parkinson's disease by inhibiting the deterioration of olfactory dysfunction.

#6830 APPLICATION OF THE NEURAL NETWORK ALGORITHM IN THE ASSESSMENT OF THE STAGE OF ACUTE KIDNEY DAMAGE AND THE SELECTION OF TREATMENT

Abstract Background and Aims Acute kidney injury is a syndrome that occurs in different clinical situations, under the influence of different risk factors, in patients of all ages, especially those in the intensive care unit. The problem of acute kidney damage refers to numerous clinical situations, different disease mechanisms and poor outcomes. In addition, with the current definition of acute kidney injury, only one conventional marker is available for diagnosis in daily clinical practice. To recognize the disease promptly and start treatment, and thereby improving the outcome, the paper presents a model for recognizing acute kidney damage in the stage that requires hemodialysis treatment. Method The study included 86 hospitalized patients with acute renal impairment who were divided according to the stage of renal impairment at admission to hospital treatment into three groups. The assessment of acute renal impairment and the classification of disease stages were based on the diagnostic stages by the K / DIGO group. All examined patients were over 18 years of age. In the first stage of the disease it was 12.79%, in the second stage it was 15.12%, and in the third 72.09% of patients. Test methods included clinical processing, laboratory evaluation, functional tests, and echosonographic examination. Clinical data included demographic, comorbidity and vital parameters, baseline full blood count, biochemistry and renal function tests. Further laboratory investigations were performed as indicated clinically thereafter. Spot blood and urine samples were collected from all patients in the morning after overnight fasting. The neural network was created in feed forward back propagation of the connection between the data of 69 patients with 31 parameters. In pattern recognition, the neural network learns to recognize the conditions in which it was decided to send the patient to dialysis 10 or to send to classical treatment 01. The training function analyzed the patients separated in three special categories 80% training, 10% test and 10% validation. The algorithm of the learning function is a scaling gradient that adapts the input data to the output data. Results The neural network achieved a performance of 0.14322 in 6 epochs. In a test with the data of 17 patients, it was shown that the neural network indicates for which patients dialysis treatment is a better option that fits with AKI stage 3. For patients with the first and second stages of the disease, conservative treatment is a better therapeutic choice. Conclusion This paper deals with a current topic by analyzing data using a neural network algorithm to help assess the stage of the disease in high-risk hospitalized patients with acute kidney injury and select treatment modalities. The conclusions derived from this analysis should help with stage recognition and the selection of treatment modalities for patients with acute kidney injury.

Based on what parameters is safe to discontinuate inhaled corticosteroids in children with asthma?

Objective Remission of childhood asthma has not been widely studied. Patients in clinical remission continue to have some degree of bronchial hyperresponsiveness (BHR). The aim of this study was to investigate whether clinical parameters and lung function test are good parameters for discontinuation of inhaled corticosteroids (ICS) in asthmatic children, including patients with persistent BHR, as measured by the methacholine challenge test (MCT). Methods One year after discontinuation of inhaled corticosteroids (ICS), MCT was performed in a group of 40 asthmatic children to confirm or exclude BHR. In all patients, ICS treatment was discontinued based on the same parameters: symptoms, spirometry, daily PEF, and negative bronchodilator test. After achieving complete asthma control for at least 6 to 12 months, ICS treatment was stepped down and discontinued. Clinical course and spirometry were followed up after ICS discontinuation. Results Positive MCT was found in 50% of the patients. There was no statistically significant difference between the positive and negative MCT groups in age at initiation and discontinuation of ICS therapy, duration of ICS therapy, duration of stepping down period, FEV1, and PEF at the time of withdrawal of ICS and one year later. ICS treatment had to be restarted in two patients from the positive MCT group, due to recurrence of asthma symptoms. Conclusion Clinical parameters, normal spirometry, daily PEF values, and a negative bronchodilator test are good parameters for discontinuing ICS treatment in asthmatic children, even in patients with persistent BHR. Children should continue to be monitored, as symptoms may recur.

Return to Sports Following Shoulder Injury: Clinical Evaluation, Isokinetic, and Functional Testing.

The shoulder is commonly injured in overhead sports. This is associated with a high degree of mobility at the expense of stability, sports specific demands, high volume or intensity of practice and competition, biomechanical deficits, and poor technique. Following injury, the return to competition process includes nonsurgical or surgical treatment, comprehensive rehabilitation, and a structured return to sports program. The return to sports continuum is divided into phases which include return to practice of the sport, return to competition at a lower level or with reduced performance, and return to expected performance. Components of the return to sports decision include clinical evaluation of physical and psychological readiness, measurement of muscle strength using isokinetic tests, evaluation of overhead functional tasks, and progression in a supervised interval throwing program. The evidence for the effectiveness of return to sports programs following shoulder injury is limited but evolving and is an area that will merit continued investigation.

Effects of Sensorimotor Training on Transversus Abdominis Activation in Chronic Low Back Pain Patients.

(1) Background: The aim of this study was to investigate and compare the effect of sensorimotor training on transversus abdominis activation. (2) Methods: Seventy-five patients with chronic low back pain were randomly assigned to one of three groups (whole body vibration training using Galileo®, coordination training using Posturomed®, or physiotherapy (control)). Transversus abdominis activation was measured by using sonography pre- and post-intervention. Second, changes in clinical function tests and their correlation with the sonographic measurements were determined. (3) Results: All three groups showed an improvement in activation of the transversus abdominis post-intervention, with the Galileo® demonstrating the largest improvement. There were no relevant (r > 0.5) correlations between activation of the transversus abdominis muscle and any clinical tests. (4) Conclusions: The present study provides evidence that sensorimotor training on the Galileo® significantly improves the activation of the transversus abdominis muscle.

Characteristics and Outcome of Patients with Young-Onset Multiple System Atrophy (P8-11.005)

<h3>Objective:</h3> To evaluate the characteristics and disease course of patients with young-onset multiple system atrophy (YOMSA). <h3>Background:</h3> YOMSA is defined as the onset of MSA before age 40 years. There is limited information about the disease course and outcome in these patients. <h3>Design/Methods:</h3> We retrospectively reviewed medical records of all patients with a diagnosis of clinically established or clinically probable MSA who were evaluated at all Mayo Clinic sites from 1998 to 2021. We identified patients who were ≤40 years at time of disease onset. We evaluated clinical characteristics, disease course, and autonomic function testing results. Composite Autonomic Severity Score (CASS) was calculated based on autonomic testing. <h3>Results:</h3> Of 1496 patients with a diagnosis of clinically established or probable MSA, 20 patients had YOMSA. The mean age of onset was 38.61 (±2.16) years; 13 patients (65%) were male. MSA-parkinsonism was the most common subtype (65%). At the time of medical record review, 15 patients were deceased with a mean age of death of 47.88 (±3.83) years. The median duration of disease course (onset to death) and onset to diagnosis were 7.67 [IQR: 6.36, 10.23] and 4.90 [IQR: 3.70, 8.61] years, respectively. Patients with autonomic symptoms at the time of disease onset had a shorter disease course compared to those without autonomic complaints (6.60 years versus 10.74 years; p=0.037). At the time of YOMSA diagnosis, thermoregulatory sweat test was performed in 17 patients with a median of 88% anhidrosis; CASS was available in 19 patients with a median of 5 [IQR: 4, 6.5]. Genetic evaluations were performed in 6 patients with no revealing results. <h3>Conclusions:</h3> Patients with YOMSA are often diagnosed late in the disease course. Those with autonomic symptoms at the time of disease onset have a more rapid course compared to those with initial motor-only presentation. <b>Disclosure:</b> Dr. Badihian has nothing to disclose. The institution of Dr. Savica has received research support from ACADIA Pharmaceuticals, Inc. Dr. Adler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Adler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion. Dr. Adler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CND Life Sci. Dr. Adler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Jazz. Dr. Adler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Precon. Dr. Adler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. The institution of Dr. Adler has received research support from NIH. The institution of Dr. Adler has received research support from Michael J. Fox Foundation. The institution of Dr. Adler has received research support from Arizona Biomedical Research Commission. Dr. Adler has received publishing royalties from a publication relating to health care. Dr. Wszolek has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Polish Neurological Society/Via Medica. Dr. Jackson has nothing to disclose. Dr. Benarroch has nothing to disclose. Dr. Sandroni has nothing to disclose. Dr. Low has nothing to disclose. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Singer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UniQure. The institution of Dr. Singer has received research support from NIH. The institution of Dr. Singer has received research support from FDA. Dr. Singer has received intellectual property interests from a discovery or technology relating to health care. Dr. Coon has nothing to disclose.

Thyroid Dysfunction in Patients with and Without Venous Thromboembolism: a Case Control Study.

Recent studies report an association between thyroid dysfunction and venous thromboembolism (VTE). Considering the high prevalence of thyroid diseases in India, identification of thyroid dysfunction as a risk factor for VTE will have implications in management. The aim of study was to determine if thyroid dysfunction could be considered as risk factor for unprovoked VTE. The study was conducted on 102 patients with unprovoked VTE and 102 age and gender matched controls in a tertiary care centre. Clinical profile and thyroid function tests (Free T3, Free T4, TSH) including antibody profile (Anti TPO and Anti TG) were compared between two groups. Thyroid disease was identified in 34 cases and 14 controls (33.1% vs. 13.7%,P=0.001) Out of 34 cases with thyroid dysfunction, 17 had subclinical hypothyroidism (SCH) while 6 out of 14 controls had SCH. Both thyroid dysfunction and SCH were found to be associated with unprovoked VTE, as compared with controls; [Odds ratio (OR) = 3.14, 95% CI 1.56-6.33, P = 0.001] and (OR = 3.71; 95% CI 1.4-9.9; P = 0.01) respectively. Thyroid dysfunction was significantly higher among patients with unprovoked VTE. Thyroid dysfunction, SCH were associated with unprovoked VTE.

A PROSPECTIVE STUDY OF THYROID FUNCTION TEST IN GERIATRIC POPULATION AND ITS CLINICAL CORRELATION IN A TERTIARY TEACHING CARE CENTER

Aim: The objective of the present investigation was to investigate the clinical relationship between hypothyroidism and hyperthyroidism in the elderly population as well as the demographics of thyroid dysfunction in this population.Materials and Method: An extensive clinical examination and thyroid function (T3, T4, and TSH) testing were performed on 100 patients older than 60 who were believed to have thyroid problems as part of a prospective study in our tertiary care center. Other pertinent examinations, such as USG &amp; FNAC neck, were carried out when thyroid swelling or nodules were present in order to obtain an accurate diagnosis. As necessary, further analysis was conducted using PS for expert opinion and 2DECHO. The determination of serum T3, T4, and TSH levels using the chemiluminescence assay method served as the basis for the laboratory evaluation of thyroid functioning. Result: In this investigation, it was discovered that 28% patients had thyroid function tests that were abnormal, and 18% of these patients also showed clinical signs of thyroid problems. 22% of cases had hypothyroidism, and 6% had hyperthyroidism. The prevalence of thyroid disorders rises with advancing age. Conclusion: In the elderly, thyroid dysfunction is more common. Older people should have their thyroid function checked, and long-term follow-up should be advised. Thyroid diseases in older individuals should be treated gradually and carefully, as they always need lifelong monitoring.

Mechanisms of gas transfer impairment utilizing nitric oxide following severe COVID-19 pneumonitis.

Reduced carbon monoxide diffusing capacity (DLCO ) is common after recovery from severe COVID-19 pneumonitis. The extent to which this relates to alveolar membrane dysfunction as opposed to vascular injury is uncertain. Simultaneous measurement of nitric oxide diffusing capacity (DLNO ) and DLCO can partition gas diffusion into its two components: alveolar-capillary membrane conductance (DmCO ) and capillary blood volume (VC ). We sought to evaluate DmCO and VC in the early and later recovery periods after severe COVID-19. Patients attended for post-COVID-19 clinical review and lung function testing including DLNO /DLCO . Repeat testing occurred when indicated and comparisons made using t-tests. Forty-nine (eight female) subjects (mean ± SD age: 58 ± 13, BMI: 34 ± 8) who had severe COVID-19 pneumonitis, WHO severity classification of 6 ± 1, and prolonged (21 ± 22 days) hospital stay, were assessed 2 months (61 ± 35 days) post discharge. DLCO adj (z-score -1.70 ± 1.49, 25/49 < lower limit of normal [LLN]) and total lung capacity (z-score -1.71 ± 1.30) were both reduced. DmCO and VC and were reduced to a similar extent (z-score -1.19 ± 1.05 and -1.41 ± 1.20, p = 0.4). Seventeen (one female) patients returned for repeat testing 4 months (122 ± 61 days) post discharge. In this subgroup with more impaired lung function, DLCO adj improved but remained below LLN (z-score -3.15 ± 0.83 vs. -2.39 ± 0.86, p = 0.01), 5/17 improved to >LNN. DmCO improved (z-score -2.05 ± 0.89 vs. -1.41 ± 0.78, p = 0.01) but VC was unchanged (z-score -2.51 ± 0.55 vs. -2.29 ± 0.59, p = 0.16). Alveolar membrane conductance is abnormal in the earlier recovery phase following severe COVID-19 but significantly improves. In contrast, reduced VC persists. These data raise the possibility that persisting effects of acute vascular injury may contribute to gas diffusion impairment long after severe COVID-19 pneumonitis.

Pain management with epidural catheter and epidural analgesia after spinal dorsal instrumentation of lumbar spine.

Spinal dorsal instrumentation (SDI) is an established treatment for degenerative spinal diseases. Adequate and immediate postoperative pain control is important for patient recovery and may be compromised by uncertainty about its efficacy and concern about early postoperative surgical complications or adverse events. The aim of the current study was to compare the use of epidural analgesia (EA) with systemic analgesia (SA) as regards pain reduction and early postoperative complications after SDI. Pain management with epidural or systemic analgesia in patients undergoing SDI by posterior approach between January 2019 and July 2020 was evaluated by clinical functional testing, measuring total opioid amounts used, and evaluating numerical rating scale values 24 and 96 hours postoperatively. The following were also monitored: demographic data, number of affected segments, length of hospital stay, inflammatory markers (leukocytes and serum C-reactive protein), early postoperative surgical complication rates, and adverse events. In total 79 patients were included (33 in the EA and 46 in the SA group). The SA group had significantly lower numerical rating scale values at days 1 to 4 after surgery (P ≤ .001) and lower cumulative opioid use than the EA group (P < .001). We found no difference in infection parameters, length of hospital stay or surgery-related complication rates. Our data demonstrate that epidural anesthesia was inferior to an opioid-based SA regime in reducing postoperative pain in patients undergoing spinal surgery. There is no benefit to the use of epidural catheters.

Assessing the Feasibility of Using Electrochemical Skin Conductance as a Substitute for the Quantitative Sudomotor Axon Reflex Test in the Composite Autonomic Scoring Scale and Its Correlation with Composite Autonomic Symptom Scale 31 in Parkinson’s Disease

The Composite Autonomic Scoring Scale (CASS) is a quantitative scoring system that integrates the sudomotor, the cardiovagal, and the adrenergic subscores, and the Composite Autonomic Symptom Scale 31 (COMPASS 31) is based on a well-established comprehensive questionnaire designed to assess the autonomic symptoms across multiple domains. We tested the hypothesis that electrochemical skin conductance (Sudoscan) can be a substitute for the quantitative sudomotor axon reflex test (QSART) in the sudomotor domain and assessed its correlation with COMPASS 31 in patients with Parkinson's disease (PD). Fifty-five patients with PD underwent clinical assessment and cardiovascular autonomic function tests and completed the COMPASS 31 questionnaire. We compared the modified CASS (integrating the Sudoscan-based sudomotor, adrenergic, and cardiovagal subscores) and CASS subscores (the sum of the adrenergic and cardiovagal subscores). The total weighted score of COMPASS 31 was significantly correlated with both the modified CASS and the CASS subscore (p = 0.007 and p = 0.019). The correlation of the total weighted score of COMPASS 31 increased from 0.316 (CASS subscores) to 0.361 (modified CASS). When we added the Sudoscan-based sudomotor subscore, the case numbers for autonomic neuropathy (AN) increased from 22 (40%, CASS subscores) to 40 (72.7%, modified CASS). The modified CASS not only better reflects the exact autonomic function, but also improves the characterization and quantification of AN in patients with PD. In areas in which a QSART facility is not easily available, Sudoscan could be a time-saving substitution.

Clinical, radiological outcomes and pulmonary function tests in patients recovered from COVID-19 in a three-month follow-up

Introduction: Long-term pulmonary consequences of coronavirus disease 2019 (COVID-19) are unknown. Objectives: The aim of this study was the clinical and radiologic consequences and pulmonary function test in the cured COVID-19 patients in a three-month follow-up. Patients and Methods: Patients with laboratory-confirmed COVID-19 infection by a reverse transcription polymerase chain reaction (RT-PCR) assay were recruited in this prospective descriptive epidemiological study. Computerized tomography (CT) scan and blood oxygen measurement were performed before and three months after discharge for all the patients. Spirometry test and 6-minute walk test (6MWT) were conducted to determine the levels of dyspnea and persistent respiratory symptoms. Results: Eighty patients were recruited in this study. At the 3-month follow-up, oxygen saturation was higher than the time of discharge from the hospital. Chest CT scan showed abnormal results in 66.3% of patients. The pulmonary function test results indicated that only 27 (35.75%) of patients had abnormal test. The median distance in the 6MWT was 325 meters (interquartile range, 96-480 m). Conclusion: Follow-up of COVID-19 patients revealed radiological abnormalities in most cured COVID-19 patients, indicating the need for more extended follow-up periods for investigating the long-term consequences of COVID-19.

Benefit of burosumab in adults with X-linked hypophosphataemia (XLH) is maintained with long-term treatment

ObjectivesTo report the impact of continued burosumab treatment on clinical laboratory tests of efficacy, patient-reported outcomes (PROs) and ambulatory function in adults with X-linked hypophosphataemia who continued from a 96-week...

Relationship between clinical outcome measurements and muscle thickness in cerebral palsy

BACKGROUND: The World Health Organization (WHO) uses the International Classification of Functioning, Disability, and Health (ICF) model to provide physical therapy diagnoses and interventions. However, the relationship between clinical assessment and imaging remains unclear. OBJECTIVE: This study aimed to determine the relationships between body function/structure, activity, and participation outcomes following neurorehabilitation in children with cerebral palsy (CP). METHODS: Nineteen children (9 girls mean age 8.8 ± 1.8 years) with CP participated in this study. Clinical motor function tests included the quality of upper extremity skills test (QUEST), Wolf motor function test (WMFT), Functional Independence Measure for Children (WeeFIM), and the Jebsen-Taylor Hand Function Test (JTHFT). Ultrasound imaging was used to measure muscle thickness, which characterizes the body structure, and activity domain variables. RESULTS: The correlations between body structure domain (muscle thickness), activity domain (QUEST, WMFT, WeeFIM) and participants variable (JTHFT) were significant, ranging from r=-0.484 to 0.893, P&lt; 0.05. CONCLUSIONS: These novel findings suggest that muscle thickness ultrasound imaging is closely associated with WMFT, WeeFIM, and QUEST variables. This finding provides important clinical insights when using broad clinical assessment and imaging in children with CP.

Cutaneous α-Synuclein Signatures in Patients With Multiple System Atrophy and Parkinson Disease.

Multiple system atrophy (MSA) is a progressive neurodegenerative disorder caused by the abnormal accumulation of α-synuclein in the nervous system. Clinical features include autonomic and motor dysfunction, which overlap with those of Parkinson disease (PD), particularly at early disease stages. There is an unmet need for accurate diagnostic and prognostic biomarkers for MSA and, specifically, a critical need to distinguish MSA from other synucleinopathies, particularly PD. The purpose of the study was to develop a unique cutaneous pathologic signature of phosphorylated α-synuclein that could distinguish patients with MSA from patients with PD and healthy controls. We studied 31 patients with MSA and 54 patients with PD diagnosed according to current clinical consensus criteria. We also included 24 matched controls. All participants underwent neurologic examinations, autonomic testing, and skin biopsies at 3 locations. The density of intraepidermal, sudomotor, and pilomotor nerve fibers was measured. The deposition of phosphorylated α-synuclein was quantified. Results were compared with clinical rating assessments and autonomic function test results. Patients with PD had reduced nerve fiber densities compared with patients with MSA (p < 0.05, all fiber types). All patients with MSA and 51/54 with PD had evidence of phosphorylated α-synuclein in at least one skin biopsy. No phosphorylated α-synuclein was detected in controls. Patients with MSA had greater phosphorylated α-synuclein deposition (p < 0.0001) and more widespread peripheral distribution (p < 0.0001) than patients with PD. These results provided >90% sensitivity and specificity in distinguishing between the 2 disorders. α-synuclein is present in the peripheral autonomic nerves of patients with MSA and when combined with synuclein distribution accurately distinguishes MSA from PD. This study provides Class II evidence that measurement of phosphorylated α-synuclein in skin biopsies can differentiate patients with MSA from those with PD.

Accuracy of a computer vision system for estimating biomechanical measures of body function in axial spondyloarthropathy patients and healthy subjects

Objective Advances in computer vision make it possible to combine low-cost cameras with algorithms, enabling biomechanical measures of body function and rehabilitation programs to be performed anywhere. We evaluated a computer vision system's accuracy and concurrent validity for estimating clinically relevant biomechanical measures. Design Cross-sectional study. Setting Laboratory. Participants Thirty-one healthy participants and 31 patients with axial spondyloarthropathy. Intervention A series of clinical functional tests (including the gold standard Bath Ankylosing Spondylitis Metrology Index tests). Each test was performed twice: the first performance was recorded with a camera, and a computer vision algorithm was used to estimate variables. During the second performance, a clinician measured the same variables manually. Main measures Joint angles and inter-limb distances. Clinician measures were compared with computer vision estimates. Results For all tests, clinician and computer vision estimates were correlated (r2 values: 0.360–0.768). There were no significant mean differences between methods for shoulder flexion (left: 2 ± 14° (mean ± standard deviation), t = 0.99, p < 0.33; right: 3 ± 15°, t = 1.57, p < 0.12), side flexion (left: − 0.5 ± 3.1 cm, t = −1.34, p = 0.19; right: 0.5 ± 3.4 cm, t = 1.05, p = 0.30) and lumbar flexion ( − 1.1 ± 8.2 cm, t = −1.05, p = 0.30). For all other movements, significant differences were observed, but could be corrected using a systematic offset. Conclusion We present a computer vision approach that estimates distances and angles from clinical movements recorded with a phone or webcam. In the future, this approach could be used to monitor functional capacity and support physical therapy management remotely.

Profiles of Clinical and Liver Function Test of Hepatitis B and C Patients with Liver Cirrhosis

Highlights:1. Liver cirrhosis due to viral hepatitis is still a big problem in developing countries.2. There were no significant differences in clinical and laboratory profile results between patients with liver cirrhosis caused by hepatitis B and C. AbstractIntroduction: Liver cirrhosis is a degenerative liver disease that ranks 14th as a global problem and has a high prevalence rate. This study aimed to determine the clinical and laboratory profile of inpatients with liver cirrhosis.Methods: Medical record data of liver cirrhosis patients at Dr. Soetomo General Academic Hospital, Surabaya, in 2018-2019, were used in this cross-sectional descriptive observational study. The results were analyzed statistically to determine the different profiles between patients with liver cirrhosis caused by hepatitis B and C.Results: 112 subjects in this study had liver cirrhosis caused by hepatitis B or C. The majority of cirrhotic patients were males over 40 years old. Melena was the most frequent complaint, and abdominal enlargement and hepatitis B virus (HBV) infection were the most common causes. Liver function tests in hepatitis B and C patients respectively showed albumin results of 2.73 g/dL (± 0.54); 2.75 g/dL (± 0.61), prothrombin time was 14.75 seconds (10.80-49.40); 14.9 seconds (11.1-19.1), direct bilirubin 1.17 mg/dL (0.9-17.05); 0.82 mg/dL (0.12-8.43), total bilirubin 2.18 mg/dL (0.28-24.9); 1.58 mg/dL (0.38-9.7), AST 50.5 U/L (16-826); 48.5 U/L (31-545), ALT 51.5 U/L (8-869); 38.5 (12-127). Subjects with hepatitis B and C had a median length of stay of 7.00 days, with an overall mean of 7.16 days. There was no significant difference in the results between patients with liver cirrhosis due to hepatitis B and C.Conclusion: There was no significant difference between patients with liver cirrhosis caused by hepatitis B and C.