Functional Assessment Research Articles

Rehabilitation Assessment and Intervention to Facilitate Return to Work in Coronary Artery Disease Patients: A Narrative Review

Introduction: Coronary artery disease (CAD), causes significant changes in a person's life and is often accompanied by complex emotional reactions which further cause a decrease in the ability to complete work responsibilities, lower wages, and increase the risk of early dismissal. Promoting a return to work (RTW) program after CAD will improve economic burdens and the quality of life. This review aimed to explore the RTW program in CAD patients focused on the impact of CAD on the patients’ ability to back to their previous work and rehabilitation management to fulfill RTW criteria. Methods: Articles published in the last 10 years based on PubMed and Google Scholar databases were reviewed narratively. Keywords used were “coronary artery disease”, “ischemic heart disease”, “cardiovascular disease”, “cardiac rehabilitation”, “return to work”, and “return to vocational activity”. Results: The impact of CAD on RTW includes a decrease in the ability to RTW and work performance as well as an increase in the risk of premature dismissal. Factors that influence the RTW ability in CAD patients are sociodemographic, psychosocial, cardiovascular risk, medical history, complications during hospitalization, and clinical characteristics. Efforts to facilitate this process involve a wide range of assessments and interventions. The RTW ability can be determined through objective assessment of cardiac function, including exercise capacity and left ventricular ejection fraction, the presence or absence of comorbidities, job satisfaction, and other assessments of general well-being. Interventions aimed at promoting RTW consist of an initial CR (phase II CR) and an extended CR program. Conclusion: The rehabilitation assessments and interventions given to patients with CAD have shown good results for RTW rates and the quality of work.

Apolipoprotein E epsilon4 allele is associated with better performance language and visual memory in spinocerebellar ataxia type 3.

The regulatory role of the apolipoprotein E (APOE) ε4 allele in the clinical manifestations of spinocerebellar ataxia type 3 (SCA3) remains unclear. This study aimed to evaluate the impact of the APOE ε4 allele on cognitive and motor functions in SCA3 patients. This study included 281 unrelated SCA3 patients and 182 controls. APOE genotypes were analyzed using PCR amplification combined with Sanger sequencing. Additionally, 96 SCA3 patients were prospectively recruited for neuropsychological and motor function assessments. Neuropsychological phenotypes were evaluated using the modified Chinese version of the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS). Motor function was assessed using the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). The frequency of the APOE ε4 allele was increased in SCA3 patients compared to the control group. The APOE ε4 allele was associated with better performance in language and visual memory, but also with more severe speech disturbances in SCA3 patients. Furthermore, in SCA3, the expanded CAG repeat length was correlated with poorer language memory performance and slower information processing speed, as well as more severe gait disturbances, fast alternating hand movements, speech disturbance, and oculomotor disorders. The APOE ε4 allele may serve as a disease-modifying factor in SCA3, influencing both cognitive and motor functions.

Overall Survival and the Impact of Albumin-bilirubin Grade in Patients with Advanced Hepatocellular Carcinoma: Data from a Tertiary Care Hospital in a Lower-middle-income Country.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Most patients are diagnosed at an advanced stage, limiting their treatment options. The traditional assessment of liver function using the Child-Pugh score has limitations due to its subjectivity. The albumin-bilirubin (ALBI) grade delivers a more precise evaluation of liver function. This study examines overall survival (OS) in advanced HCC patients treated with first-line systemic therapy and the impact of ALBI grading on these outcomes. A total of 104 patients with advanced HCC treated between January 2017 and December 2023 with one of the three first-line therapy options: Sorafenib, lenvatinib or atezolizumab/bevacizumab were retrospectively analyzed. The Kaplan-Meier method was utilized to examine the survival results, and the log-rank test was employed to evaluate the variations in survival among ALBI grades and therapy types. Cox proportional hazards regression examined the impact of ALBI grading and other covariates on OS, with a significance threshold of p < 0.05 for the multivariable model. The median age of HCC patients was 58.5 years, with 70% males, and a primary etiology of hepatitis C (43%). The median OS and time to progression (TTP) in this cohort were 9 months and 3.25 months. In ALBI grade I patients, the OS was 21 months, while in grade II or III patients, it was just 5 months. Treatment-related side effects necessitated dose reductions in over 84% of patients. Albumin-bilirubin grade, Child-Pugh class, and treatment modifications due to adverse effects were significant predictors of survival. Lenvatinib appears to have better survival outcomes compared to other options. The albumin-bilirubin grading is a useful method for evaluating liver function and forecasting survival rates for individuals with HCC. Our findings support the use of ALBI grading in clinical decision-making for advanced HCC. Naviwala MSS, Tariq M, Ahmed F, et al. Overall Survival and the Impact of Albumin-bilirubin Grade in Patients with Advanced Hepatocellular Carcinoma: Data from a Tertiary Care Hospital in a Lower-middle-income Country. Euroasian J Hepato-Gastroenterol 2024;14(2):251-257.

A Study on Functional and Radiological Assessment of Distal End Radius Fractures Treated with Percutaneous Pinning

A Study on Functional and Radiological Assessment of Distal End Radius Fractures Treated with Percutaneous Pinning

Dutch Validation of the Self-Evaluation of Negative Symptoms Scale (SNS)

Background/objectives: Negative symptoms in schizophrenia spectrum disorders are related to impaired social functioning and lower quality of life, making accurate assessment important. To date, most tools for assessing negative symptoms are observational, which can be influenced by the raters’ experience and opinion. Self-rating scales, like the Self-Evaluation of Negative Symptoms (SNS), could complement observer ratings by adding information from the patient’s perspective. Here, we aim to evaluate the psychometric properties of the Dutch translation of the SNS and the relationship between the SNS and functional outcomes. Methods: The SNS was added to the Pharmacotherapy Monitoring Outcome Survey (PHAMOUS)-protocol for adults with a DSM-5 classification of a disorder in the psychosis spectrum. Internal consistency was assessed by Cronbach’s alpha. Confirmatory factor analysis (CFA) was used to evaluate the construct validity of the five subscales of the SNS. Correlational analyses were performed between the SNS and the Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), the Global Assessment of Functioning (GAF), Functional Remission tool (FR) and the Manchester Short Assessment of Quality of Life (ManSA). Results: A total of 247 patients participated in this study. Internal consistency was good (α = 0.87). CFA confirmed the five-factor structure of the SNS. The SNS was significantly correlated (all p &lt; 0.001) with the PANSS positive (r = 0.31), PANSS negative (r = 0.33), HoNOS (r = 0.37), FR (r = 0.27) and the ManSA (r = −0.40). Conclusions: The Dutch SNS shows good psychometric properties and is related to functional outcomes and quality of life. The SNS can be valuable in complementing current observational-based instruments, and future research may investigate whether the SNS can be used as a standalone measurement tool for the assessment of negative symptoms.

Psychometric evaluation and derivation of the Kannada version of the modified (29-item model) Indian Vision Function Assessment Questionnaire.

India's linguistic and cultural diversity necessitates a region-specific validated Visual Functioning Questionnaire. The objective of this study was to translate the Indian Vision Function Questionnaire-33 (IND-VFQ-33) into the Kannada language and test its psychometric properties, underlying factor structure, and model fit. A cross-sectional study was conducted among 330 participants, and basic psychometric properties (reliability, convergent, discriminant, construct validity, responsiveness, etc.) were assessed. The underlying factor structure was evaluated by exploratory factor analysis (EFA) and model fit by confirmatory factor analysis (CFA). The Kannada version of IND-VFQ-33 exhibited robust psychometric properties [excellent content validity, reliability (Cronbach α = 0.91), test-retest reliability (RhoS = 0.99; P < 0.001), convergent (RhoS = 0.58; P < 0.001), and discriminant validity (RhoS = 0.06; P = 0.274)]. On EFA, items in the general functioning subscale fell into two categories, namely "Mobility" (10 items: Q1, Q2, Q4-Q9, Q15, and Q16) and "Daily Activities" (8 items: Q3, Q10, Q11, and Q17-Q21), and two other subscales "psycho-social impact" subscale (Q22-Q26) and the "visual symptoms" subscale (Q27-Q32, excluding Q33). Thus, a new Kannada-translated VFQ-29 questionnaire was derived with excellent psychometric properties. All observed variables showed significant factor loadings on their respective latent constructs (>0.50), establishing convergent validity on CFA by using the structural equation model. The model-fit to the data assessed by various indices [Root Mean Squared Error of Approximation = 0.08 (90% CI: 0.081-0.091); Comparative Fit Index = 0.877; Tucker-Lewis Index = 0.866; Akaike's Information Criterion = 23447.133; Bayesian Information Criterion = 23800.45, and Coefficient of Determination = 0.998] demonstrated acceptable fit. The refined 29-item Kannada-translated IND-VFQ model not only offers an improved factor structure across four subscales but also consistently demonstrates excellent reliability, convergent and discriminant validity, and responsiveness.

Lost and found: dynamics of relationship and employment status over time in people with affective and psychotic spectrum disorders.

Employment and relationship are crucial for social integration. However, individuals with major psychiatric disorders often face challenges in these domains. We investigated employment and relationship status changes among patients across the affective and psychotic spectrum - in comparison with healthy controls, examining whether diagnostic groups or functional levels influence these transitions. The sample from the longitudinal multicentric PsyCourse Study comprised 1260 patients with affective and psychotic spectrum disorders and 441 controls (mean age ± s.d., 39.91 ± 12.65 years; 48.9% female). Multistate models (Markov) were used to analyse transitions in employment and relationship status, focusing on transition intensities. Analyses contained multiple multistate models adjusted for age, gender, job or partner, diagnostic group and Global Assessment of Functioning (GAF) in different combinations to analyse the impact of the covariates on the hazard ratio of changing employment or relationship status. The clinical group had a higher hazard ratio of losing partner (hazard ratio 1.46, P < 0.001) and job (hazard ratio 4.18, P < 0.001) than the control group (corrected for age/gender). Compared with controls, clinical groups had a higher hazard of losing partner (affective group, hazard ratio 2.69, P = 0.003; psychotic group, hazard ratio 3.06, P = 0.001) and job (affective group, hazard ratio 3.43, P < 0.001; psychotic group, hazard ratio 4.11, P < 0.001). Adjusting for GAF, the hazard ratio of losing partner and job decreased in both clinical groups compared with controls. Patients face an increased hazard of job loss and relationship dissolution compared with healthy controls, and this is partially conditioned by the diagnosis and functional level. These findings underscore a high demand for destigmatisation and support for individuals in managing their functional limitations.

The functional heterogeneity of non-suicidal self-injury: insights from latent profile analysis

BackgroundThe functional aspects of non-suicidal self-injury (NSSI) among adolescents represent a complex phenomenon requiring deeper understanding. While research has identified various NSSI functions, including emotional regulation, attention-seeking, and social avoidance, the field lacks comprehensive analysis of how these functions cluster into distinct profiles. Understanding these functional profiles is crucial for developing targeted interventions.MethodA cross-sectional study of 1,783 adolescents (1,464 girls, 318 boys) aged 12–18 years was conducted across 14 psychiatric or general hospitals in nine Chinese provinces. Participants completed the Functional Assessment of Self-Mutilation (FASM), which assesses 22 distinct NSSI functions across three primary dimensions: emotional regulation, attention-seeking, and social avoidance. Additional measures included the Patient Health Questionnaire (PHQ-9) for depression and Generalized Anxiety Disorder Scale (GAD-7) for anxiety symptoms. Latent profile analysis was employed to identify distinct patterns in NSSI functions, with model selection based on fit indices including AIC, BIC, entropy, and LMRT.ResultsLatent profile analysis revealed four distinct functional profiles: low attention-seeking-high social avoidance (LA-HS, 19.7%), high attention-seeking-high social avoidance (HA-HS, 9.5%), low attention-seeking and social avoidance (LA-LS, 57.8%), and high attention-seeking-low social avoidance (HA-LS, 13.0%). The HA-HS profile demonstrated the most severe clinical presentation, showing significantly elevated scores in NSSI frequency (M = 26.160, SD = 9.771), anxiety (GAD-7: M = 16.265, SD = 4.951), and depression (PHQ-9: M = 20.612, SD = 6.003). The LA-HS profile showed the second-highest severity (NSSI: M = 25.800, SD = 10.058; GAD-7: M = 14.775, SD = 5.376; PHQ-9: M = 19.966, SD = 5.938). Both profiles also demonstrated significantly higher rates of suicidal ideation (HA-HS: 77.6%; LA-HS: 79.2%) compared to other profiles.ConclusionsOur findings reveal distinct patterns in how adolescents utilize NSSI functionally, particularly regarding attention-seeking and social avoidance dimensions. These functional profiles show meaningful associations with psychological outcomes, suggesting that understanding NSSI functions, rather than just behaviors, may be crucial for assessment and intervention. The identification of these distinct functional profiles among Chinese adolescents highlights the importance of function-specific approaches in clinical assessment and treatment planning.

Fibula flap reconstruction for maxillary stage 3 medication-related osteonecrosis of the jaw from recipient and donor site perspectives: a preliminary single-center study

BackgroundWhile the surgical treatment of mandibular stage 3 medication-related osteonecrosis of the jaw (MRONJ) is well-documented, research on maxillary stage 3 MRONJ is limited. Antiresorptive medications can induce MRONJ and atypical femoral fracture (AFF), but their impact on the feasibility of using fibula flaps for reconstruction remains controversial. This study aimed to assess the surgical outcomes and functional recovery of fibula flap reconstruction for maxillary stage 3 MRONJ, considering both recipient and donor site outcomes.MethodsThis retrospective study included patients with maxillary stage 3 MRONJ who underwent fibula flap reconstruction. Demographic and clinical features, postoperative complications, long-term outcomes and functional recovery of both recipient and donor sites were analyzed. Long-term outcomes included the survival of fibula flaps, the incidence of fibula graft or tibia fractures, recurrence of MRONJ, and patient survival status. Function assessments focused on speech, swallowing, and ankle joint.ResultsSeven patients (two with multiple myeloma, five with bone metastases) were included. Two patients experienced delayed healing at the donor site, both of whom recovered within two months postoperatively. All fibula flaps survived with primary healing. There were no recurrences of MRONJ or fractures of fibula graft or tibia. The mean speech function score was 28.00 ± 12.03, the mean swallowing function score was 2.86 ± 2.79, the mean pain score of donor site was 2.71 ± 2.29, and the mean ankle function score was 94.43 ± 4.35.ConclusionFibula flap reconstruction is feasible for maxillary stage 3 MRONJ, yielding satisfactory surgical outcomes and functional recovery.

Associations of Body Mass Index and Percent Body Fat with Osteoporosis, Sarcopenia, and Osteosarcopenia: A Retrospective Study Based on Postmenopausal Women in China.

Background/Objectives: Alterations in the body mass index (BMI) and percent body fat (PBF) have been considered to be related to aging-induced changes in bone and muscle. This study aimed to evaluate the associations of the BMI and PBF with osteoporosis, sarcopenia, and osteosarcopenia in postmenopausal women. Methods: A total of 342 participants who underwent musculoskeletal function assessments at the First Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2022 were retrospectively screened. The diagnosis of osteoporosis was based on the WHO criteria, and sarcopenia was diagnosed according to the 2019 consensus of the Asian Working Group for Sarcopenia. Results: The BMI was positively correlated with the musculoskeletal function assessment parameters (bone mineral density, relative skeletal muscle index, and grip strength) and identified as an independent protective factor for sarcopenia alone (OR = 0.592, 95% CI: 0.455-0.769) or osteosarcopenia (OR = 0.411, 95% CI: 0.319-0.529), with a moderate diagnostic accuracy (area under the curve [AUC] = 0.682) for the former and a high diagnostic accuracy (AUC = 0.823) for the latter. However, the PBF was negatively correlated with the relative skeletal muscle index and identified as a risk factor for osteosarcopenia (OR = 1.404, 95% CI: 1.007-1.959), with a moderate diagnostic accuracy (AUC = 0.613). Conclusions: A higher BMI and lower PBF were associated with a lower prevalence of osteosarcopenia in postmenopausal women. Further research is required to elucidate the independent effects of the BMI and PBF on bone health.

Time-restricted eating to address persistent cancer-related fatigue among cancer survivors: A randomized controlled trial.

Time-restricted eating (TRE) helps regulate rest-activity rhythms, blood glucose, and other diurnally regulated energetics processes, which may have implications for persistent fatigue. In a randomized controlled trial, we tested the effects of TRE vs. control on fatigue in cancer survivorship. Adult cancer survivors were recruited who were 2 months to 2 years post-treatment and reported moderate to severe fatigue. Participants were randomized 1:1, TRE:control and all received individualized nutrition counseling. The TRE group self-selected a 10-hour eating window for 12 weeks. At baseline, week 6, and week 12, participants were asked to log eating instances, complete the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire (FACIT-F, higher score=less fatigue), and wear an actigraph and continuous glucose monitor. Thirty participants completed baseline assessments and were randomized (77% female, 53% Black/African American, 43% White, 7% Hispanic; 54.1±14.7 years old; 87% with blood cancer); 25 completed 12-week assessments. TRE led to a meaningful reduction in fatigue at week 12 controlling for baseline levels (change in FACIT-F fatigue subscale=0.0±5.4 for control, 4.1±5.7 for TRE, p=0.11, effect size [ES]=0.70; clinically meaningful threshold=3.0 points). Glucose parameters (e.g., average interstitial glucose, average fasting glucose) tended to be lower and rest-activity rhythms tended to indicate more regularity for those in the TRE vs. control group at weeks 6 and 12, though differences were not statistically significant (p>0.19). A 12-week, nutritionist-led TRE program led to less fatigue than control. Continued study of TRE patterns are warranted to optimize this eating pattern and address persistent cancer-related fatigue.

MScope: A Reliable Battery for Functional Status Assessment in Multiple Sclerosis

Multiple sclerosis (MS) is a neurodegenerative disease that often leads to severe disability. Although exercise, particularly strength training, improves health outcomes in MS, no standardized, reliable tool exists for functional assessment to inform tailored exercise prescriptions and patients’ categorization. This study aimed to validate the reliability of the MScope battery, a comprehensive tool incorporating structural, functional, and neuromuscular assessments to objectively evaluate patients with MS. A reproducibility study was conducted with 40 MS patients who completed the MScope battery twice, 72 h apart. Tests included structural (muscle thickness of the vastus lateralis and rectus femoris), functional (sit-to-stand, timed up-and-go, 10 m and six-minute walking test), and neuromuscular tests (isometric strength during the squat and leg extension exercises and handgrip strength). Intraclass correlation coefficients (ICCs), Bland–Altman plots, and the coefficient of variation (CV) were used to evaluate intra- and inter-day reliability. The MScope battery showed high intra- and inter-day reliability, with ICC values ranging from 0.79 to 0.99. Muscle thickness measurements, along with handgrip strength, demonstrated excellent reliability (ICC &gt; 0.9, CV &lt; 5%). Functional tests, including the timed up-and-go, 10 m walk, and sit-to-stand variations, maintained consistent scores (ICC &gt; 0.85, CV &lt; 10%). The six-minute walking test exhibited excellent inter-day reliability (ICC = 0.94, CV &lt; 4%). Neuromuscular assessments showed strong reliability with minor day-to-day variability (ICC = 0.75–0.95, CV &lt; 8%). The battery’s overall consistency supports its use as a reliable tool for assessing functional status in MS patients.

Brain aging rejuvenation factors in adults with genetic and sporadic neurodegenerative disease

Abstract The largest risk factor for dementia is age. Heterochronic blood exchange studies have uncovered age-related blood factors that demonstrate ‘pro-aging’ or ‘pro-youthful’ effects on the mouse brain. The clinical relevance and combined effects of these factors for humans is unclear. We examined five previously identified brain rejuvenation factors in cerebrospinal fluid of adults with autosomal dominant forms of frontotemporal dementia and sporadic Alzheimer’s disease. Our frontotemporal dementia cohort included 100 observationally followed adults carrying autosomal dominant frontotemporal dementia mutations (Mage = 49.6; 50% female; 43% C9orf72, 24% GRN, 33% MAPT) and 62 non-carriers (Mage = 52.6; 45% female) with cerebrospinal fluid analysed on Somascan, and longitudinal (Mvisits = 3 years, range 1–7 years) neuropsychological and functional assessments and plasma neurofilament light chain. Our Alzheimer’s disease cohort included 35 adults with sporadic Alzheimer’s disease (Mage = 69.4; 60% female) and 56 controls (Mage = 68.8, 50% female) who completed the same cerebrospinal fluid and clinical outcome measures cross-sectionally. Levels of C-C motif chemokine ligand 11, C-C motif chemokine ligand 2, beta-2-micorglobulin, bone gamma-carboxyglutamate protein (aka Osteocalcin) and colony stimulating factor 2 in cerebrospinal fluid were linearly combined into a composite score, with higher values reflecting ‘pro-youthful’ levels. In genetic frontotemporal dementia, higher baseline cerebrospinal fluid rejuvenation proteins predicted slower decline across cognitive, functional, and neurofilament light chain trajectories; estimates were similar across genotypes. In transdiagnostic analyses, higher cerebrospinal fluid rejuvenation proteins associated with better functional, cognitive, and neurofilament light chain outcomes in adults with sporadic Alzheimer’s disease. Proteins with pre-clinical evidence for brain rejuvenation show translational clinical relevance in adults with Alzheimer’s disease and related dementias and warrant further investigation.

Factors Associated With Depression in Caregivers of Adults With Down Syndrome.

Family caregivers of those with developmental disabilities have higher rates of depression and anxiety compared with caregivers of those without development disability. Few studies have examined factors that contribute to caregiver depression, including the appraisal of caregiving responsibilities and the physical fitness and daily function of the care recipient. The purpose of this study was to identify intrapersonal (caregiver) and interpersonal (care recipient) factors associated with depressive symptoms in caregivers of adults with Down syndrome (DS). Twenty-four adults with DS participating in a 12-month physical activity trial completed physical fitness and function tests (VO2peak, hand grip strength, timed up and go, five times sit to stand) and activities of daily living (ADL) surveys at their baseline visit. Caregivers (n = 24) of the adults with DS completed surveys on caregiving distress, quality of life (QoL) and depressive symptoms. We evaluated the associations of these assessments on caregiver depressive symptoms using Mann-Whitney U tests and Spearman correlations. Adults with DS were 23 ± 7.5 years, 58% female; caregivers were 54 ± 10 years, 100% female, 96% family members. Caregiver depressive symptoms were significantly associated with caregiving distress (p = 0.024) and caregiving QoL (r = -0.58, p = 0.003). Hand grip strength of care recipients was inversely correlated with caregiver depressive symptoms (r = -0.45, p = 0.03), but other assessments of physical function and ADL were not associated with caregiver depressive symptoms. Caregiver depressive symptoms were related to modifiable factors related to the caregiver and care recipient. Intervening to improve caregiving appraisal and functional strength of the care recipient may positively impact caregiver mental health.

Systematic Evaluation of IMU Sensors for Application in Smart Glove System for Remote Monitoring of Hand Differences.

Human hands have over 20 degrees of freedom, enabled by a complex system of bones, muscles, and joints. Hand differences can significantly impair dexterity and independence in daily activities. Accurate assessment of hand function, particularly digit movement, is vital for effective intervention and rehabilitation. However, current clinical methods rely on subjective observations and limited tests. Smart gloves with inertial measurement unit (IMU) sensors have emerged as tools for capturing digit movements, yet their sensor accuracy remains underexplored. This study developed and validated an IMU-based smart glove system for measuring finger joint movements in individuals with hand differences. The glove measured 3D digit rotations and was evaluated against an industrial robotic arm. Tests included rotations around three axes at 1°, 10°, and 90°, simulating extension/flexion, supination/pronation, and abduction/adduction. The IMU sensors demonstrated high accuracy and reliability, with minimal systematic bias and strong positive correlations (p > 0.95 across all tests). Agreement matrices revealed high agreement (<1°) in 24 trials, moderate (1-10°) in 12 trials, and low (>10°) in only 4 trials. The Root Mean Square Error (RMSE) ranged from 1.357 to 5.262 for the 90° tests, 0.094 to 0.538 for the 10° tests, and 0.129 to 0.36 for the 1° tests. Likewise, mean absolute error (MAE) ranged from 0.967 to 4.679 for the 90° tests, 0.073 to 0.386 for the 10° tests, and 0.102 to 0.309 for the 1° tests. The sensor provided precise measurements of digit angles across 0-90° in multiple directions, enabling reliable clinical assessment, remote monitoring, and improved diagnosis, treatment, and rehabilitation for individuals with hand differences.

Validity and reliability of Glittre activities of daily living test in lower-limb prosthetic users.

Functional capacity assessments have an important role in determining the level of mobility in lower-limb prosthetic users. Our aim was to investigate the reliability and validity of the Glittre activities of daily living (ADL) test in lower-limb prosthetic users. A cross-sectional study. The study included 66 people over the age of 18 years who had used a lower-limb prosthesis for at least 6 months and could walk at least 30 m independently. For construct validity, the correlation of the Glittre ADL test with the 2-min walk test, timed up and go test, and functional reach test was examined, and Bland-Altman agreement analysis was performed. Intra-rater reliability was examined with 2 tests performed by the same physiotherapist on different days, and inter-rater reliability was examined with a test performed by a second physiotherapist on a different day. The reliability of the Glittre ADL test was found to be excellent for intra-rater (intraclass correlation coefficient = 0.940, 95% confidence interval = 0.903-0.963, standard error of measurement = 26.03, minimal detectable change = 72.31) and good for inter-rater (intraclass correlation coefficient = 0.890, 95% confidence interval = 0.806-0.936, standard error of measurement = 36.80, minimal detectable change = 102.06, p < 0.001). There was a strong negative correlation between Glittre ADL test and 2-min walk test (r = -0.785), a strong positive correlation with timed up and go (r = 0.805), and a weak negative correlation with functional reach test (r = -0.266, p < 0.05). Bland-Altman plots showed 95% agreement for both validity and reliability measurements. The Glittre ADL test is a valid and reliable test that can be used in the assessment of functional capacity in lower extremity prosthesis users.

Pericytes and Extracellular Vesicle Interactions in Neurovascular Adaptation to Chronic Arterial Hypertension.

Chronic arterial hypertension restructures the vascular architecture of the brain, leading to a series of pathological responses that culminate in cerebral small-vessel disease. Pericytes respond dynamically to vascular challenges; however, how they manifest under the continuous strain of hypertension has not been elucidated. In this study, we characterized pericyte behavior alongside hypertensive states in the spontaneously hypertensive stroke-prone rat model, focusing on their phenotypic and metabolic transformation. Flow cytometry was used to characterize pericytes by their expression of platelet-derived growth factor receptor β, neuroglial antigen 2, cluster of differentiation 13-alanyl aminopeptidase, and antigen Kiel 67. Microvessels were isolated for gene expression profiling and invitro pericyte expansion. Immunofluorescence validated the cell culture model. Plasma-derived extracellular vesicles from hypertensive rodents were applied as a treatment to assess their effects on pericyte function and detailed metabolic assessments on enriched pericytes measured oxidative phosphorylation and glycolysis. Our results reveal a shift in platelet-derived growth factor receptor β+ pericytes toward increased neuroglial antigen 2 and cluster of differentiation 13-alanyl aminopeptidase coexpression, indicative of their critical role in vascular stabilization and inflammatory responses within the hypertensive milieu. Significant alterations were found within key pathways including angiogenesis, blood-brain barrier integrity, hypoxia, and inflammation. Circulating extracellular vesicles from hypertensive rodents distinctly influenced pericyte mitochondrial function, evidencing their dual role as carriers of disease pathology and potential therapeutic agents. Furthermore, a shift toward glycolytic metabolism in hypertensive pericytes was confirmed, coupled with ATP production dysregulation. Our findings demonstrate that cerebral pericytes undergo phenotypic and metabolic reprogramming in response to hypertension, with hypertensive-derived plasma-derived extracellular vesicles impairing their mitochondrial function. Importantly, plasma-derived extracellular vesicles from normotensive controls restore this function, suggesting their potential as both therapeutic agents and precision biomarkers for hypertensive vascular complications. Further investigation into plasma-derived extracellular vesicle cargo is essential to further explore their therapeutic potential in vascular health.

A prospective observational comparative study of effectiveness and adverse effects of amitriptyline versus duloxetine in the treatment of somatoform pain disorders in a tertiary care hospital

Background: To compare the effectiveness and adverse effects as well as treatment compliance of amitriptyline and duloxetine in treating somatoform pain disorder. Methods: This study was done on 100 patients, with 50 in each group, at Mandya Institute of Medical Sciences (MIMS) over 6 months. Group A was treated with amitriptyline 75 mg per day, and Group B with duloxetine 40 mg per day. Patient Health Questionnaire (PHQ-15) as well as Social and Occupational Functional Assessment Score (SOFAS) were used to compare effectiveness of treatment. For medication adherence Medication Adherence Rating Scale (MARS) was used. Adverse effects were also monitored. The baseline measurements were taken, and evaluations were conducted at 4th, 8th, and 12th weeks of follow-up. Results: There were 31% males and 69% females. At baseline and after 12 weeks, Group A had average PHQ-15 scores of 14.72±6.13 and 3.16±0.97, respectively, while group B had scores of 17.12±5.45 and 7.22±2.46. During the same period SOFAS scores were 48.70±6.27 and 85.9±5.06 for group A, and 50.86±5.99 and 82.62±6.10 for group B. The effectiveness of Amitriptyline group showed statistically significant difference (p&lt;0.05) when compared with Duloxetine. Group A experienced more adverse effects like dry mouth, drowsiness when compared to Group B. Conclusions: Amitriptyline and duloxetine are effective in treatment of somatoform pain disorder; the effectiveness of amitriptyline was higher when compared to duloxetine in our study.

Diagnostic Accuracy of Computational Fluid Dynamics-Based Fractional Flow Reserve Derived From Coronary Angiography: The ACCURATE Study.

Although fractional flow reserve (FFR) is the contemporary standard to detect hemodynamically significant coronary stenosis, it remains underused for the need of pressure wire and hyperemic stimulus. Coronary angiography-derived FFR could break through these barriers. The aim of this study was to assess the feasibility and performance of a novel diagnostic modality deriving FFR from invasive coronary angiography (AccuFFRangio) for coronary physiological assessment. The ACCURATE (Angiography-Derived Fractional Flow Reserve for Functional Evaluation of Coronary Artery Disease) study was a prospective, multicenter study conducted at 5 centers. Patients who had at least 1 lesion with a diameter stenosis of 30% to 90% were eligible. AccuFFRangio was measured on site in real time and compared with invasive FFR measurements in a blinded fashion. Primary end point was the diagnostic accuracy of AccuFFRangio in identifying functional relevant lesions. Between November 2020 and June 2021, pairwise analyses of AccuFFRangio and FFR were performed in 304 coronary arteries. AccuFFRangio showed good correlation (r=0.89; P<0.001) and agreement (mean difference: 0.01±0.06) with FFR. The diagnostic accuracy was 95.07% (95% CI, 91.99%-97.21%), which were significantly exceeded the prespecified target value (P<0.001). The sensitivity, specificity, and area under the receiver operating characteristic curve of 95.83% (95% CI, 89.67%-98.85%), 94.71% (95% CI, 90.73%-97.33%), and 0.972 (95% CI, 0.947-0.988), respectively. AccuFFRangio derived from coronary angiography alone has high diagnostic accuracy, sensitivity, and specificity compared with FFR. AccuFFRangio bears the potential for increasing the adoption of functional assessment of coronary artery stenosis and improving the use of physiological guided decision-making. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04814550.

5-years outcomes following arthroscopic anterior cruciate ligament reconstruction comparing quadruple hamstring and peroneus longus tendon autografts: a randomized control trial.

This study presents clinical outcomes, functional results, and return to sports after anterior cruciate ligament (ACL) reconstruction using quadruple hamstring tendon autograft or peroneus longus tendon autograft in a randomized controlled trial. Between February 2018 and July 2019, patients who underwent ACL reconstruction were randomly assigned to two groups: hamstring and peroneus longus. Patient related outcome measurements and pain intensity were evaluated using IKDC, Lysholm, and visual analog scores at 3 and 6months, 1, 2, and 5years after the surgery. At the 5year follow-up, anterior stability was tested using the 3D printable Knee Arthrometer. In addition, in the peroneus longus group, ankle functional assessment was performed using the American foot and ankle score. Additionally, data on the return to sports/activities was collected for both groups at the last follow-up. Sixty patients, with 30 in the hamstring group and 30 in the peroneus group, were included in the study. Patients were predominately male and with low activity demands. After five years of follow-up, there was no significant difference in functional assessment scores (IKDC and Lysholm) between the two groups (P n.s). The median graft diameter was 7.9 ± 0.4mm in the hamstring tendon group and 8.9 ± 0.2mm in the PL group (P < 0.001). The improvement in Arthrometer testing measurements (AMT) for the operated knees in the hamstring and peroneus longus groups were similar. In the peroneus longus group, the mean postoperative foot and ankle score was 98.6 ± 3.9 (range = 85-100). Using Peroneus longus tendon autograft for arthroscopic ACL reconstruction is a feasible alternative as studied in this cohort of predominately male patients with low activity demands. The graft diameter in this study was sufficient, and the results regarding laxity and patient related outcome measurements were similar to those achieved with hamstring tendon autografts. Level I TRIAL REGISTRATION: ChiCTR2000036989.