Functional Performance Research Articles

Cognition and Functional Capacity: An Initial Comparison of Veteran and Non-Veteran Older Adults.

The U.S. Military Veterans aged 65 and older comprise an estimated 43% of the 22 million living Veterans in the United States. Veterans have high rates of physical, psychiatric, and social challenges, but it is not known whether Veteran status confers additional risk for cognitive or functional impairments in later life. Thus, this investigation specifically compared older Veterans with their non-Veteran peers in cognitive functioning and performance-based functional capacity. Participants (N = 110; 29 Veterans and 81 non-Veterans) were part of a larger longitudinal study on biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. The University of California San Diego Institutional Review Board approved the study and all participants provided written informed consent. Participants provided demographic and mental health information and were administered a comprehensive neuropsychological battery. Functional capacity was assessed using the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), which uses financial and communication role-plays to assess everyday functioning skills. Neuropsychological scores were appropriately normed prior to analysis. Multivariate Analyses of Variances with post hoc t-tests and an Analysis of Covariance were used to examine neuropsychological and functional capacity differences, respectively, between Veterans and non-Veterans. Veterans did not differ from non-Veterans in educational attainment (16.4 years versus 15.5 years, P = 0.110), but they were significantly older (mean age 86.9 years ± 5.7, versus 81.74 years ± 6.53; P < 0.001) and were more likely to be male (X2 [1, N = 110] = 62.39, P < 0.001). Thus, though neuropsychological norms already accounted for demographic differences in our participants, age and sex were controlled in the Analysis of Covariance predicting UPSA-B score from Veteran status. Results suggested that, compared to non-Veterans, Veterans had significantly worse performance in the list learning portion of a test of verbal memory (Hopkins Verbal Learning Test-Revised, Total Recall; t = 2.56, P = 0.012, d = 0.56). Veterans and non-Veterans did not significantly differ in performance on the delayed recall portion of the verbal learning test and did not differ on a cognitive screening test (Montreal Cognitive Assessment) or on measures of premorbid intellectual functioning (Wide Range Achievement Test-4 Reading), language (Boston Naming Test, Verbal Fluency), visual memory (Brief Visuospatial Memory Test-Revised), attention/working memory (WAIS-IV Digit Span), processing speed (WAIS-IV Digit Symbol Coding), executive function (Delis-Kaplan Executive Function System Trails and Color-Word Test), or functional capacity (UPSA-B). Because our examination of multiple outcomes might have inflated Type I error, we performed a post hoc adjustment of P values using Benjamini-Hochberg procedures and the group difference in verbal learning remained significant. Despite largely similar function in most domains, Veterans performed significantly more poorly in verbal list learning than their non-Veteran peers. Additional attention should be given to the understanding, assessment, and possible treatment of learning and memory differences in older Veterans, as this may be an area in which Veteran status confers additional risk or vulnerability to decline. This is the first study to compare objective neuropsychological and functional performance between older (age 65+) US Veterans and non-Veterans.

Recent advances, challenges and functional applications of protein glycosylation modification in food industry

SummaryProtein glycosylation modification is an effective way to enhance the functional properties of natural proteins. This study aims to explore the preparation of glycosylation products (PPCs) through the Maillard reaction or enzymatic glycosylation using transglutaminase. The study discusses the advantages and disadvantages of preparing PPCs using dry heat, wet heat, and enzymatic glycosylation, as well as factors influencing the glycosylation process. Compared to natural proteins, PPCs demonstrate superior functional properties, including solubility, viscosity, emulsifying ability, gelling ability, thermal stability, antioxidant activity, and antibacterial activity. With improved functional performance, PPCs have broad application prospects as raw materials in food processing. For example, PPCs can be used as antioxidants, emulsifiers, gelling agents, and carriers for various bioactive molecules in the food industry. In the pharmaceutical field, PPCs are expected to serve as contrast agents and dressings. Furthermore, the application of PPCs in food processing should also consider specific processing requirements to achieve the intended enhancement of glycosylated protein functionality.

DESIGN AND DEVELOPMENT OF CAMPUS ROOM USE MONITORING APPLICATION BASED ON ANDORID WITH MAGNETIC DOOR LOCK IN THE DEPARTMENT OF INFORMATICS AND COMPUTER ENGINEERING UNM

The condition of campus room doors that are often open has the potential for misuse of campus rooms that do not comply with the schedule set in the room and affect the security of the room facilities. This research aims to produce an Android-based campus room usage monitoring application using magnetic door locks at JTIK FT UNM as well as knowing the results of functional testing and performance testing or system performance. This research uses the Research and Development method with the Rapid Application Development Development model with stages: needs analysis, system design, system building, validation, testing, and final product. The final product of this research is a system developed in an Android-based room usage monitoring application that is integrated with a magnetic door lock using the QR Code feature. In this case, the system utilizes the ESP32 microcontroller as a chip that receives and provides signals according to the program in the system. The test results obtained validation of the Android-based campus room usage monitoring application using magnetic door locks can be said to be valid and suitable for use.

Acute effects of kinesiology taping on physical parameters and functional performance in handball players: a double-blinded, randomised placebo-controlled trial

Acute effects of kinesiology taping on physical parameters and functional performance in handball players: a double-blinded, randomised placebo-controlled trial

Recognition of multi-component compounds based on occurrence time of secondary crest in the fluorescence lifetime attenuation curve

Fluorescence lifetime is the main characteristic parameter of fluorescence. It is a widely used to draw fluorescence lifetime attenuation curves and to fit fluorescence lifetime parameters by using gated detection methods to identify the species of substances. However, the fluorescence attenuation of each fluorophore in a multi-component compound interferes with one another, affecting the accuracy of identification. In this paper, we propose a method to accurately identify substances by using the occurrence time of the secondary crest of the fluorescence lifetime attenuation curve based on the principle of gated detection to measure the fluorescence lifetime. Furthermore, we design a fluorescence lifetime imaging measurement system and select the same areas of interest in the images for analysis and comparison. The average lifetime of the fluorescence and the occurrence time of the secondary crest are considered as the characteristic parameters. We use five commercially available motor engine oils as the experimental samples and compare the recognition performance of different kernel functions based on a support vector machine (SVM). The radial basis kernel function presents the best performance in terms of recognition accuracy and speed. The recognition rates of the SVM model with the average fluorescence lifetime and the occurrence time of the secondary crest in the attenuation curve of the fluorescence lifetime as a feature vector are 76.24% and 74.65%, respectively. The recognition rate of the SVM model which combines them as feature vectors reaches 91.88%. The experimental results demonstrate that the occurrence time of the secondary crest in the attenuation curve of the fluorescence lifetime can be employed as the basis for substance identification in the analysis of the fluorescence characteristics of multi-component compounds, whose recognition accuracy is similar to the average fluorescence lifetime parameter. Moreover, the occurrence time of the secondary crest of the fluorescence lifetime attenuation curve can be implemented to identify multi-component compounds when it is used as a characteristic parameter.

Physical function as a marker to assess the effects of occupational long-term pesticide exposure.

In this cross-sectional study, we determined the relative impact of long-term occupational exposure to pesticides on physical performance and perception of tiredness. Experimental data was collected in locus from agricultural communities and included surveys to assess the duration of exposure to pesticides, social status, habitual physical activity levels, presence of common mental disorders (CMD), and self-reported tiredness. Plasmatic cholinesterase (PChE), body composition and traditional functional performance tests (Handgrip strength-HGS; Time up and go-TUG; and Sit-to-stand-STS) were obtained. From the 127 individuals tested, cluster analysis yielded 80 individuals divided in Direct Exposed (n = 37) and Indirect Exposed (n = 43); Tired (n = 16), and Not Tired (n = 64). PChE values were within the reference values (5209.64-13943.53 U/L). Pesticide exposure had no influence on PChE levels, CMD or fatigue (p > 0.05), while Self-reported tiredness had (p < 0.05). Principal Component Analyses showed that HGS; STS and TUG (i.e., physical performance variables) are negatively influenced by two independent factors: pesticide exposure and self-reported tiredness. We conclude that chronic pesticide exposure and tiredness can negatively impact physical performance, independently, without clinically significant changes in PChE levels that is a biomarker used to track pesticide intoxication. Functional physical tests can be a useful tool to identify chronic pesticide exposure, and help with the limitations of commonly used parameters (i.e. PChE and CMD). Self-reported tiredness is a confounding variable.

The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial.

Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001). According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.

Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease

BackgroundDegenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD.MethodsFourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment.ResultsAfter the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05).ConclusionThis is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.

Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial

BackgroundImprovement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling.PurposeThis study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients.MethodologyTwo equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained.ResultsBoth groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of &amp;lt;0.001.ConclusionSystematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.

Transient brain structure changes after high phenylalanine exposure in adults with phenylketonuria.

Phenylketonuria is a rare metabolic disease resulting from a deficiency of the enzyme phenylalanine hydroxylase. Recent cross-sectional evidence suggests that early-treated adults with phenylketonuria exhibit alterations in cortical grey matter compared to healthy peers. However, the effects of high phenylalanine exposure on brain structure in adulthood need to be further elucidated. In this double-blind, randomised, placebo-controlled crossover trial, we investigated the impact of a four-week high phenylalanine exposure on the brain structure and its relationship to cognitive performance and metabolic parameters in early-treated adults with phenylketonuria. Twenty-eight adult patients with early-treated classical phenylketonuria (19-48 years) underwent magnetic resonance imaging before and after the four-week phenylalanine and placebo interventions (four timepoints). Structural T1-weighted images were preprocessed and evaluated using DL+DiReCT, a deep-learning-based tool for brain morphometric analysis. Cortical thickness, white matter volume, and ventricular volume were compared between the phenylalanine and placebo periods. Brain phenylalanine levels were measured using 1H spectroscopy. Blood levels of phenylalanine, tyrosine, and tryptophan were assessed at each of the four timepoints, along with performance in executive functions and attention. Blood phenylalanine levels were significantly higher after the phenylalanine period (1441µmol/L) than after the placebo period (873µmol/L, P<0.001). Morphometric analyses revealed a statistically significant decrease in cortical thickness in 17 out of 60 brain regions after the phenylalanine period compared to placebo. The largest decreases were observed in the right pars orbitalis (point estimate=-0.095mm, P<0.001) and the left lingual gyrus (point estimate=-0.070mm, P<0.001). Bilateral white matter and ventricular volumes were significantly increased after the phenylalanine period. However, the structural alterations in the Phe-placebo group returned to baseline measures following the washout and placebo period. Additionally, elevated blood and brain phenylalanine levels were related to increased bilateral white matter volume (rs=0.43 to 0.51, P≤0.036) and decreased cortical thickness (rs=-0.62 to -0.39, not surviving FDR correction) after the phenylalanine and placebo periods. Moreover, decreased cortical thickness was correlated with worse cognitive performance after both periods (rs=-0.54 to -0.40, not surviving FDR correction). These findings provide evidence that a four-week high phenylalanine exposure in adults with phenylketonuria results in transient reductions of the cortical grey matter and increases in white matter volume. Further research is needed to determine the potential long-term impact of high phenylalanine levels on brain structure and function in adults with phenylketonuria.

Educational Attainment Moderates Task-state Control Network Connectivity Relations to Response Conflict Among Healthy Older Adults.

Older adult executive function varies widely due to brain and cognitive aging. Variance in older adult executive function is linked to increased response conflict from cognitive and brain aging. Cognitive Reserve (CR) is a theoretical protective mechanism that lessens brain aging's impact on cognition and is associated with greater educational attainment. Recent work in rest-state fMRI suggests CR proxies moderate the relationship between functional connectivity (FC) and cognitive performance. Brain network FC in "control networks", including the salience (SN), dorsal attention (DAN) and frontoparietal (FPN) networks, are associated with cognitive processes in older adults. CR is hypothesized to maintain cognitive processing in part through changes in how brain networks respond to cognitive demands. However, it is unclear how CR proxies like educational attainment are related to control network FC during performance when cognitive demands are increased relative to rest. Because CR is expressed more in those with higher education, we hypothesized stronger control network FC would relate to better performance, where this relationship would be strongest among the most educated. We collected flanker task data during fMRI to assess the impact of a CR-proxy (i.e., educational attainment) on response conflict among older adult subjects (n=42, age=65-80). Linear mixed effects models showed more educated older adults with greater SN-FC had a smaller flanker effect (i.e., less influence of distractors; p<.001) during task performance. For the first time, we show that educational attainment moderates the relationship between task-state SN-FC and executive function among older adults.

Using PLS-SEM to test the relationship model of corporate social performance across the product/service continuum: When do shared values matter?

Is it as simple as do good and keep customers? Does the principle operate similarly across the product-service continuum? To better understand the complex consumer relationship with corporate social performance (CSP), the moderation of shared values in an established trust mediating relationship model including both corporate functional performance (CFP) and CSP as antecedents was tested. PLS-SEM was used to explore how the model holds up along three points of the product service continuum: pure good (shoes), good with retail service (fast-food restaurants), and pure service (tax services). The one size fits all approach to relationship development and CSP strategy does not bear true. The shared values congruence effect is greater in the fast-food model, and the trust effect is greater in the shoe and tax service models.

Assessment of cerebral venous sinus: Anatomical and functional diagnostic performance of three-dimensional reconstruction models based on venous sinus MRI and CT images

Venous sinus stenosis is commonly observed in patients presenting with pulsatile tinnitus (PT). While magnetic resonance imaging (MRI) and computed tomography (CT) are commonly used for assessing venous sinus geometries, the preferred modality remains unclear. In this study, we reconstructed the three-dimensional (3D) geometries of the venous sinus using MRI and CT imaging data from 20 PT patients. We conducted comparisons of the anatomical features of the venous sinus through case-wise analysis and anatomic geometrical parameter-wise analysis. Our findings indicate that by taking the geometries from CT as a reference, MRI could provide a better illustration of venous structure, primarily due to a stronger flow signal concentrated in the vascular tree. We observed high agreements in anatomic parameters measured from 3D geometries reconstructed based on CT and MRI in 19 out of 20 cases. Notably, the cross-sectional area of the sinus and segment length displayed the highest consistency, with a mean difference of -5.01% and 6.5% between modalities, respectively. In addition, we noticed that 55% of cases exhibited consistency in analyzing the confluence of the sinus, while variants of connectivity and collateral branching were observed between CT and MRI. Importantly, CT-based geometric reconstruction provided better detail of inflow side branches in the straight sinus, whereas MRI preserved more side branches of outflow in the downstream sinus. It is important to note that CT-based evaluation may be affected by the bone structures surrounding the venous sinus, whereas MRI-based evaluation focuses on blood flow to the segments, potentially indicating both anatomical and functional abnormalities.

Investigating the effects of synbiotic supplementation on functional movement, strength and muscle health in older Australians: a study protocol for a double-blind, randomized, placebo-controlled trial

BackgroundAging has been associated with a progressive loss of skeletal muscle quality, quantity and strength, which may result in a condition known as sarcopenia, leading to a decline in physical performance, loss of independence and reduced quality of life. While the cause of impaired physical functioning observed in elderly populations appears to be multifactorial, recent evidence suggests that age-associated alterations in gut microbiota could be a contributing factor. The primary objective will be to assess the effects of a dietary synbiotic formulation on sarcopenia-related functional outcomes such as handgrip strength, gait speed and physical performance within older individuals living independently. The secondary objective will be to examine associations between changes in gut microbiota composition, functional performance and lean muscle mass.MethodsSeventy-four elderly (60–85 years) participants will be randomized in a double-blind, placebo-controlled fashion to either an intervention or control group. The intervention group (n = 37) will receive oral synbiotic formulation daily for 16 weeks. The control group (n = 37) will receive placebo. Assessments of physical performance (including Short Physical Performance Battery, handgrip strength and timed up-and-go tests) and muscle ultrasonography will be performed at 4 time points (baseline and weeks 8, 16 and 20). Likewise, body composition via bioelectric impedance analysis and blood and stool samples will be collected at each time point. Dual-energy X-ray absorptiometry will be performed at baseline and week 16. The primary outcomes will be between-group changes in physical performance from baseline to 16 weeks. Secondary outcomes include changes in body composition, muscle mass and architecture, fecal microbiota composition and diversity, and fecal and plasma metabolomics.DiscussionGut-modulating supplements appear to be effective in modifying gut microbiota composition in healthy older adults. However, it is unclear whether these changes translate into functional and/or health improvements. In the present study, we will investigate the effects of a synbiotic formulation on measures of physical performance, strength and muscle health in healthy older populations.Trial registrationThis study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000652774) in May 2022.

SiC and MWCNT Blending Actions on Functional Performance of Hybrid AA2024 Alloy Nanocomposite Via Two Step Stir Cast Route

SiC and MWCNT Blending Actions on Functional Performance of Hybrid AA2024 Alloy Nanocomposite Via Two Step Stir Cast Route

Efficiency assessment of follow-up methodology of patients with knee replacement to predict post-surgical functionality: a protocol for randomised control PROKnee trial

IntroductionEven when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the...

Effectiveness of Personalized Hippocampal Network–Targeted Stimulation in Alzheimer Disease

Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe and promising intervention for Alzheimer disease (AD). To investigate the effect of a 4-week personalized hippocampal network-targeted rTMS on cognitive and functional performance, as well as functional connectivity in AD. This randomized clinical trial, which was sham-controlled and masked to participants and evaluators, was conducted between May 2020 and April 2022 at a single Korean memory clinic. Eligible participants were between ages 55 and 90 years and had confirmed early AD with evidence of an amyloid biomarker. Participants who met the inclusion criteria were randomly assigned to receive hippocampal network-targeted rTMS or sham stimulation. Participants received 4-week rTMS treatment, with assessment conducted at weeks 4 and 8. Data were analyzed between April 2022 and January 2024. Each patient received 20 sessions of personalized rTMS targeting the left parietal area, functionally connected to the hippocampus, based on fMRI connectivity analysis over 4 weeks. The sham group underwent the same procedure, excluding actual magnetic stimulation. A personalized 3-dimensional printed frame to fix the TMS coil to the optimal target site was produced. The primary outcome was the change in the AD Assessment Scale-Cognitive Subscale test (ADAS-Cog) after 8 weeks from baseline. Secondary outcomes included changes in the Clinical Dementia Rating-Sum of Boxes (CDR-SOB) and Seoul-Instrumental Activity Daily Living (S-IADL) scales, as well as resting-state fMRI connectivity between the hippocampus and cortical areas. Among 30 participants (18 in the rTMS group; 12 in the sham group) who completed the 8-week trial, the mean (SD) age was 69.8 (9.1) years; 18 (60%) were female. As the primary outcome, the change in ADAS-Cog at the eighth week was significantly different between the rTMS and sham groups (coefficient [SE], -5.2 [1.6]; P = .002). The change in CDR-SOB (-4.5 [1.4]; P = .007) and S-IADL (1.7 [0.7]; P = .004) were significantly different between the groups favoring rTMS groups. The fMRI connectivity analysis revealed that rTMS increased the functional connectivity between the hippocampus and precuneus, with its changes associated with improvements in ADAS-Cog (r = -0.57; P = .005). This randomized clinical trial demonstrated the positive effects of rTMS on cognitive and functional performance, and the plastic changes in the hippocampal-cortical network. Our results support the consideration of rTMS as a potential treatment for AD. ClinicalTrials.gov Identifier: NCT04260724.

Immediate effect of extracorporeal shockwave therapy in patients with chronic non-specific low back pain: A randomised placebo-controlled triple-blind trial.

To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Randomised placebo-controlled study with three intervention groups. The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Eighty-one patients with chronic non-specific low back pain aged 18-80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = -3.6, -0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain.

Two-Year Functional Outcomes of Nonsurgical Treatment in Concomitant Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Case-Control Study.

The anterior cruciate ligament (ACL) is a common knee injury in high-intensity sports, which can cause early career loss in young athletes. Concomitant damage to other knee stabilizers may occur, such as the medial collateral ligament (MCL). Recent studies have shown that knee stability can increase without surgical intervention in patients with ACL and MCL injuries. Regarding the importance of functional tests in return to exercise prediction, this study aims to measure nonsurgical approach's long-term outcome for concomitant ACL and MCL injuries with a focus on functional tests. This is a case-control study with a 2-year follow-up. The case group consisted of patients who had provided written consent and completed their 2-year follow-up, and the control group was made up of healthy people who did not have any knee medical conditions and were matched by age, gender, and activity level. Physical examinations, Tegner and International Knee Documentation Committee questionnaires, and knee magnetic resonance imaging were conducted, and functional performance tests were performed after a 10-minute warm-up. Lody's index (the ratio of injured-to-uninjured knee results) was calculated. The data were analyzed using independent t-test, one-way analysis of variance, chi-squared test, and Fisher's exact test. The study involved 11 patients in each concomitant ACL and MCL injury cases and healthy control groups with a mean age of 32.4 and 28 years, respectively. None of the patients reported knee instability symptoms in the 2-year follow-up. More than half of the patients continued their sports field without reinjury, with no significant difference in activity levels between case and control groups. The 6-meter hop test and single-leg hop test showed no significant difference between case and control groups (p-value: 0.326, 0.859), and no significant difference was observed in the three Carioca, cocontraction, and Shuttle tests in the 2-year follow-up. Functional tests in ACL and MCL injuries revealed normal outcomes, implying a nonsurgical approach for patients with proximal ACL tears, better knee stability, and no significant differences between the injured and control groups.

RATIONALE FOR DESIGN CRITERIA FOR THE SECOND GENERATION OF INTERVERTEBRAL DISC PROSTHESIS

First-generation intervertebral disc prostheses (IDPs) have well-established design fea-tures, but an inconsistent functional performance and they are not entirely accepted for clinical use. Currently, second-generation IDPs aim to overcome first-generation problems. Design features and performance of IDPs are related from first- to second-generation, but the relationship is unclear. In 1990, Hedman et al. determined design criteria for the first generation, but the lit-erature has not reported any further criteria for the second generation. This paper is focused on design criteria for second-generation prostheses, clarifying the relationship between the design features and performance of IDPs. We analyzed biomechanical prop-erties of natural intervertebral discs and technological evolution of IDPs to characterize functional performance. A group of functional parameters were identified. A comprehensive review of the literature regarding design criteria showed inconsistent and ambiguous criteria. So, a structure of criteria based on information content is proposed to avoid these conflicts. The criteria are structured into three parts including the functional parameters. In a straight relation to functionality, three design criteria are sufficient to evaluate holistically the features of the second-generation IDPs. The criteria avoid the absence or incongruence of information of the design features and relate the performance of IDP to its features in the route to overcome functional problems.