Function Testing Research Articles

Current understanding of ELF4 deficiency: a novel inborn error of immunity.

ELF4 deficiency has been recently recognized as a novel disorder within the spectrum of inborn errors of immunity (IEIs), specifically categorized as a "disease of immune dysregulation." Cases of this condition, reported by our team and others, are very limited worldwide. As such, our current knowledge of this new disease remains preliminary.This review aims to provide a brief overview of the clinical manifestations, pathogenesis, and treatment strategies for this novel IEI. A comprehensive review was conducted after an extensive literature search in the PubMed/Medline database and websites concerning transcriptional factor ELF4 and reports concerning patients with ELF4 deficiency. Our search strategy was "ELF4 OR ETS-related transcription factor Elf-4 OR EL4-like factor 4 OR myeloid Elf-1-like factor" as of the time of manuscript submission. The current signature manifestations of ELF4 deficiency disorder are recurrent and prolonged oral ulcer, abdominal pain, and diarrhea in pediatric males. In some cases, immunodeficiency and autoimmunity can also be prominent. Targeted Sanger sequencing or whole exome sequencing can be used to detect variation in ELF4 gene. Western blotting for ELF4 expression of the patient's cells can confirm the pathogenic effect of the variant. To fully confirm the pathogenicity of the variant, further functional test is strongly advised. Glucocorticoid and biologics are the mainstream management of ELF4 deficiency disorder. Pediatric males presenting with recurring ulcerations in digestive tract epithelium with or without recurrent fever should be suspected of DEX. When atypical presentations are prominent, variations in ELF4 gene should be carefully evaluated functionally due to the complex nature of ELF4 function. Experience of treating DEX includes use of glucocorticoid and biologics and more precise treatment needs more patients to identify and further mechanistic study.

The association between dynamic balance andexecutive function: Which dynamic balance test hasthe strongest association with executive function? Asystematic review and meta-analysis.

The aging global population poses increasing challenges related to falls and dementia. Early identification of cognitive decline, particularly before noticeable symptoms manifest, is crucial for effective intervention. This review aims to determine the dynamic balance test most closely associated with executive function, potentially serving as a biomarker for cognitive decline. Based on recent reviews, inhibitory control, a component of executive function, holds significance in influencing balance performance. Studies suggest that the strength of the correlation between cognition and balance tends to be domain-specific and task-specific. Despite these findings, inconclusive evidence remains regarding the connection between executive function and various dynamic balance assessments. Our review identifies a significant association between all dynamic balance tests and executive function, albeit with varying strengths. Notably, a medium effect size is observed for the Timed Up and Go and Functional Reach Test, a small effect size for balance scales, and a strong effect size for postural sway. This review underscores a clear relationship between dynamic balance task performance and executive function. Dynamic posturography holds potential as a clinical biomarker for early detection of cognitive decline, with a note of caution due to observed heterogeneity and limited studies.

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.

A Smartphone-Based Algorithm for L Test Subtask Segmentation

Background: Subtask segmentation can provide useful information from clinical tests, allowing clinicians to better assess a patient’s mobility status. A new smartphone-based algorithm was developed to segment the L Test of functional mobility into stand-up, sit-down, and turn subtasks. Methods: Twenty-one able-bodied participants each completed five L Test trials, with a smartphone attached to their posterior pelvis. The smartphone used a custom-designed application that collected linear acceleration, gyroscope, and magnetometer data, which were then put into a threshold-based algorithm for subtask segmentation. Results: The algorithm produced good results (&gt;97% accuracy, &gt;98% specificity, &gt;74% sensitivity) for all subtasks. Conclusions: These results were a substantial improvement compared with previously published results for the L Test, as well as similar functional mobility tests. This smartphone-based approach is an accessible method for providing useful metrics from the L Test that can lead to better clinical decision-making.

Coronary Microvascular Disease in Women: Epidemiology, Mechanisms, Evaluation, and Treatment.

Coronary microvascular dysfunction (CMD) involves functional or structural abnormalities of the coronary microvasculature resulting in dysregulation of coronary blood flow (CBF) in response to myocardial oxygen demand. This perfusion mismatch causes myocardial ischemia, which manifests in patients as microvascular angina (MVA). CMD can be diagnosed non-invasively via multiple imaging techniques or invasively using coronary function testing (CFT), which assists in determining the specific mechanisms involving endothelium-independent and dependent epicardial and microcirculation domains. Unlike traditional coronary artery disease (CAD), CMD can often occur in patients without obstructive atherosclerotic epicardial disease, which can make the diagnosis of CMD difficult. Moreover, MVA due to CMD is more prevalent in women and carries increased risk of future cardiovascular events. Successful treatment of symptomatic CMD is often patient-specific risk factor and endotype targeted. This article aims to review newly identified mechanisms and novel treatment strategies for managing CMD, and outline sex-specific differences in the presentation and pathophysiology of the disease.

Routine Functional Testing or Standard Care in High-Risk Patients after Percutaneous Coronary Intervention.

This review aimed to collate the available evidence on outcomes following routine functional stress testing vs standard of care (i.e. symptom-guided stress testing) in high-risk patients following percutaneous coronary intervention (PCI). The most recent pragmatic POST-PCI trial provided randomized evidence showing that routine functional stress testing post-PCI did not lead to a reduction in 2-year ischemic cardiovascular events or all-cause mortality, as compared to a symptom-guided standard-of-care approach. This was also true for sub-analyses including multivessel or left main disease, diabetics, as well as following imaging or physiology guided PCI. In the absence of a change in their clinical or functional status suggestive of stent failure, post-PCI routine periodic stress testing in stable patients on guideline-directed medical therapy is currently not recommended by American clinical practice guidelines. While evidence on the cost-effectiveness of routine stress testing strategy is scarce, physician, payer, and policy-level interventions to reduce inappropriate use of routine functional testing need to be addressed.

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.

Driving Domain Classification Based on Kernel Density Estimation of Urban Land Use and Road Network Scaling Models

Current research on automated driving systems focuses on Level 4 automated driving (AD) in specific operational design Domains (ODD). Measurement data from customer fleet operation are commonly used to extract scenarios and ODD features (road infrastructure, etc.) for the testing of AD functions. To ensure data relevance for the vehicle use case, driving domain classification of the data is required. Generally, classification into urban, extra-urban and highway domains provides data with similar ODD features. Highway classification can be implemented using global navigation satellite system coordinates of the driving route, map-matching algorithms, and road classes stored in digital maps. However, the distinction between urban and extra-urban driving domains is more complex, as settlement taxonomies and administrative-level hierarchies are not globally consistent. Therefore, this paper presents a map-based method for driving domain classification. First, potential urban areas (PUA) are identified based on urban land-use density, which is determined based on land-use categories from OpenStreetMap (OSM) and then spatially smoothed by kernel density estimation. Subsequently, two road network scaling models are used to distinguish between urban and extra-urban domains for the PUA. Finally, statistics of ODD feature distribution are analysed for the classified urban and extra-urban areas.

Experiment and simulation study on the functional fatigue of shape memory alloy beam actuators

Abstract The functional fatigue behavior of shape memory alloy (SMA) beam actuators is gaining importance as their utilization in engineering applications becomes more widespread. However, research on the functional fatigue behavior of SMA beam actuators under bending conditions is not as extensive as that on SMA wires. In this paper, an experimental study and theoretical analysis of the functional fatigue behavior of SMA beam actuators were conducted. A measuring method for bending deflection and an automatic thermal cyclic test bench was designed. A series of functional fatigue tests were conducted on SMA beam actuators under different bias load conditions and the functional fatigue patterns were obtained. The material damage factor is defined and calculated through specimen tests. By incorporating the damage factor to modify the existing constitutive model, a model considering functional fatigue and tension-compression asymmetry is obtained. Finite Element Analysis (FEA) is performed based on this modified model to simulate the actuating performance of SMA beam actuators and to compute the deflection at different numbers of cycles. Additionally, a small parameter study on the actuator shape is conducted using FEA. By comparing the FEA results with functional fatigue experimental data, the effectiveness of the modified model is validated, demonstrating its capability to describe functional fatigue and predict actuator lifespan.

Relationship between natural muscle oscillation frequency and lower limb muscle performance during instrumented sit-to-stand and stand-to-sit movements on a novel device in sedentary subjects

BackgroundDespite the significance of muscle oscillation frequency, previous research has not established a correlation with muscle performance due to the challenges of applying resistance without altering natural motion during functional tests. Research questionWhat is the correlation between muscle oscillation frequency and lower limb muscle strength, power, and work during an instrumented sit-to-stand and stand-to- sit (iSTS-TS) task among sedentary subjects? MethodsIn a cross-sectional study, the oscillation frequency of the gastrocnemius medialis (GM), biceps femoralis (BF), and vastus medialis (VM) muscles in both the dominant (D) and non-dominant (ND) legs was assessed with a handheld myotonometer in 34 sedentary individuals before performing the iSTS-TS task. ResultsIn the isokinetic mode, no significant correlations were found. In the isotonic mode, the BF muscle oscillation frequency in the D and ND legs exhibited significant positive correlations with peak force, peak power, and work during sitting down, as well as peak power and work during standing up. Positive correlations were observed in both legs between the GM oscillation frequency and sitting down peak force and work. Additionally, significant positive correlation was found with standing up work in the D leg. Muscle oscillation frequency of the VM exhibited a positive correlation with sitting down peak force in the ND leg. SignificanceDue to a greater number of correlations found, it is advisable to use the isotonic mode when assessing muscle oscillation frequency in relation to muscle performance during functional iSTS-TS tasks in sedentary subjects.

Incidence of Seromucous Otitis in Schools in Southern Algeria

Introduction: Seromucous otitis (SMO) is a very common pathology, affecting almost 50% of children. It is a benign condition, but should be investigated in adults for neoplasia of the nasopharynx. It is bilateral in 85% of cases, with an average age of 5 years. Although the evolution of this pathology is often favorable in children, with a tendency to spontaneous regression, in adulthood these ears can evolve into simple or dangerous chronic otitis. Aim: To assess the incidence of seromucous otitis in children in southern Algeria (Laghouat), where the hot season is longer than in temperate or cold regions, and to detect and treat chronic forms. Materials &amp; Methods: This is a monocentric, prospective study involving all schoolchildren aged between 3 and 12, with no history of otitis (chronic otitis) or sensorineural hearing loss, over a 13- month period (October 2020 to October 2021). The diagnosis of sensorineural hearing loss is based on anamnesis and confirmed by clinical examination and functional hearing tests. Results: Of the 340 children examined over a one-year period, 28 presented with seromucous otitis, i.e. 8.2% of the sample size, with a peak in frequency between the ages of 4 and 6. There was also a slight male predominance. Promiscuity was the most frequent risk factor, observed in 64% of cases. Spontaneous regression of seromucous otitis was observed in 10 children (35.7%), and surgical treatment with a trans-tympanic aerator with or without adenoidectomy was instituted in 13 children. Conclusion: The natural evolution of SMO does not always lead to spontaneous regression, and many cases require early management and strict monitoring to prevent complications. It is therefore necessary to introduce screening as part of school hygiene in order to reduce the incidence of chronic otitis in adults.

Fabrication of porous biochar supported Bi2MoO6 photocatalyst for efficient degradation of ciprofloxacin in seawater under visible light irradiation: Mechanistic investigation and intermediates analysis

Efficient separation of photocarriers is a critical approach for advancing high-performance photocatalyst systems to effectively remove environmental contaminants. In this investigation, a hydrothermal technique was employed to synthesize composites of Bi2MoO6 and porous biochar derived from banana peels (BPB). The samples underwent various characterization methods to assess their composition, morphology, and photoelectrochemical properties. The BPB/Bi2MoO6 composite exhibited a synergistic adsorption and photocatalytic impact in eliminating the antibiotic ciprofloxacin (CIP) from pure water and seawater. The optimized BPB/Bi2MoO6 sample displayed a significant degradation efficiency of 98.7 % for CIP after 90 min of visible-light exposure in pure water. In artificial seawater, the degradation efficiency for CIP remained high at 93.6 %, which was 12.2 times greater than that of pure Bi2MoO6. The study also explored the impact of various factors such as catalyst dosage, solution pH, and pollutant concentration on the photocatalytic performance of BPB/Bi2MoO6. Moreover, the catalyst exhibited enhanced efficiency in the adsorption-photocatalytic degradation of CIP within a continuous flow reaction system. The enhanced photocatalytic performance was attributed to the composite's exceptional adsorption capacity, enhanced response to visible light, and efficient separation of photoinduced electron-hole pairs. Furthermore, the BPB/Bi2MoO6 photocatalyst displayed good stability and recyclability over five consecutive photodegradation cycles. Radical trapping and electron spin resonance (ESR) experiments verified that the degradation of CIP was mainly driven by •OH and h+ radicals. A thorough investigation employing density functional theory (DFT), radical trapping and ESR tests, and liquid chromatography mass spectrometry (LC-MS) was conducted to elucidate the degradation mechanism and pathways. Furthermore, toxicity assessment software was utilized to illustrate the progressive reduction in toxicity of the intermediate products. In conclusion, this study provides valuable insights into the role of biochar in enhancing the photocatalytic degradation of pollutants and offers guidance for the future development of environmentally friendly photocatalysts.

Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial

BackgroundKnee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA.MethodologyA randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee’s functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests—the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05.ResultOf the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM − 4.15; TSE − 4.42; KSE − 3.78), during stair ascent (MWM − 3.89; TSE − 4.88; KSE − 3.56) and descent (MWM − 3.78; TSE − 4.05; KSE − 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM − 7.05; TSE − 7.16; KSE − 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05).ConclusionIn this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA.Trial noClinicalTrials.gov = NCT04099017 23/9/2019.

Patients With Coronary Microvascular Dysfunction Have Less Circulating α-Klotho.

Coronary microvascular dysfunction (CMD) represents an early functional characteristic of coronary vascular aging. Klotho (α-klotho) is a circulating protein inversely linked to physiological aging. We examined low klotho as a potential marker for vascular aging in patients with CMD and no coronary artery disease. Patients undergoing nonurgent angiogram for chest pain who had no coronary artery disease underwent invasive coronary microvascular and endothelial function testing. CMD was defined by ≤50% increase in coronary blood flow (percentage change in coronary blood flow) in response to intracoronary acetylcholine or coronary flow reserve ≤2. Fresh arterial whole blood was used to analyze circulating endothelial progenitor cells with flow cytometry. Stored arterial plasma was used for klotho analysis by ELISA. Participants with CMD (n=62) were compared with those without CMD (n=36). Those with CMD were age 55±10 years (versus 51±11 years; P=0.07) and 73% women (versus 81%; P=0.38). Traditional risk factors for coronary artery disease were similar between groups. Patients with CMD had less klotho (0.88±1.50 versus 1.75±2.38 ng/mL; P=0.03), and the odds of low klotho in CMD were significant in a logistic regression model after adjusting for traditional cardiovascular risk factors (odds ratio [OR], 0.80 [95% CI, 0.636-0.996]; P=0.05). Higher klotho was associated with higher numbers of endothelial progenitor cells with vascular regenerative potential (CD34+ and CD34+CD133+KDR+). Among a subgroup of patients with atherosclerotic cardiovascular disease risk <5% (n=58), CMD remained associated with lower klotho (OR, 0.80 [95% CI, 0.636-0.996]; P=0.047). Klotho may be a biomarker for CMD and may be a therapeutic target for groups of patients without significant traditional cardiovascular risk.

Development and functional testing of a novel in vitro delayed scratch closure assay.

As the development of chronic wound therapeutics continues to expand, the demand for advanced assay systems mimicking the inflammatory wound microenvironment in vivo increases. Currently, this is performed in animal models or in in vitro cell-based models such as cell culture scratch assays that more closely resemble acute wounds. Here, we describe for the first time a delayed scratch closure model that mimics some features of a chronic wound in vitro. Chronic wounds such as those suffered by later stage diabetic patients are characterised by degrees of slowness to heal caused by a combination of continued localised physical trauma and pro-inflammatory signalling at the wound. To recreate this in a cell-based assay, a defined physical scratch was created and stimulated by combinations of pro-inflammatory factors, namely interferon, the phorbol ester PMA, and lipopolysaccharide, to delay scratch closure. The concentrations of these factors were characterised for commonly used human keratinocyte (HaCaT) and dermal fibroblast (HDF) cell lines. These models were then tested for scratch closure responsiveness to a proprietary healing secretome derived from human Wharton's jelly mesenchymal stem cells (MSCs) previously validated and shown to be highly effective on closure of acute wound models both in vitro and in vivo. The chronically open scratches from HaCaT cells showed closure after exposure to the MSC secretome product. We propose this delayed scratch closure model for academic and industrial researchers studying chronic wounds looking for responsiveness to drugs or biological treatments prior to testing on explanted patient material or in vivo.

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.

Physical function as a predictor of chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer

BackgroundA growing body of research indicates that poor functional status before chemotherapy may be correlated with the severity of chemotherapy-induced peripheral neuropathy (CIPN) after the neurotoxic treatment. However, little is known about the associations between pre-chemotherapy physical function and CIPN in patients with pancreatic cancer.PurposeTo identify the predictors of CIPN in relation to pre-chemotherapy physical function in patients with pancreatic cancer.MethodsThis secondary analysis included data from patients with pancreatic cancer who participated in a longitudinal research study at National Cheng Kung University Hospital, Tainan, Taiwan. Four physical function tests (i.e., grip strength, Timed Up and Go (TUG), 2-minute step test (2MST), and Romberg test) and two questionnaires (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] and Chemotherapy-Induced Peripheral Neuropathy Module [CIPN20]) were assessed at baseline (i.e., before first chemotherapy session) and 2-, 3-, 4-, and 6-month follow-up. Multiple linear regression with adjustment for confounding factors was used to assess the associations between the four functional tests at baseline and the CIPN20 total score and individual subscale scores (sensory, motor, and autonomic) at 6-month follow-up.ResultsData from a total of 209 pancreatic cancer patients (mean age: 64.4 years, 54.5% male) were analyzed. The findings showed that the severity of CIPN at 6-month follow-up was significantly associated with the baseline TUG completion time (β = 0.684, p = 0.003). The TUG completion time was also positively correlated with the 6-month CIPN sensory and autonomic subscales. In addition, a baseline positive Romberg test (β = 0.525, p = 0.009) was a significant predictor of the severity of motor neuropathy at 6-month follow-up.ConclusionThe TUG completion time and positive Romberg test before chemotherapy may be predictive factors of the CIPN severity 6 months after the commencement of chemotherapy. Accordingly, the incorporation of TUG and Romberg tests into the clinical assessment protocol emerges as imperative for individuals diagnosed with pancreatic carcinoma undergoing chemotherapy regimens.

Deferred revascularization in diabetic patient according to combined invasive functional and intravascular imaging data: A case report

BACKGROUND Invasive functional evaluation by fractional flow reserve (FFR) is considered as a gold standard for the evaluation of intermediate coronary stenosis. However, in patients with diabetes due to accelerated progression of atherosclerosis the outcome may be worse even in the presence of negative functional testing. CASE SUMMARY We present a case of 55-year-old male diabetic patient who was admitted for chest pain. Diagnostic coronary angiography disclosed 2 intermediate stenoses of the obtuse marginal branch with no evidence of restenosis on previously implanted stent. Patient undergone invasive functional testing of intermediate lesion with preserved FFR (0.88), low coronary flow reserve (1.2) and very high index of microvascular resistance (84). Due to discrepancy in invasive functional parameters, intravascular imaging with optical coherence tomography showed fibrotic stenoses without signs of thin-sup fibroatheroma. Because of the preserved FFR and no signs of vulnerable plaque, the interventional procedure was deferred and the patient continued with optimal medications. CONCLUSION Combined functional and anatomic imaging of intermediate coronary stenosis in diabetic patients represent comprehensive contemporary decision pathway in the management of the patients.

Effect Of Improving Lumbar Mobility, Spinal Stability ; With Core Stability Training To Achieve Per-sonal Best Runner

Running consists of simple basic movements, and to achieve these simple basic movements requires good mobility and stability, because the weakening of mobility and stability of the body causes misalignment or weakness of the legs so as to interfere with the absorption or propulsion phase in leg movement while running. Apply appropriate exercise methods to improve lumbar mobility and spinal stability. One training method that can be used is the core stability training method. Core stability is an exercise model to improve the ability to control the position of trunk movement through the pelvis and legs to allow optimal motion production. This study aims to ascertain whether core stability training can improve lumbar mobility and spinal stability in running athletes. The study used an experimental method with a research pattern using a group pretest-posttest design. 10 running athletes were sampled according to the criteria to be treated in the form of core stability training for 6 weeks. The athletes were assessed before and after training using the Functional Reach Test and Unilateral Hip Bridge Endurance. This study showed that there was a significant effect between core stability training and lumbar mobility (P = 0.000) and spinal stability (P = 0.000) in athletes. The results of this study show that the application of core stability exercises can increase the ability of lumbar mobility and spinal stability, so if the core stability exercises are done properly, they can increase stability in the spine and mobility in the lumbar, which causes dynamic limb movement to be more efficient. Key Words: athletics; Core Stability; Lumbar Mobility; spine stability.

Intelligent Liver Function Testing (iLFT): An Intelligent Laboratory Approach to Identifying Chronic Liver Disease.

The intelligent Liver Function Testing (iLFT) pathway is a novel, algorithm-based system which provides automated laboratory investigations and clinical feedback on abnormal liver function test (LFT) results from primary care. iLFT was introduced to NHS Tayside, Scotland, in August 2018 in response to vast numbers of abnormal LFTs, many of which were not appropriately investigated, coupled with rising mortality from chronic liver disease. Here, we outline the development and implementation of the iLFT pathway, considering the implications for the diagnostic laboratories, primary care services and specialist hepatology clinics. Additionally, we describe the utility, outcomes and evolution of iLFT, which was used over 11,000 times in its first three years alone. Finally, we will consider the future of iLFT and propose areas where similar 'intelligent' approaches could be used to add value to laboratory investigations.