Height-matched Controls Research Articles

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Background: Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. Purpose/Hypothesis: The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). Results: The LPD group demonstrated reduced medial patellar width (Δ = −3.6 mm; P < .001) and medial facet length (Δ = −3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = −3.2 mm; P = .009), decreased patellar volume (Δ = −0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. Conclusion: The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

Down syndrome patients with normal hearts: are they really normal?

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term "normal" might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.

Greater central airway luminal area in people with COVID-19: a case–control series

Respiratory epithelium in the conducting airways of the human body is one of the primary targets of SARS-CoV-2 infection, however, there is a paucity of studies describing the association between COVID-19 and physical characteristics of the conducting airways. To better understand the pathophysiology of COVID-19 on the size of larger conducting airways, we determined the luminal area of the central airways in patients with a history of COVID-19 compared to a height-matched cohort of controls using a case–control study design. Using three-dimensional reconstruction from low-dose high-resolution computed tomography, we retrospectively assessed airway luminal cross-sectional area in 114 patients with COVID-19 (66 females, 48 males) and 114 healthy, sex- and height-matched controls (66 females, 48 males). People with a history of smoking, cardiopulmonary disease, or a body mass index greater than 40 kg·m−2 were excluded. Luminal areas of seven conducting airways were analyzed, including trachea, left and right main bronchus, intermediate bronchus, left and right upper lobe, and left lower lobe. For the central conducting airways, luminal area was ~ 15% greater patients with COVID-19 compared to matched controls (p < 0.05). Among patients with COVID-19, there were generally no differences in the luminal areas of the conducting airways between hospitalized patients compared to patients who did not require COVID-19-related hospitalization. Our findings suggest that males and females with COVID-19 have pathologically larger conducting airway luminal areas than healthy, sex- and height-matched controls.

Bone Mineral Density in Pituitary Stalk Interruption Syndrome: The Role of Insulin-Like Growth Factor-1 and Testosterone at Different Skeletal Sites

ObjectiveThis study aimed to determine the clinical indicators influencing bone mineral density (BMD) of the lumbar spine and femoral neck in patients with pituitary stalk interruption syndrome (PSIS) who underwent multiple hormone replacement therapy (MHRT). MethodsMale patients with PSIS (n = 51) who underwent MHRT for at least 1 year were enrolled in this study. Their BMD parameters were recorded and compared with age-, weight-, and height-matched control adults. In addition, we performed multiple linear regression analysis to correlate clinical parameters with BMD parameters at 2 different sites. ResultsFifty-one patients with PSIS had a mean age of 30.39 ± 5.50 years. After 36 months of treatment, patients with PSIS who underwent MHRT had slightly lower BMD than those in the control group. Multiple linear regression models revealed a positive association between the Z-score values for the lumbar spine with treatment duration (r = 0.453, P < .001), insulin-like growth factor-1 (IGF-1) standard deviation score (SDS) values (r = 0.248, P = .038), and total testosterone level (r = 0.260, P = .036) and a positive association between the Z-score values for the femoral neck with treatment duration (r = 0.425, P < .001) and IGF-1 SDS values (r = 0.338, P = .009). ConclusionCollectively, long-term MHRT improves bone density in patients with PSIS to the normal range. A combination of recombinant human growth hormone replacement is more beneficial to the BMD than non–recombinant human growth hormone treatment. Moreover, serum IGF-1 contributes to femoral and lumbar mineralization, whereas serum testosterone plays a role in lumbar mineralization.

Ventilatory Function Phenotypes in Patients with Pulmonary Tuberculosis

Background: Ventilatory function abnormalities following pulmonary TB has now emerged as a distinct clinical entity, yet the prevalence of these abnormalities in Nigeria remains unknown. This study aimed at determining the prevalence of these abnormalities and investigating its associated factors. Methods: The design was prospective comparative study whereby ventilatory function of 88-consecutive patients aged 18-years and above (57 males and 31 females) who completed 6-months of treatment for pulmonary TB was compared with that of equal number of age, sex and height-matched controls. Both groups underwent spirometry at recruitment and after 3-months follow-up. Their lung functions were classified as normal or abnormal (obstructive, restrictive or mixed). Chest x-rays of the cases at end of 5-months of treatment were also reviewed. Data obtained were analyzed using SPSS version 20. Results: The prevalence of abnormal ventilatory function of was 77.3%, with restrictive pattern being the most common 65 (73.9%), followed by obstructive pattern 2 (2.3%). Ventilatory function improved after 3-months post-treatment. The control group had an overall prevalence of ventilatory function abnormality of 22.6% at recruitment with 15 (17.0%) having restrictive abnormality, 4 (4.5%) having obstructive abnormality. After 3- months follow-up however, abnormal ventilatory function among the control group was seen in 8 (9.0%) subjects, 6 (6.8%) of whom were restrictive and 1 (1.1%) each with obstructive and mixed disorders. Conclusions: More than two-third of the cases studied had ventilatory function abnormalities after 6 months of completed treatment. This underscores the need for ventilatory function assessment after treatment fora

Health impact and lung function indices of adult residents of Ibeno Community exposed to gas flaring in south-south Nigeria

Background: Epidemiological studies indicate that exposure to air pollution caused by gas flaring may have an association with an increased risk of adverse respiratory effects. This study investigates the effects of gas flaring on the lung health of Ibeno community residents, Akwa Ibom State focusing on respiratory symptoms and lung function indicesMethods: A total of 386 adult resident in Ibeno for at least two years and 386 age, sex and height matched controls resident in Etinan, also for at least two years were recruited to a cross-sectional survey comparing their respiratory symptoms and lung function indices. The study was conducted between March and May 2014 using spirometer and questionnaire as investigative tools. Both descriptive and inferential statistics were used to analyze the data.Results: Most of the respondents in both exposed and control communities were aged 18-30 years, with a height range of 161-170cm. Both exposed and controls subjects experienced similar symptoms suggestive of respiratory disorders, however the prevalence was higher among exposed subjects than controls: cough- 57(14.8%) vs. 39(10.1%); breathlessness 58(15%) vs. 28(7.3); wheezing 22(5.7) vs. 12(3.1). The respondents from the exposed community were mostly traders and fishermen while the controls were predominantly farmers. The PEFR, FVC and FEV1 (mean ± SD) for the subjects were 300.6±2.15 l/min, 2.58±8.43 and 2.01±0.76 respectively; while the PEFR, FVC and FEV1 for the controls were 342±2.16l/min, 2.27±0.82 and 2.13±0.75 respectively.Conclusion: In view of these findings, there is evidence that prolonged exposure to air pollution from gas flaring impacts negatively on lung function reflected as reduced PEFR, FEV1, and worsening respiratory symptoms among residents in the exposed community. There is need for the government to speed up the implementation of polices regarding the reduction of flaring of natural gas associated with oil production. There is also a need for further research to be carried out on the long term effects of chronic exposure to gas flaring on lung health and methods of interventions to minimize or possibly eliminate these effects.

Effects of Textured Insoles on the Balance of Individuals with Knee Osteoarthritis in Dynamic Perturbations

The effectiveness of adding plantar-surface texture to improve balance has been demonstrated in a variety of demographics. It is critical to investigate whether textured insoles can improve balance in people with knee osteoarthritis (OA), who have compromised the somatosensory function of the affected joint and, as a result, are at a higher risk of falling. Thus, this study investigated the degree of benefit from the use of textured insoles for improving balance and compared the balance of people with knee OA to healthy matched peers. This study included eighteen people with knee OA and eighteen healthy, aged, gender, height, weight, and BMI matched controls who were assessed on balance using the sensory organization test and the motor control test. Balance was improved in both groups when the textured insoles were worn, and the healthy knee group demonstrated significantly better balance performance than the knee OA group. The benefits of this study for individuals with knee OA are that it may lead to the development of an evidence-based footwear intervention that is noninvasive, simple to use, and inexpensive, in addition to allowing the user to self-manage and the ability to reduce the risk of falls, thereby improving their quality of life.

Peripheral nervous system electrodiagnostic abnormalities in predominantly Hispanic Multiple Sclerosis patients

BackgroundPeripheral nervous system (PNS) abnormalities in Multiple Sclerosis (MS) have been reported in case reports and small case series over the past several decades. Little is known, however, about the prevalence of electrodiagnostic abnormalities in patients with MS, including not only demyelinating neuropathies such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) but also axonal peripheral neuropathy and sympathetic dysfunction. MethodsThis is an observational, cross-sectional study with the objective of identifying the prevalence of the electrodiagnostic abnormalities in predominantly Hispanic MS patients in Miami, Florida. Electrodiagnostic data including nerve conduction study (NCS), electromyography (EMG) and sympathetic skin response (SSR) information was prospectively collected in 18 patients (16 females; 43.7±15.2 years) with a diagnosis of MS compared to 18 healthy (16 females; 39.9±11 years), age- and height-matched controls. The study was offered to all-comers in the MS Clinic over a period of 3 months, regardless of clinical suspicion for an underlying neuropathic process, in an effort to estimate the prevalence of abnormalities. Demographic data including age, sex, race/ethnicity was evaluated in addition to MS-specific characteristics including MS subtype, duration of disease, duration of therapy, clinical symptoms and laboratory data. ResultsThere were no significant differences in baseline characteristics of patients and controls for age (p=0.4) and height (164.0±6.4 vs 162.3±4.6 centimeters; p=0.3). The mean disease duration was 106±27 months (median 107 months; range 5-336 months). The mean Expanded Disability Status Scale (EDSS) was 2.4±1.87 (median: 2.5; range 1.0-6.5). The ethnicity of patients (15 Hispanic, 3 non-Hispanic) and controls (13 Hispanic, 5 non-Hispanic; p=0.56) was similar. The frequency of electrophysiological axonal polyneuropathy (PN) was 77.8% (14/18 patients), and 85.6% of these patients had clinical sensory symptoms. Interestingly, 1 patient had previously unrecognized CIDP. All 18 patients displayed prolonged SSR latencies consistent with autonomic dysfunction. Thirteen patients (72.2%) reported autonomic symptoms such as bladder abnormalities and blood pressure fluctuations. ConclusionThe prevalence of electrodiagnostic abnormalities, especially axonal polyneuropathy, in the MS population may be higher than traditionally considered. The relationship between axonal polyneuropathy and central axonopathy in the context of neurodegeneration in MS should be further explored. Analytic studies may identify common symptomatic and pathophysiologic etiologies to further understanding and potentially guide treatment of MS subtypes with PNS involvement.

Isokinetic knee strength deficit in patients with moderate haemophilia.

Knee joint bleedings are responsible for quadriceps atrophy and strength deficit in patients with severe haemophilia. Little is known about patients with moderate haemophilia (PWMH). To evaluate isokinetic quadriceps and hamstrings strength in PWMH and to assess correlation with radiological and clinical parameter. 18 PWMH aged 37.1±11.4 and 18 healthy age-, weight- and height-matched controls performed a knee isokinetic test at 180°/s to assess quadriceps and hamstrings strength. In the PWMH group, knee Pettersson's score was pursued and Haemophilia Joint Health Score 2.1 (HJHS) was performed to determine unaffected knees (knee HJHS=0) and affected ones (knee HJHS >0). Affected knees had a decrease of quadriceps strength compared to controls, 1.26±0.47 vs 1.64±0.27Nm/kg and a decrease of hamstring strength, 0.60±0.29 vs 1.03±0.21Nm/kg, (P<0.001). Unaffected knees also had a decrease of quadriceps strength compared to controls, 1.36±0.31 vs 1.64±0.27Nm/kg and a decrease of hamstring strength, 0.69±0.18 vs 1.03±0.21Nm/kg, (P<0.001). The conventional hamstring-to-quadriceps ratio was significantly decreased in affected knees compared to controls, 0.46±0.15 vs 0.64±0.13 (P<0.001) but also in unaffected knees, 0.53±0.16 vs 0.64±0.13 (P=0.02).No correlation was found between strength and HJHS or Pettersson's score. PWMH have a significant knee strength deficit, both on the quadriceps and the hamstrings, which is responsible for an important muscle imbalance.

Resting Respiratory Resistance in Female Teenage Athletes With and Without Exercise-Induced Laryngeal Obstruction

Exercise-induced laryngeal obstruction (EILO) occurs with paradoxical vocal fold motion or supraglottic collapse during moderate to vigorous exercise. Previously, Gallena etal (2015) reported lower-than-normal inspiratory (Ri) and expiratory (Re) resistances during resting tidal breathing (RTB) in female teenage athletes with EILO. This study aimed to replicate that unexpected result. The Airflow Perturbation Device measured Ri and Re during three 1-minute trials of RTB in 16 teenage female athletes with EILO and 16 sex-, age-, and height-matched controls. Multiple linear regression examined group, age, height, and weight as predictors of Ri and Re. Ri and Re tended to be lower in the EILO group than the control group [Ri: F(1,30)=3.58, P=0.068, d=0.686; Re: F(1,30)=3.28, P=0.080, d=0.640], but there was no statistically significant difference in the overall effect [F(2,29)=1.75, P=0.192]. After one outlier for Re from the EILO group and her matched control were removed, the overall difference was statistically significant, F(2,27)=3.38, P=0.049, with Re primarily contributing to the difference [Ri: F(1,28)=3.66, P=0.066, d=0.719; Re: F(1,28)=5.69, P=0.024, d=0.899]. These results did not replicate the robust differences found previously between Ri and Re during RTB in teenage girls with and without EILO, but the results trended in the same direction and met criterion for statistical significance once an outlier was removed from analysis. Overall, the observation that resting respiratory resistances were lower in most teenage girls with EILO suggests that reduced tone of the laryngeal and/or lower airways may predispose young athletes to EILO.

The supine position improves but does not normalize the blunted pulmonary capillary blood volume response to exercise in mild COPD.

Patients with mild chronic obstructive pulmonary disease (COPD) demonstrate resting pulmonary vascular dysfunction as well as a blunted pulmonary diffusing capacity (DLCO) and pulmonary capillary blood volume (VC) response to exercise. The transition from the upright to supine position increases central blood volume and perfusion pressure, which may overcome microvascular dysfunction in an otherwise intact alveolar-capillary interface. The present study examined whether the supine position normalized DLCO and VC responses to exercise in mild COPD. Sixteen mild COPD participants and 13 age-, gender-, and height-matched controls completed DLCO maneuvers at rest and during exercise in the upright and supine position. The multiple -DLCO method was used to determine DLCO, VC, and membrane diffusion capacity (DM). All three variables were adjusted for alveolar volume (DLCOAdj, VCAdj, and DMAdj). The supine position reduced alveolar volume similarly in both groups, but oxygen consumption and cardiac output were unaffected. DLCOAdj, DMAdj, and VCAdj were all lower in COPD. These same variables all increased with upright and supine exercise in both groups. DLCOAdj was unaffected by the supine position. VCAdj increased in the supine position similarly in both groups. DMAdj was reduced in the supine position in both groups. While the supine position increased exercise VCAdj in COPD, the increase was of similar magnitude to healthy controls; therefore, exercise VC remained blunted in COPD. The persistent reduction in exercise DLCO and VC when supine suggests that pulmonary vascular destruction is a contributing factor to the blunted DLCO and VC response to exercise in mild COPD.NEW & NOTEWORTHY Patients with mild chronic obstructive pulmonary disease demonstrate a combination of reversible pulmonary microvascular dysfunction and irreversible pulmonary microvascular destruction.

Diminished Blood Pressure Profiles in Children With Down Syndrome.

This study sought to analyze blood pressure trends in children with Down syndrome at multiple centers. A multicenter, retrospective, cross-sectional study was performed. All patients were <18 years and had a diagnosis of Down syndrome. Existing comorbidities were nonexclusionary. For each patient, 3 blood pressure recordings were obtained from routine clinic visits. In total, 887 patients with 2661 total blood pressure recordings were included in this study. The average blood pressure percentile for patients was 38.87 with a median percentile of 31.5. Age, sex, and race were not predictive of blood pressure percentile. Compared with established data from the National Heart Lung and Blood Institute and National Health and Nutrition Examination Survey cohort (ages 8-18 years), blood pressure in our Down syndrome population was statistically lower by 6.1 percentile points (P<0.001), with the greatest difference at higher blood pressure percentiles (P<0.001). Only 10% of all Down syndrome cohort blood pressure recordings were greater than the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey 70th percentile, with no patients meeting criteria for prehypertension or hypertension. Additional comparisons against American Academy of Pediatrics data were similar and statistically significant. In children with Down syndrome, there is a 12 percentile point reduction in baseline blood pressure compared with age- and height-matched controls reported in the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey and American Academy of Pediatrics cohorts. This data can potentially be utilized in the evaluation and care of persons with Down syndrome in their pediatric medical homes.

Should We Stick with Step Counts after Incomplete Spinal Cord Injury? A Case-Control Investigation

Step count is a common metric or criterion to prescribe physical activity. Step activity benchmarks were designed to reflect an overall daily energy expenditure, but this objective measure is exposed to error when gait is impaired. Individuals with functional limitations are known to expend more energy during locomotion when compared to non-impaired controls (CON). PURPOSE: The primary goal was to evaluate metabolic cost per step for someone with an incomplete spinal cord injury (iSCI) when compared to a CON. A secondary goal was to evaluate estimated daily energy expended between the individuals to determine if step count is an appropriate metric for activity recommendations for those with functional limitations. METHODS: This case-control study included a participant with an iSCI and an age-, sex-, height-matched CON. Participants completed a 6-minute walk (6MWT) and timed walks at slow, moderate, and fast paces (matching the step monitor’s intensity benchmarks) while wearing a portable metabolic cart. Relative oxygen consumption (VO2) was determined using a 15-breath moving average. Daily step activity was recorded during the 7-day period between sessions. Stride length was determined using 3D motion analysis. RESULTS: Differences were observed between participants for average 6MWT VO2 (iSCI=21.5 ml/kg/min; CON=28.18 ml/kg/min), step length (iSCI: 0.36m; CON: 0.73m), energy expenditure during the 6MWT (iSCI: 0.34kcal/m; CON: 0.09kcal/m), and daily step activity (iSCI: 2616, CON: 9890). Estimated energy expended from walking for iSCI and CON was 336 kcal/day and 735 kcal/day, respectively, when extrapolating VO2 from paced walks to data retrieved from the step monitor. CONCLUSION: Supporting previous literature, it is likely inappropriate to standardize activity recommendations based on step metrics for those with functional limitations. Unrealistic expectations may heighten perceived barriers, undermine mobility related self-efficacy, and discourage adoption or adherence. Exercise prescription based on energy expenditure goals may serve as an alternative means to individualize recommended daily activity. Future research should attempt to establish new recommendations based on functional status for those outside of the typical gate norm.

Single-fiber F waves compared with conventional surface F waves, and their utility in detecting early diabetic neuropathy.

The single-fiber F-wave (SFF-wave) technique assesses the entire length of single motor fibers using a concentric needle. Herein we investigated the utility of this approach in the detection of early diabetes-related neuropathy, and compared it with the use of conventional surface F waves (CF waves). Sixteen patients with diabetes and either no neuropathy or mild neuropathy were assessed and compared with 16 age- and height-matched control participants. Both CF and SFF waves were abnormal in all 5 patients who had mild neuropathy. However, SFF waves demonstrated subclinical abnormalities in 7 of 11 patients (64%) with no neuropathy, whereas only 2 of these patients (18%) had prolonged CF waves. Minimum F-wave latency was comparable between techniques, but maximum SFF-wave latency was more frequently prolonged, as these delayed motor units were better isolated, rather than buried among summated CF-wave responses. SFF waves highlight the segmental involvement in diabetic neuropathy, and use of the SFF-wave technique detects more abnormalities than with CF waves. Muscle Nerve 58: 665-670, 2018.

Isometric maximal voluntary force evaluated using an isometric mid-thigh pull differentiates English Premier League youth soccer players from a maturity-matched control group

ABSTRACTPurpose: The purpose of the present study was to record normative isometric maximum voluntary force (MVF) data at baseline and after an 8-week training period using the isometric mid-thigh pull (IMTP) for English Premier League academy players and a maturation-matched control group.Methods: In total, 155 English Premier League academy players across under 9 to under 21 age groups and 93, maturation-, weight- and height-matched control participants performed an IMTP. In total, 142 and 62 of the elite and control cohorts respectively were retested 8 weeks later following a period of integrated soccer training or physical education lessons. Allometrically scaled (peak force divided by body mass0.66) MVF was recorded. MVF was analysed in three maturity groups based on years from/to age of predicted peak height velocity (PHV): pre-PHV, mid-PHV, and post-PHV in elite and control groups.Results: A small difference was seen in isometric MVF in elite (115.42 ± 21.96 N) compared to control (109.36 ± 29.90 N) at baseline (P = 0.004) though no difference was seen between or within groups after 8 weeks (P > 0.167).Conclusion: Differences in baseline MVF suggest that strength is likely important to elite youth soccer performance though training undertaken by this elite group may be insufficient to elicit adaptation in isometric strength.

Oscillometric pulse wave analysis in newly diagnosed never treated Gujarati hypertensives

INTRODUCTION: Hypertension is on a high with preponderance of undiagnosed and untreated at-risk individuals. Pulse wave analysis (PWA) provides noninvasive assessment of arterial stiffness and central hemodynamic parameters. It provides more discrete and direct inference about cardiovascular aging that is expected to be exaggerated with systemic hypertension. MATERIALS AND METHODS: A case–control study was conducted in 116 newly diagnosed, never treated, apparently healthy hypertensives and 116 matched nonhypertensive controls. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed. P RESULTS: Cases showed significantly higher brachial arterial parameters (blood pressure [BP], heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work) than age-, gender-, and height-matched controls. Major study parameters correlated with BP, heart rate, and age, but in multiple regressions, they were independent of most of these parameters. CONCLUSIONS: Oscillometric PWA is feasible in our population. It revealed beyond brachial BP abnormal profile suggestive of early cardiovascular aging in new and never treated hypertensives. It also suggests further work to consolidate and explore these results.

What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study

Describing the morphologic features of the thoracic pedicle in patients with adolescent idiopathic scoliosis is necessary for placement of pedicle screws. Previous studies showed inadequate reliability owing to small sample size and heterogeneity of the patients surveyed. To use CT scans (1) to describe the morphologic features of 2718 thoracic pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 age-, sex-, and height-matched controls; and (2) to classify the pedicles in three types based on pedicle width and analyze the distribution of each type. A total of 2718 pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 matched female controls were analyzed via CT. All patients surveyed were diagnosed with adolescent idiopathic scoliosis, Lenke Type 1, at the First Affiliated Hospital of Sun Yat-sen University, and all underwent pedicle screw fixation between January 2008 and December 2013 with preoperative radiographs and CT images on file. We routinely obtained CT scans before these procedures; all patients who underwent surgery during that period had CT scans, and all were available for analysis here. Control subjects had CT scans for other clinical indications and had no abnormal findings of the spine. The control subjects were chosen to match patients in terms of age (15 ± 2.6 years versus 15 ± 2.6 years) and sex. Height of the two groups also was matched (154 ± 9 cm versus 155 ± 10 cm; mean difference, -1.06 cm; 95% CI, -1.24 to -0.81 cm; p < 0.001). Pedicle width and length were measured from T1 to T12. The thoracic spine was classified in four regions: apical vertebra in the structural curve (AV-SC), nonapical vertebra in the structural curve (NAV-SC), apical vertebra in the nonstructural curve (AV-NSC), and nonapical vertebra in the nonstructural curve (NAV-NSC). Pedicles were classified in three types: pedicle width less than 2 mm as Type I, 2 mm to 4 mm as Type II, and greater than 4 mm as Type III. Types I and II were defined as dysplastic pedicles. Paired t test, independent samples t test, one-way ANOVA, followed by Bonferroni's post hoc test and chi-square or Fisher's exact tests were used for statistical comparisons between patients and controls, as appropriate. No difference was found between pedicle width on the convex side (PWv) and in controls (PWn), but pedicle width on the concave side (PWc) (4.99 ± 1.87 mm) was found to be narrower than PWv (6 ± 1.66 mm) and PWn (6 ± 1.45 mm). The variation degree of pedicle width (VDPW) was greatest in the AV-SC region (34% ± 37%), in comparison to AV-NSC (20% ± 25%) (mean difference, 14%; 95% CI, 1.15%-27%; p = 0.025), NAV-SC (17% ± 30%) (mean difference, 17%; 95% CI, 7%-27%; p < 0.001), and NAV-NSC (11% ± 24%) (mean difference, 24%; 95% CI, 13%-34%; p < 0.001). Dysplastic pedicles appeared more in patients with adolescent idiopathic scoliosis (22%; 293 of 1322) compared with controls (13%; 178 of 1396) (odds ratio [OR] = 0.51; 95% CI, 0.42-0.63; p < 0.001). In patients with adolescent idiopathic scoliosis, they commonly occurred on the concave side 34% (228 of 661) and on the AV-SC region (32%; 43 of 136). Pedicle width on the concave side was narrower than pedicle width on the convex side and pedicle width in healthy control subjects. The apical vertebra in the structural curve was the most variegated region of the curve with the highest prevalence of dysplastic pedicles. Our study can help surgeons perform preoperative assessments in females with adolescent idiopathic scoliosis, and with preoperative and intraoperative management for difficult pedicle screw placement. In particular, our results suggest that surgeons should exercise increased vigilance when selecting pedicle screw dimensions, especially in the concave aspect of the mid-thoracic curve, to avoid cortical breeches. Future studies should evaluate other Lenke types of adolescent idiopathic scoliosis, and males with adolescent idiopathic scoliosis.

The relationship of high-intensity cross-training with arterial stiffness

BackgroundCentral arterial stiffness is a cardiovascular risk factor that can be readily affected through engagement in physical exercise training, with resistance and aerobic exercise having disparate affects. Despite the growing popularity of high-intensity cross-training (HICT), little is currently known about the effects of this mixed modality exercise stimulus on arterial stiffness. Therefore, the purpose of this study was to characterize the arterial stiffness of habitual HICT participants vs. aerobically active and sedentary controls using a cross-sectional design. MethodsA total of 30 participants were recruited: 10 middle-aged long-term participants of HICT (CrossFit) and 20 age, sex, and height matched controls (10 recreationally active, 10 sedentary). Central and peripheral pulse wave velocities were measured for the carotid-femoral and femoral-dorsalis pedis arterial segments. Aerobic fitness (maximal oxygen uptake, VO2max) was measured and typical exercise participation rates were self-reported for each group. ResultsHICT participants manifested central pulse wave velocity (PWV) (5.3 ± 1.0 m/s, mean ± SD) and VO2max (43 ± 6 mL/kg/min) values nearly identical to active controls. Both active groups had significantly better values than sedentary controls (7.1 ± 1.0 m/s, p ≤ 0.001; and 32 ± 7 mL/kg/min, p = 0.01). No differences were observed in peripheral PWV between groups. ConclusionHabitual participation in HICT exercise was not associated with increased central nor peripheral arterial stiffness. Long-term HICT participants presented with similar fitness and arterial stiffness as compared with participants who practiced traditional aerobic exercise. Compared to sedentary living, HICT may offer musculoskeletal and cardiovascular health benefits without negatively impacting arterial stiffness.

Cardiovascular Risk Factors in Children and Adolescents with Subclinical Hypothyroidism.

Background:Subclinical hypothyroidism (SCH) is a commonly encountered entity in day-to-day clinical practice and has been associated with adverse cardiovascular risk profile in adults and children. Data on children and adolescents with SCH, from India, are limited.Materials and Methods:This study was a cross-sectional case–control study, conducted at a tertiary care center in Northeast India. Twenty-seven children and adolescents aged 11 ± 2.4 years with SCH and thyroid-stimulating hormone >7.5 mIU/L were included in the study along with 20 age-, gender-, and height-matched controls. Multiple clinical, biochemical, and radiological cardiovascular risk factors were assessed and compared between the two groups.Results:Body mass index (BMI) (P = 0.048), waist circumference (P = 0.008), waist to height ratio (P = 0.007), low-density lipoprotein cholesterol (P = 0.04), triglycerides (TGs) (P = 0.038), TGs to high-density lipoprotein (HDL) cholesterol ratio (P = 0.005), non-HDL cholesterol (P = 0.019), fasting insulin (P = 0.006), and homeostasis model assessment of insulin resistance (P = 0.007) were found to be significantly higher while free T4 (P = 0.002) and HDL cholesterol (P = 0.019) were found to be significantly lower in SCH subjects compared to controls. On multiple regression analysis, BMI was found to have significant association with multiple cardiovascular risk factors.Conclusion:Children and adolescents with SCH were found to have adverse cardiovascular risk profile. Long-term follow-up studies are required to assess the clinical significance of these findings and requirement for therapy.

Characterisation of the patellar tendon reflex in cerebral palsy children using motion analysis.

The patellar tendon reflex (PTR) is an important spinal reflex and an important diagnostic tool assessing neurological disturbances. Reflexes are conveniently assessed but quantifying the response can be subjective. Motion analysis is commonly used to assess gait kinematics in a variety of populations. It can be used to objectively assess the PTR with the advantage that standard technique and hammer can be used without the need for bulky apparatus or fixing the subject position. To compare the PTR in 15 cerebral palsy (CP) children with age and height matched controls. EMG reflex latency in the rectus femoris was assessed using a Noraxon 2400T unit. Knee movement latency, knee angular displacement and peak angular velocity were captured using the CODA mpx 30 system. EMG reflex latency was significantly reduced in CP compared to control limbs (13.11 versus 18.11ms; p<0.01) confirming a 'brisk' response in this population. The kinematic data found that while knee angular displacement was significantly reduced in CP (12.82° versus 20.06°; p<0.01) there was no significant difference in movement latency or peak angular velocity compared to controls. Subjective evaluation of the PTR relies mostly on change in knee angle. Using motion analysis we have confirmed a difference in this variable in CP compared to controls. We have also shown reduced reflex latency associated with a brisk reflex. Knee movement latency and peak angular velocity did not differentiate CP from normal. Further examination of the knee angular response of the PTR is warranted in CP.