Significant Mean Improvement Research Articles

Effect of Chiropractic Manipulation on Vertical Jump Height in Young Female Athletes with Talocrural Joint Dysfunction: A Single-Blind Randomized Clinical Pilot Trial

ObjectiveThe main objective of this pilot study was to explore the effect of chiropractic high-velocity, low-amplitude (HVLA) manipulation on vertical jump height in young female athletes with talocrural joint dysfunction. MethodsThis was a randomized assessor-blind clinical pilot trial. Twenty-two female handball players with talocrural joint dysfunction were randomized to receive either HVLA manipulation (n = 11) or sham treatment (n = 11) once a week during a 3-week period. The main outcome was change in vertical jump height from baseline to follow-up within and between groups after 3 weeks. ResultsNineteen athletes completed the study. After 3 weeks, the group receiving HVLA manipulation (n = 11) had a statistically significant mean (SD) improvement in vertical jump height of 1.07 (1.23) cm (P = .017). The sham treatment group (n = 8) improved their vertical jump height by 0.59 (2.03) cm (P = .436). The between groups' change was 0.47 cm (95% confidence interval, −1.31 to 2.26; P = .571) in favor of the group receiving HVLA manipulation. Blinding and sham procedures were feasible, and there were no reported adverse events. ConclusionThe results of this pilot study show that a larger-scale study is feasible. Preliminary results suggest that chiropractic HVLA manipulation may increase vertical jump height in young female athletes with talocrural joint dysfunction. However, the clinical result in favor of HVLA manipulation compared with sham treatment needs statistical confirmation in a larger randomized clinical trial.

Comparison of Epley Maneuver and Brandt- Daroff Exercises on Short- Term Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV) - Related Quality of Life

Background and purpose : Benign paroxysmal positional vertigo (BPPV) is a recurrent chronic disease of the inner ear and the handicap caused by it is usually underestimated. Several studies have indicated that physical therapy, including rehabilitative exercises and physical maneuvers, is an effective treatment for BPPV. The aim of the present study was to determine the impact of treatment with the Epley maneuver and that with the Brandt- Daroff exercises on short- term BPPV related quality of life and at comparing the effects of the two treatment approaches. Study design : Comparative prospective study. Materials and method : Out of 30 subjects suffering from posterior canal BPPV, 15 were administered a single sitting of the Epley maneuver and 15 underwent a home exercise program of the Brandt- Daroff exercises for two weeks. Analysis of the efficacy of treatment was done based on the Dizziness handicap Inventory scores before and after the treatment. Results : The patients who received the Epley maneuver showed a highly significant mean improvement in the DHI scores of 48.67(p= .001). The Brandt- Darff exercise group too, demonstrated a highly significant improvement of 40.00 (p= .001). There was no significant difference in the improvements shown by the patients between the two groups. Conclusion : Both the Epley maneuver and the Brandt- Daroff exercises are highly effective in treating posterior canal BPPV, reducing the BPPV- related perceived disability handicap and at improving short- term BPPV- related quality of life.

Heterogeneity of antibody responses among clinical responders during grass pollen sublingual immunotherapy

During allergen-specific sublingual immunotherapy (SLIT), the relevance of changes in specific IgE and IgG antibody titres to treatment efficacy remains to be evaluated at an individual patient level. To investigate whether antibody responses can be used as biomarkers for SLIT efficacy. Comprehensive quantitative, qualitative and functional analyses of allergen-specific IgA, IgE, IgG1-4 and IgM responses were performed using purified Phl p 1 to 12 allergens in sera, saliva and nasal secretions from 82 grass pollen allergic patients. These patients were enrolled in a randomized, double-blind placebo-controlled study and assessed in an allergen challenge chamber (ClinicalTrials.gov NCT00619827). Antibody responses were monitored in parallel to clinical responses before and after daily sublingual treatment for 4months with either a grass pollen or a placebo tablet. A significant mean improvement (i.e. 33-40.6%) in rhinoconjunctivitis total symptom scores was observed in SLIT recipients, irrespective of their baseline patterns of IgE sensitization (i.e. narrow, intermediate, broad) to grass pollen allergens. SLIT did not induce any de novo IgE sensitization. Clinical responders encompassed both immunoreactive patients who exhibited strong increases in titres, affinity and/or blocking activity of grass-pollen-specific IgGs (representing 17% of treated patients), as well as patients with no detectable antibody responses distinguishing them from the placebo group. No significant changes were detected in antibody titres in saliva and nasal washes, even in clinical responders. Sublingual immunotherapy with a grass pollen tablet is efficacious irrespective of the patients' baseline sensitization to either single or multiple grass pollen allergens. Seric IgG responses may contribute to SLIT-induced clinical tolerance in a fraction (i.e. 17%) of patients, but additional immune mechanisms are involved in most patients. Consequently, antibody responses cannot be used as a marker of SLIT efficacy at an individual patient level.

Predictors of Persistent Sleep Apnea After Surgery in Children Younger Than 3 Years

Obstructive sleep apnea (OSA) is a common disorder in children and can lead to important sequelae. Predictors of persistent OSA after adenotonsillectomy (T&A) in younger children are not well studied. To evaluate residual OSA in a subgroup of children younger than 3 years after T&A and identify predictors of postoperative residual disease. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of medical records at a tertiary academic children's hospital involving children younger than 3 years who had OSA documented by polysomnogram(PSG) and underwent T&A during the period October 1, 2002, through June 30, 2010. Some of these children had both preoperative and postoperative PSGs. MAIN OUTCOMES AND MEASURES Effect of T&A on sleep study parameters and predictors of persistent disease after surgery. RESULTS A total of 283 patients (mean [SD] age, 22 [7] months) underwent a preoperative PSG, with 70 of these patients having both a preoperative and postoperative PSG. In the group who had preoperative and postoperative PSGs, there were statistically significant improvements in mean (SD) apnea hypopnea index (AHI) (34.8 [40.7] to 5.7 [13.8]; P < .001), baseline oxygen saturation (96.6%[2.1%] to 97.2%[1.4%]; P = .05), minimum oxygen saturation (77.2%[11.4%] to 89.9%[6.8%]; P < .001), and sleep efficiency (84.7%[14.9%] to 88.7%[9.1%]; P = .02) after T&A. When AHI greater than 5 was used as the definition of OSA, 21% of the patients (15 of 70) had residual OSA. The most consistent predictor of residual OSA after T&A was the severity of preoperative OSA (P = .02). CONCLUSIONS AND RELEVANCE In a subgroup of children younger than 3 years with OSA, we found a high rate of residual OSA after T&A. Predictors of residual disease include severity of preoperative OSA as determined by PSG result. Postoperative PSGs might be indicated in these patients.

Patient‐Reported Outcomes and the Association With Clinical Response in Patients With Active Psoriatic Arthritis Treated With Golimumab: Findings Through 2 Years of a Phase III, Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Trial

ObjectiveTo evaluate the effect of golimumab on physical function, health-related quality of life (HRQOL), and productivity in psoriatic arthritis (PsA).MethodsGO-REVEAL was a multicenter, randomized, placebo-controlled study. Adult patients with active PsA (n = 405) received golimumab (50 or 100 mg) or placebo every 4 weeks, with early escape at week 16 (placebo → 50 mg, 50 → 100 mg) or placebo crossover to golimumab 50 mg at week 24. Patient-reported outcomes included physical function (Health Assessment Questionnaire [HAQ] disability index [DI] score), HRQOL (36-item Short Form health survey [SF-36] mental component summary [MCS] and physical component summary [PCS] scores), and productivity (home/school/work). Clinical response was assessed using the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP) and the Psoriasis Area and Severity Index (PASI) score for arthritis and skin symptoms, respectively.ResultsAt week 24, golimumab-treated patients had significant mean improvements in HAQ DI (0.36), SF-36 (PCS 7.83, MCS 3.84), and productivity (2.24) scores compared with placebo (−0.01, 0.67, −0.60, and 0.08, respectively; P <0.001 for all). Also, greater proportions of golimumab- than placebo-treated patients had clinically meaningful improvements in HAQ DI (≥0.30) and SF-36 PCS and MCS (≥5) scores at week 24 (P <0.05). Also at week 24, improvements in DAS28-CRP scores were significantly but moderately correlated with improvements in HAQ DI, SF-36 PCS, and productivity scores. Correlations between these patient-reported outcomes and improvements in PASI, enthesitis, and dactylitis scores were very weak. Improvements in HAQ DI, SF-36, and productivity scores were similar among all groups by week 52 and week 104 when including placebo → golimumab crossover patients.ConclusionGolimumab-treated patients had significant improvements in physical function, HRQOL, and productivity through week 24; these improvements correlated with clinical improvement in signs and symptoms of peripheral arthritis and were sustained through 2 years.

Development of physical performance after acute hip fracture. A pragmatic study in a regular clinical geriatric setting

Background and aim: Hip fracture is a leading cause of mortality, morbidity, and disability in older people. The aim of the present study was to prospectively assess the development of physical performance in patients with hip fracture after surgery. Setting: Prospective, observational study in a Swedish university hospital. Methods: Assessment of 102 consecutive patients (65 females), with a mean age of 82 years (range 35-98) without specific inclusion or exclusion criteria. Seven physical functions were assessed using the following 4 measuring methods and 3 rating scales at baseline 7 to 10 days after surgery and follow-up after 4 months (F4): 10-m habitual walking speed (HWS), timed up and go (TUG), 30-second chair stand test (CST), handgrip strength (HGS), Berg balance scale (BBS), functional ambulation category (FAC), and general mobility. Results: The 47% dropout patients were significantly older and more often lived alone or in nursing homes and used indoor walking aids. At baseline, the mean HWS was 0.4/0.5 (females/males) m/s; TUG 53/30 s; CST 4/5 kg, and HGS 17.4/31.2 kg. The medians of BBS and FAC were 20/20 and 4/4, respectively. There were significant mean improvements at F4 for all 4 measured functions, except for HGS in males but for neither of the rating scales. There was a large heterogeneity in all assessed variables, both at baseline and regarding change at 4 months. Therefore, the mean/median results are depicted in figures, showing all individual results at baseline and F4, compared to reference values and discussed in relation to degree of improvement. Conclusion: The observed large heterogeneity at baseline as well as F4 makes it essentially meaningless to report means and median data of functional assessment of patients with hip fracture. There is a strong need for individualization in both health analysis and how the treatment program is targeted, carried through, and evaluated over time in patients with hip fracture.

Durability of partial humeral head resurfacing

Partial humeral head resurfacing arthroplasty uses a stemless device, which conserves bone and restores normal anatomy. We hypothesized that this does not offer a reasonable alternative to full resurfacing or total shoulder arthroplasty. We performed a retrospective study of 39 shoulders with focal chondral defects of the humeral head treated with partial resurfacing arthroplasty. A minimum of 2 years' follow-up was reported, unless failure and operative intervention superseded this duration. The mean follow-up period was 51.3 months. The mean age was 45.6 years (range, 27-76 years). Preoperative and postoperative evaluation included history, physical examination, radiographs, and clinical scoring with the American Shoulder and Elbow Surgeons Shoulder Score Index and Subjective Shoulder Value. Of the 39 shoulders, 25 (64.1%) showed functional improvement and decreased pain. Significant mean improvements were observed in forward flexion (121° to 152°, P = .002), external rotation (37° to 58°, P = .0003), mean Subjective Shoulder Value (31% to 74%, P < .0001), and ASES score (29 to 70, P < .0001). However, at a mean of 26.6 months' follow-up, the failure group included 6 patients (15.3%) who underwent revision and another 4 (10.2%) who were recommended to undergo revision. Patients with no prior or concomitant procedures were rare (n = 5) but had the most reliable outcomes with partial resurfacing, with no failures in that group. Of the 24 patients with prior procedures, 5 had undergone revision, and the clinical outcome scores for the remaining patients were consistently lower than those seen in patients without prior procedures. Concomitant pathology and prior or concomitant surgical procedures potentially impair the outcome of the resurfacing procedure and could be a contraindication. Long-term success remains guarded with this treatment modality, especially in patients whose chondral injury is not an isolated finding.

Subjective Assessment of Rehabilitation Protocol by Patients after ACL Reconstruction – Preliminary Report

Subjective evaluation by patients has recently become an important adjunct to postoperative clinical assessment. Apart from standard physical examination, scales demonstrating patients’ subjective outcome measures are used for assessing the efficacy of the treatment and rehabilitation of knee ligamentous injuries. The present work presents patients’ subjective assessment of rehabilitation protocols after ACL reconstruction. Forty individuals who had undergone ACL reconstruction were randomised into two groups (G1, G2) and followed one of two rehabilitation protocols (A or B). The subjects assessed their knee function at baseline and after physical therapy using the Lysholm score and the IKDC form. The results were analysed with the Mann-Whitney U test. The subjects also completed a questionnaire at discharge. Analysis of Lysholm and IKDC scores revealed significant differences between the mean pre- and postrehabilitation results in the groups (p<0.05). The greatest improvement was seen in G2 patients rehabilitated with protocol B, with significant mean improvements of 56.3% and 46.7% for the Lysholm and IKDC scores, respectively. Group G1 registered only half of this magnitude of change. Protocol B was also highly rated in the questionnaires. According the patients opinion a rehabilitation protocol involving a larger number of open kinetic chain exercises may prove more effective in the rehabilitation of patients after ACL reconstruction compared to a programme basing mainly on closed kinetic chains.

Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians

Atrophic facial scars which commonly occur after inflammatory acne vulgaris can be extremely disturbing to patients both physically and psychologically. Treatment with fractional laser devices has become increasingly popular, but there has been disappointment in terms of effectiveness. The objective of this study was to assess the safety and efficacy of ablative full-face resurfacing on atrophic acne scars in the Korean population. A total of 22 patients, aged 25-44 years, underwent a new modality of resurfacing combining both short-pulsed and dual-mode erbium:yttrium-aluminum garnet (Er:YAG) laser. The patients had Fitzpatrick skin types ranging from III to V. Photographs were taken before and up to 6 months after treatment. Results were evaluated for the degree of clinical improvement and any adverse events. Degree of improvement was graded using a four-point scale: poor (1) = <25%, fair (2) = 25-50%, good (3) = 51-75%, and excellent (4) = >75%. Based on the blinded photo assessments by two independent reviewers, clinically and statistically significant mean improvement of 3.41 was observed (one-sample Wilcoxon signed rank test, P < 0.001). Complete wound healing occurred between 6 and 9 days. Erythema occurred in all patients and lasted longer than 3 months in two patients (9.1%). Postinflammatory hyperpigmentation occurred in ten patients (45.5%) and lasted longer than 3 months in one patient (4.5%). One patient experienced mild hypopigmentation (4.5%). Mild to moderate acne flare-up occurred in five patients (22.7%). No other adverse effects were observed. A new modality of Er:YAG laser resurfacing combining short-pulsed and dual-mode Er:YAG laser is a safe and very effective treatment modality for atrophic facial acne scars in Asians with darker skin tones.

SAT0537 Health-Related Quality of Life, Dependence and Need for Help after Total Knee Replacement

BackgroundThe need for help in daily activities is influenced not only by chronic diseases that present with disability and pain, such as knee osteoarthritis (OA), but also by psychosocial or...

Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease.

Despite the high incidence of muscle weakness in individuals with amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND), the effects of exercise in this population are not well understood. This is an update of a review first published in 2008. To systematically review randomised and quasi-randomised studies of exercise for people with ALS or MND. We searched The Cochrane Neuromuscular Disease Group Specialized Register (2 July 2012), CENTRAL (2012, Issue 6 in The Cochrane Library), MEDLINE (January 1966 to June 2012), EMBASE (January 1980 to June 2012), AMED (January 1985 to June 2012), CINAHL Plus (January 1938 to June 2012), LILACS (January 1982 to June 2012), Ovid HealthSTAR (January 1975 to December 2012). We also searched ProQuest Dissertations & Theses A&I (2007 to 2012), inspected the reference lists of all papers selected for review and contacted authors with expertise in the field. We included randomised or quasi-randomised controlled trials of people with a diagnosis of definite, probable, probable with laboratory support, or possible ALS, as defined by the El Escorial criteria. We included progressive resistance or strengthening exercise, and endurance or aerobic exercise. The control condition was no exercise or standard rehabilitation management. Our primary outcome measure was improvement in functional ability, decrease in disability or reduction in rate of decline as measured by a validated outcome tool at three months. Our secondary outcome measures were improvement in psychological status or quality of life, decrease in fatigue, increase in, or reduction in rate of decline of muscle strength (strengthening or resistance studies), increase in, or reduction in rate of decline of aerobic endurance (aerobic or endurance studies) at three months and frequency of adverse effects. We did not exclude studies on the basis of measurement of outcomes. Two review authors independently assessed trial quality and extracted the data. We collected adverse event data from included trials. The review authors contacted the authors of the included studies to obtain information not available in the published articles. We identified two randomised controlled trials that met our inclusion criteria, and we found no new trials when we updated the searches in 2012. The first, a study with overall unclear risk of bias, examined the effects of a twice-daily exercise program of moderate load endurance exercise versus "usual activities" in 25 people with ALS. The second, a study with overall low risk of bias, examined the effects of thrice weekly moderate load and moderate intensity resistance exercises compared to usual care (stretching exercises) in 27 people with ALS. After three months, when the results of the two trials were combined (43 participants), there was a significant mean improvement in the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) measure of function in favour of the exercise groups (mean difference 3.21, 95% confidence interval 0.46 to 5.96). No statistically significant differences in quality of life, fatigue or muscle strength were found. In both trials adverse effects, investigators reported no adverse effects such as increased muscle cramping, muscle soreness or fatigue The included studies were too small to determine to what extent strengthening exercises for people with ALS are beneficial, or whether exercise is harmful. There is a complete lack of randomised or quasi-randomised clinical trials examining aerobic exercise in this population. More research is needed.

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Lower heart rate variability implies increased risk of cardiovascular disease. This study aimed to evaluate the relationship between mineral metabolism and heart rate variability and longitudinal changes of heart rate variability after parathyroidectomy in stage 5 CKD patients. This cross-sectional study included 118 stage 5 CKD patients, 87 controls, and a prospective study in two subgroups classified as successful (n=17) and unsuccessful (n=4) parathyroidectomy follow-up enrolled from March of 2011 to December of 2012. Blood examination and 24-hour Holter for heart rate variability were measured. Most heart rate variability indices were lower in stage 5 CKD patients. In multivariate stepwise regression models, serum intact parathyroid hormone was correlated with mean normal-to-normal R-R intervals, mean heart rate, and very low frequency, serum calcium was correlated with SD of 5-minute average of normal R-R intervals, and serum phosphorus was correlated with very low frequency and low frequency/high frequency. Compared with baseline, the successful parathyroidectomy subgroup had significant improvements in mean normal-to-normal R-R intervals, mean heart rate, SD of normal-to-normal R-R intervals, SD of 5-minute average of normal R-R intervals, very low frequency, high frequency, and low frequency/high frequency. There was no significant change of heart rate variability in patients after unsuccessful parathyroidectomy. Disorders of mineral metabolism are associated with decreased heart rate variability in stage 5 CKD. Successful parathyroidectomy may contribute to reverse this cardiovascular disease risk in severe secondary hyperparathyroidism patients.

Treatment of Pseudoptosis Secondary to Aberrant Regeneration of the Facial Nerve With Botulinum Toxin Type A

To report on low-dose minimal injection treatment using botulinum toxin A for pseudoptosis secondary to aberrant facial nerve regeneration. A retrospective chart review was carried out on 16 consecutive patients with pseudoptosis secondary to aberrant facial nerve regeneration who received botulinum toxin A injections. Study patients include 6 men and 10 women with median age of 65 years (range 34-78). Etiology of facial nerve palsy included Bell palsy (11), surgical injury (2), trauma (2), and Ramsay-Hunt syndrome (1). Mean duration of facial nerve palsy was 8.5 years (1.1-30). Mean duration of pseudoptosis was 6.8 years (0.5-29). Botulinum toxin A (Botox; Allergan) injections were given in the medial and lateral pretarsal upper eyelid orbicularis oculi with some patients also receiving a central and/or additional lateral injection. Mean number of injections was 2.6 (2-4). Mean total dose was 10.3 units (5-20). Subjective improvement of symptoms at follow up was noted in all cases. Margin reflex distance in all patients showed statistically significant (p < 0.001) mean improvement of 1.6 mm (0.5-2.5) during orbicularis oris contracture. No side effects were reported, and all patients desired repeat injections. Repeat injection was performed at 3- to 6-month intervals, with most patients (12) returning every 3 months. Mean follow up was 12.2 months (3-61). Using low doses of carefully injected botulinum toxin A into the upper eyelid can provide safe and successful treatment of pseudoptosis due to aberrant facial nerve regeneration.

A beamformer post-filter for cochlear implant noise reduction

Cochlear implant users have limited ability to understand speech in noisy conditions. Signal processing methods to address this issue that use multiple microphones typically use beamforming to perform noise reduction. However, the effectiveness of the beamformer is diminished as the number of interfering noises increases and the acoustic environment becomes more diffuse. A multi-microphone noise reduction algorithm that aims to address this issue is presented in this study. The algorithm uses spatial filtering to estimate the signal-to-noise ratio (SNR) and attenuates time-frequency elements that have poor SNR. The algorithm was evaluated by measuring intelligibility of speech embedded in 4-talker babble where the interfering talkers were spatially separated and changed location during the test. Twelve cochlear implant users took part in the evaluation, which demonstrated a significant mean improvement of 4.6 dB (standard error 0.4, P < 0.001) in speech reception threshold compared to an adaptive beamformer. The results suggest that a substantial improvement in performance can be gained for cochlear implant users in noisy environments where the noise is spatially separated from the target speech.

Abstract No. 317 - Safety and efficacy of partial splenic embolization for hypersplenism: a meta-analysis

<h3>Purpose</h3> Partial splenic embolization (PSE) has been shown to be effective in treatment of thrombocytopenia due to hypersplenism in several small cohorts. However, PSE is infrequently performed, largely due to initial reports of high associated morbidity and mortality. Our study investigates the efficacy and complications associated with PSE using a meta-analysis. <h3>Materials and Methods</h3> Literature search was performed using Pubmed for articles published from 1980 to 2012. Studies with atleast 5 patients that used currently accepted methods of PSE with particulate and liquid embolics to achieve splenic infarction were included. Studies with embolization of the proximal splenic artery were excluded. Improvements in platelet count and complications were recorded. Meta-analysis was performed using random effects model due to heterogeneity between study groups. Comprehensive Meta-Analysis (CMA) V2 software was used to pool the results. <h3>Results</h3> 18 studies met inclusion criteria. Complications related to post-embolization syndrome occurred in most patients (abdominal pain rate=0.801,p=.003 and Fever=0.830, p=.001) but were easily managed with pain medications/antipyretics. Major complications are reported in the Table. Results fall within acceptable complications thresholds set by Society of Interventional Radiology (SIR) for splenic embolization. 6 studies reported platelet counts. Meta-analysis showed a mean platelet improvement of 114.832 +/- 24.325, p <.001. <h3>Conclusion</h3> PSE is effective in improving thrombocytopenia due to hypersplenism with a statistically significant mean improvement of platelet counts. PSE is a safe procedure with a complication rate that falls within thresholds set forth by SIR. Table 1

Midterm Outcomes and Predictors of Clinical Success with the KineSpring Knee Implant System

The purpose of this study was to (1) evaluate joint pain and function in knee osteoarthritis (OA) patients treated with a joint-sparing, extracapsular implant and (2) identify patient characteristics that influenced clinical outcomes. This study included 99 patients with symptomatic medial knee OA refractory to conservative care who were treated with the KineSpring Knee Implant System and followed for a mean of 17 months (range, 1.5 to 48 months). All devices were successfully implanted and activated with no intraoperative complications. Statistically significant mean improvements of 56%, 50%, and 38% were observed for Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Function, and Stiffness scales, respectively (all P < 0.001). Regardless of gender, age group, body mass index classification, or disease severity, all WOMAC domain scores significantly improved during the postoperative follow-up period. WOMAC clinical success rates were 77.8% for Pain, 77.8% for Function, and 68.7% for Stiffness. Neither gender, age group, body mass index classification, nor disease severity predicted clinical success in any WOMAC domain. In conclusion, the KineSpring System yields clinically meaningful improvements in joint pain and function in patients with medial knee OA. Additionally, unlike joint-altering procedures such as knee arthroplasty or high tibial osteotomy, patient characteristics had little association with postoperative clinical outcomes.

The Effect of Exercise on the Cardiovascular Risk Factors Constituting the Metabolic Syndrome

BackgroundNumerous meta-analyses have investigated the effect of exercise in different populations and for single cardiovascular risk factors, but none have specifically focused on the metabolic syndrome (MetS) patients and the concomitant effect of exercise on all associated cardiovascular risk factors.ObjectiveThe aim of this article was to perform a systematic review with a meta-analysis of randomized and clinical controlled trials (RCTs, CTs) investigating the effect of exercise on cardiovascular risk factors in patients with the MetS.MethodsRCTs and CTs ≥4 weeks investigating the effect of exercise in healthy adults with the MetS and published in a peer-reviewed journal up to November 2011 were included. Primary outcome measures were changes in waist circumference (WC), systolic and diastolic blood pressure, high-density lipoprotein cholesterol (HDL-C), triglycerides and fasting plasma glucose. Peak oxygen uptake ( {dot{{V}}text{O}}_{{ 2 {text{peak}}}} ) was a secondary outcome. Random and fixed-effect models were used for analyses and data are reported as means and 95% confidence intervals (CIs).ResultsSeven trials were included, involving nine study groups and 206 participants (128 in exercise group and 78 in control group). Significant mean reductions in WC −3.4 (95% CI −4.9, −1.8) cm, blood pressure −7.1 (95% CI −9.03, −5.2)/−5.2 (95% CI −6.2, −4.1) mmHg and a significant mean increase in HDL-C +0.06 (95% CI +0.03, +0.09) mmol/L were observed after dynamic endurance training. Mean plasma glucose levels −0.31 (95% CI −0.64, 0.01; p = 0.06) mmol/L and triglycerides −0.05 (95% CI −0.20, 0.09; p = 0.47) mmol/L remained statistically unaltered. In addition, a significant mean improvement in {dot{{V}}text{O}}_{{ 2 {text{peak}}}} of +5.9 (95% CI +3.03, +8.7) mL/kg/min or 19.3% was found.ConclusionsOur results suggest that dynamic endurance training has a favourable effect on most of the cardiovascular risk factors associated with the MetS. However, in the search for training programmes that optimally improve total cardiovascular risk, further research is warranted, including studies on the effects of resistance training and combined resistance and endurance training.

NUTRITIONAL EDUCATION FOR THE MANAGEMENT OF OSTEODYSTROPHY (NEMO) IN PATIENTS ON HAEMODIALYSIS: A RANDOMISED CONTROLLED TRIAL

To examine the effect of self-management dietary counselling (SMDC) on adherence to dietary management of hyperphosphatemia among haemodialysis patients. An eight-week cluster based randomised control trial. 122 stable adult patients were recruited from an HD unit in Sidon, Lebanon. Study groups were: full intervention (A) (n = 41), partial intervention (B) (n = 41) and control (C) (n = 40). Group (A) received SMDC, Group (B) received educational games only and Group (C) did not receive any research intervention. Serum phosphorus (P), Calcium Phosphate product (Ca × P) and two questionnaires: patient knowledge (PK) and dietary non-adherence (PDnA) to P reduced diet. Group A experienced a significant improvement in mean (± SD) P (6.54 ± 2.05 - 5.4 ± 1.97 mg/dl), Ca × P (58 ± 17 - 49 ± 12), PK scores (50 ± 17 - 69 ± 25%) and PDnA scores (21.4 ± 4.0 - 18.3 ± 2.0). Group B experienced a significant improvement in Ca × P (52 ± 14-45 ± 16). Group C did not experience any significant change post intervention. Our findings demonstrate the importance of patient-tailored counselling on serum P management.

An Investigation of Working Memory Effects on Oral Grammatical Accuracy and Fluency in Producing Questions in English

This article addresses the question of how far working memory may affect second language (L2) learners' improvement in spoken language during a period of immersion. Research is presented testing the hypothesis that individual differences in working memory (WM) capacity are associated with individual variation in improvements in oral production of questions in English. Thirty‐two Chinese adult speakers of English were tested, before and after a year's postgraduate study in the United Kingdom, to measure grammatical accuracy and fluency using a question elicitation task, and to measure WM using a battery of first language (L1) and L2 WM tests. Story recall in L1 (Mandarin) was significantly associated with individuals' improvement in oral grammatical measures (p &lt; .05). However, there was no significant mean improvement across the cohort in grammatical accuracy, although there was for fluency. The findings suggest that WM may aid certain aspects of individuals' L2 oral proficiency during academic immersion through postgraduate study. They also indicate that academic immersion in itself can lead to improvements in oral proficiency, independent of WM capacity, but there is no general guarantee of significant grammatical change. Further research to clarify the opportunities for input and interaction available in academic immersion settings is called for.

Paper 46: Long-Term Durability of Functional Improvement After Treatment with Autologous Chondrocyte Implantation (ACI): a Multicenter, Observational Study in US Subjects

Autologous Chondrocyte Implantation (ACI) for full-thickness lesions of the distal femur has demonstrated good short- to mid-term clinical improvement. However, long-term durability (> 5 years) of ACI has not been evaluated in US patients to date. The purpose of this study was to determine if patients who improve from baseline to earlier follow-up will sustain improvement at later follow-up. In a multicenter, observational, within-patient control cohort study, study patients met predefined eligibility criteria before data analyses (full-thickness distal femur lesion(s); modified overall Cincinnati knee scores at baseline and 1-5 year follow-up; ACI before Dec. 31, 1996). Per a priori analysis plan, ACI durability was determined by comparing early (1-5 year) outcomes to long-term (6-10 year) outcomes. 72 patients met eligibility criteria. Patients and defect baseline characteristics were: mean age=37 years; 61% male; mean lesion size=4.3 cm2; low mean baseline overall condition score=3.4 points (poor). Within the 5-years prior to the cartilage biopsy harvest, 68% (49/72) of patients had at least one cartilage repair procedure. At 1-5 year follow-up (mean follow-up=4.6 years), 75% (54/72) improved. At 6-10 years follow-up (mean follow-up=9.2 years), 87% (47/54) of patients who improved at the earlier follow-up period sustained a significant mean improvement in overall condition score of 3.8 points from baseline. In addition, at a mean follow-up of 9.2 years, 69% (50/72) of patients significantly improved in overall condition score from baseline. In total, ACI failed in 12 patients; 75% (9/12) of treatment failures occurred at a mean follow-up of 2.5 years. Treatment with ACI for large, symptomatic, full-thickness lesions of the distal femur in patients with a history of failed prior surgeries can result in early improvement that is sustained at longer follow-up (up to 10 years) in the majority of patients.