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Background: Adult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls. Methods: In this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics. Results: DN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps. Conclusions: DN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.
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AIM: To study if functional electrical stimulation (FES) of the peroneal nerve, which activates dorsiflexion, can improve body functions, activities, and participation and could be an effective alternative treatment in individuals with unilateral spastic cerebral palsy (CP). METHOD: A randomized cross-over trial was performed in 25 children with unilateral spastic CP (classified in Gross Motor Function Classification System levels I and II) aged 4 to 18 years (median age at inclusion 9 years 8 months, interquartile range = 7 years-13 years 8 months), 15 patients were male. The study consisted of two 12-week blocks of treatment, that is, conventional treatment (ankle foot orthosis [AFO] or adapted shoes) and FES, separated by a 6-week washout period. Outcome measures included the Goal Attainment Scale (GAS), the Cerebral Palsy Quality of Life questionnaire, and a three-dimensional gait analysis. RESULTS: Eighteen patients completed the trial. The proportion of GAS goals achieved was not significantly higher in the FES versus the conventional treatment phase (goal 1 p = 0.065; goal 2 p = 1.00). When walking while stimulated with FES, ankle dorsiflexion during mid-swing decreased over time (p = 0.006, average decrease of 4.8° with FES), with a preserved increased ankle range of motion compared to conventional treatment (p < 0.001, mean range of motion with FES +10.1° compared to AFO). No changes were found in the standard physical examination or regarding satisfaction with orthoses and feelings about the ability to dress yourself. In four patients, FES therapy failed; in 12 patients FES therapy continued after the trial. INTERPRETATION: FES is not significantly worse than AFO; however, patient selection is critical, and a testing period and thorough follow-up are needed.
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Parálisis Cerebral , Terapia por Estimulación Eléctrica , Ortesis del Pié , Trastornos Neurológicos de la Marcha , Niño , Femenino , Humanos , Masculino , Parálisis Cerebral/terapia , Estudios Cruzados , Terapia por Estimulación Eléctrica/métodos , Marcha/fisiología , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapia , Calidad de Vida , Caminata/fisiología , Preescolar , AdolescenteRESUMEN
BACKGROUND: Spastic cerebral palsy is the most common cause of motor disability in children. It often leads to foot drop or equinus, interfering with walking. Ankle-foot orthoses (AFOs) are commonly used in these cases. However, AFOs can be too restrictive for mildly impaired patients. Functional electrical stimulation (FES) of the ankle-dorsiflexors is an alternative treatment as it could function as a dynamic functional orthosis. Despite previous research, high level evidence on the effects of FES on activities and participation in daily life is missing. The primary aim of this study is to evaluate whether FES improves the activity and participation level in daily life according to patients, and the secondary aim is to provide evidence of the effect of FES at the level of body functions and activities. Furthermore, we aim to collect relevant information for decisions on its clinical implementation. METHODS: A randomized crossover trial will be performed on 25 children with unilateral spastic cerebral palsy. Patients aged between 4 and 18 years, with Gross Motor Functioning Classification System level I or II and unilateral foot drop of central origin, currently treated with AFO or adapted shoes, will be included. All participants will undergo twelve weeks of conventional treatment (AFO/adapted shoes) and 12 weeks of FES treatment, separated by a six-week washout-phase. FES treatment consists of wearing the WalkAide® device, with surface electrodes stimulating the peroneal nerve during swing phase of gait. For the primary objective, the Goal Attainment Scale is used to test whether FES improves activities and participation in daily life. The secondary objective is to prove whether FES is effective at the level of body functions and structures, and activities, including ankle kinematics and kinetics measured during 3D-gait analysis and questionnaire-based frequency of falling. The tertiary objective is to collect relevant information for clinical implementation, including acceptability using the device log file and side effect registration, cost-effectiveness based on quality adjusted life years (QALYs) and clinical characteristics for patient selection. DISCUSSION: We anticipate that the results of this study will allow evidence-based use of FES during walking in children with unilateral spastic cerebral palsy. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03440632 .
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Parálisis Cerebral , Personas con Discapacidad , Terapia por Estimulación Eléctrica , Ortesis del Pié , Trastornos Motores , Adolescente , Parálisis Cerebral/terapia , Niño , Preescolar , Estudios Cruzados , Estimulación Eléctrica , Terapia por Estimulación Eléctrica/métodos , Marcha/fisiología , Humanos , Resultado del Tratamiento , Caminata/fisiologíaRESUMEN
OBJECTIVE: Significant attempts are being made to generate multifunctional, hybrid or peptide combinations as novel therapeutic strategies for type 2 diabetes, however this presents key challenges including design and pharmaceutical development. In this study, we evaluated metabolic properties of oral nutritional supplement epigallocatechin gallate (EGCG) in combination with GLP-1 agonist exendin-4 in a mouse model of dietary-induced diabetes and obesity. METHODS: EGCG, exendin-4 or combination of both were administered twice-daily over 28 days to high fat (HF) mice on background of low-dose streptozotocin. Energy intake, body weight, fat mass, glucose tolerance, insulin sensitivity, lipid profile, biochemical and hormone markers, and islet histology were examined. RESULTS: All treatment groups exhibited significantly reduced body weight, fat mass, circulating glucose and insulin concentrations, and HbA1c levels which were independent of changes in energy intake. Similarly, there was marked improvement in glycaemic control, glucose-stimulated insulin release, insulin sensitivity, total cholesterol and triglycerides, with most prominent effects observed following combination therapy. Circulating corticosterone concentrations and 11beta-hydroxysteroid dehydrogenase type1 (11ß-HSD1) staining (in pancreas) were beneficially decreased without changes in circulating interleukin 6 (IL-6), alanine transaminase (ALT) and glutathione reductase. Combination therapy resulted in increased islet area and number, beta cell area, and pancreatic insulin content. Generally, metabolic effects were much more pronounced in mice which received combination therapy. CONCLUSIONS: EGCG alone and particularly in combination with exendin-4 exerts positive metabolic properties in HF mice. EGCG may be useful dietary adjunct alongside GLP-1 mimetics in treatment of diabetes and related disorders.
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Catequina/análogos & derivados , Diabetes Mellitus Experimental/tratamiento farmacológico , Diabetes Mellitus Experimental/metabolismo , Exenatida/uso terapéutico , 11-beta-Hidroxiesteroide Deshidrogenasa de Tipo 1/metabolismo , Adiposidad/efectos de los fármacos , Alanina Transaminasa/sangre , Animales , Glucemia/metabolismo , Peso Corporal/efectos de los fármacos , Catequina/administración & dosificación , Catequina/farmacología , Catequina/uso terapéutico , Corticosterona/sangre , Diabetes Mellitus Experimental/sangre , Dieta Alta en Grasa , Quimioterapia Combinada , Ingestión de Energía/efectos de los fármacos , Exenatida/administración & dosificación , Exenatida/farmacología , Prueba de Tolerancia a la Glucosa , Glutatión Reductasa/metabolismo , Hemoglobina Glucada/metabolismo , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/farmacología , Hipoglucemiantes/uso terapéutico , Insulina/metabolismo , Resistencia a la Insulina , Interleucina-6/sangre , Ratones ObesosRESUMEN
Sedentary behavior (sitting/lying at low energy expenditure while awake) is emerging as an important risk factor that may compromise the health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. We examined associations of sedentary time with HRQoL in CRC survivors, 2-10 years post-diagnosis. In a cross-sectional study, stage I-III CRC survivors (n = 145) diagnosed (2002-2010) at Maastricht University Medical Center+, the Netherlands, wore the thigh-mounted MOX activity monitor 24 h/day for seven consecutive days. HRQoL outcomes were assessed by validated questionnaires (EORTC QLQ-C30, WHODAS II, Checklist Individual Strength, and Hospital Anxiety and Depression Scale). Confounder-adjusted linear regression models were used to estimate associations with HRQoL outcomes of MOX-derived total and prolonged sedentary time (in prolonged sedentary bouts ≥ 30 min), and usual sedentary bout duration, corrected for waking wear time. On average, participants spent 10.2 h/day sedentary (SD, 1.6), and 4.5 h/day in prolonged sedentary time (2.3). Mean usual sedentary bout duration was 27.3 min (SD, 16.8). Greater total and prolonged sedentary time, and longer usual sedentary bout duration were associated with significantly (P < 0.05) lower physical functioning, and higher disability and fatigue scores. Greater prolonged sedentary time and longer usual sedentary bout duration also showed significant associations with lower global quality of life and role functioning. Associations with distress and social functioning were non-significant. Sedentary time was cross-sectionally associated with poorer HRQoL outcomes in CRC survivors. Prospective studies are needed to investigate whether sedentary time reduction is a potential target for lifestyle interventions aiming to improve the HRQoL of CRC survivors.
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PURPOSE: Previous research indicates that sedentary behavior is unfavorably associated with health-related quality of life (HRQoL) of colorectal cancer (CRC) survivors. Using isotemporal substitution modeling, we studied how substituting sedentary behavior with standing or physical activity was associated with HRQoL in CRC survivors, 2-10 years post-diagnosis. METHODS: A cross-sectional study was conducted in stage I-III CRC survivors (n = 145) diagnosed at Maastricht University Medical Center+, the Netherlands (2002-2010). Sedentary, standing, and physical activity time were measured by the thigh-mounted MOX activity monitor. HRQoL outcomes comprised global quality of life, physical, role, and social functioning, and disability (scales: 0-100), fatigue (20-140), and depression and anxiety (0-21). Isotemporal substitution modeling was applied to analyze associations with HRQoL of substituting sedentary time with equal time in standing or physical activity. RESULTS: On average, participants spent 10.2 h/day sedentary (SD, 1.7), 3.4 h/day standing (1.3), and 1.7 h/day in physical activity (0.8). In confounder-adjusted isotemporal models, substituting sedentary time with standing or with physical activity was associated with significantly better physical functioning (regression coefficient [ß], i.e., difference in outcome score per 1 h/day of sedentary time substituted with standing or physical activity, 3.1; 95% confidence interval [CI] 0.5, 5.7; and 5.6; 0.7, 10.6, respectively). Substituting sedentary time with standing was also associated with significantly lower disability (ß, -3.0; 95% CI -4.9, -1.1) and fatigue (-4.0; -7.6, -0.3). CONCLUSIONS: Our results suggest that substituting sedentary behavior with standing or physical activity may be beneficially associated with certain HRQoL outcomes in CRC survivors. Prospective studies are warranted to confirm whether actual substitution of sedentary behavior with these activities may improve HRQoL in CRC survivors.
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Neoplasias Colorrectales/rehabilitación , Calidad de Vida , Conducta Sedentaria , Sobrevivientes , Anciano , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Países BajosRESUMEN
AIMS/HYPOTHESIS: The study investigated cross-sectional associations of total amount and patterns of sedentary behaviour with glucose metabolism status and the metabolic syndrome. METHODS: We included 2,497 participants (mean age 60.0 ± 8.1 years, 52% men) from The Maastricht Study who were asked to wear an activPAL accelerometer 24 h/day for 8 consecutive days. We calculated the daily amount of sedentary time, daily number of sedentary breaks and prolonged sedentary bouts (≥30 min), and the average duration of the sedentary bouts. To determine glucose metabolism status, participants underwent an oral glucose tolerance test. Associations of sedentary behaviour variables with glucose metabolism status and the metabolic syndrome were examined using multinomial logistic regression analyses. RESULTS: Overall, 1,395 (55.9%) participants had normal glucose metabolism, 388 (15.5%) had impaired glucose metabolism and 714 (28.6%) had type 2 diabetes. The odds ratio per additional hour of sedentary time was 1.22 (95% CI 1.13, 1.32) for type 2 diabetes and 1.39 (1.27, 1.53) for the metabolic syndrome. No significant or only weak associations were seen for the number of sedentary breaks, number of prolonged sedentary bouts or average bout duration with either glucose metabolism status or the metabolic syndrome. CONCLUSIONS/INTERPRETATION: An extra hour of sedentary time was associated with a 22% increased odds for type 2 diabetes and a 39% increased odds for the metabolic syndrome. The pattern in which sedentary time was accumulated was weakly associated with the presence of the metabolic syndrome. These results suggest that sedentary behaviour may play a significant role in the development and prevention of type 2 diabetes, although longitudinal studies are needed to confirm our findings.
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Diabetes Mellitus Tipo 2/epidemiología , Síndrome Metabólico/epidemiología , Conducta Sedentaria , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
As accelerometers are commonly used for 24-h measurements of daily activity, methods for separating waking from sleeping time are necessary for correct estimations of total daily activity levels accumulated during the waking period. Therefore, an algorithm to determine wake and bed times in 24-h accelerometry data was developed and the agreement of this algorithm with self-report was examined. One hundred seventy-seven participants (aged 40-75 years) of The Maastricht Study who completed a diary and who wore the activPAL3™ 24 h/day, on average 6 consecutive days were included. Intraclass correlation coefficient (ICC) was calculated and the Bland-Altman method was used to examine associations between the self-reported and algorithm-calculated waking hours. Mean self-reported waking hours was 15.8 h/day, which was significantly correlated with the algorithm-calculated waking hours (15.8 h/day, ICC = 0.79, P = < 0.001). The Bland-Altman plot indicated good agreement in waking hours as the mean difference was 0.02 h (95% limits of agreement (LoA) = -1.1 to 1.2 h). The median of the absolute difference was 15.6 min (Q1-Q3 = 7.6-33.2 min), and 71% of absolute differences was less than 30 min. The newly developed automated algorithm to determine wake and bed times was highly associated with self-reported times, and can therefore be used to identify waking time in 24-h accelerometry data in large-scale epidemiological studies.
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Acelerometría/métodos , Algoritmos , Actividad Motora , Sueño , Vigilia , Actividades Cotidianas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , AutoinformeRESUMEN
PURPOSE: Introducing care pathways is seen as a method to realise patient-focussed care conform evidence-based guidelines. The goal of this study is to determine the long-term effects of a regional care pathway for patients with rectal cancer. PATIENTS AND METHODS: Data on almost 400 patients with rectal carcinoma from three hospitals were obtained from the Netherlands Cancer Registry and the Dutch Surgical Colorectal Audit. Results on seven structure and process indicators were analysed and compared before and at two time points after implementing a regional care pathway over a total period from 2007 to 2012. To determine motivation and interpret the results, relevant professionals of the participating hospitals were interviewed. RESULTS: After implementing the care pathway, the performance of computed tomography (CT) scans in the diagnostic phase significantly improved (p = 0.007/0.07). The number of patients discussed in the preoperative multidisciplinary team (MDT) meeting improved significantly (p = <0.001), and after implementing the care pathway, 94% of the patients were discussed. Further, a significant reduction in time between the first tumour biopsy and the MDT meeting was realised (p = 0.01). Professionals stated that the regional care pathway has led to more clarity about the patient route and more awareness about complying with evidence-based guidelines. CONCLUSIONS: The regional care pathway provided a solid basis for uniforming care, working according evidence-based guidelines and further cooperation on regional level. For mainly the waiting and throughput times, the guidelines and norms had probably a stronger effect on the results than the care pathway.
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Vías Clínicas , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugía , Biopsia , Medicina Basada en la Evidencia , Administración Hospitalaria , Humanos , Imagen por Resonancia Magnética , Países Bajos , Objetivos Organizacionales , Grupo de Atención al Paciente , Radioterapia Adyuvante , Neoplasias del Recto/radioterapia , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Increased forefoot loading in diabetic polyneuropathy plays an important role in the development of plantar foot ulcers and can originate from alterations in muscle strength, joint moments and gait pattern. The current study evaluated whether strength training can improve lower extremity joint moments and spatiotemporal gait characteristics in patients with diabetic polyneuropathy. An intervention group receiving strength training during 24 weeks and a control group receiving no intervention. Measurements were performed in both groups at t=0, t=12, t=24 and t=52 weeks at an individually preferred and standardized imposed gait velocity. The strength training did not affect the maximal amplitude of hip, knee and ankle joint moments, but did result in an increase in stance phase duration, stride time and stride length of approximately 5%, during the imposed gait velocity. In addition, both groups increased their preferred gait velocity over one year. Future longitudinal studies should further explore the possible effects of strength training on spatiotemporal gait characteristics. The current study provides valuable information on changes in gait velocities and the progressive lower extremity problems in patients with polyneuropathy.
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Neuropatías Diabéticas/fisiopatología , Marcha/fisiología , Pierna/fisiología , Entrenamiento de Fuerza/métodos , Anciano , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Cinética , MasculinoRESUMEN
The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n=94), without polyneuropathy (n=39) and healthy elderly (n=19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r=-.749, p<.001 at the imposed, and r=-.693, p<.001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r=-.837, p<.001 at the imposed, and r=-.731, p<.001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution.
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Articulación del Tobillo/inervación , Articulación del Tobillo/fisiopatología , Fenómenos Biomecánicos/fisiología , Neuropatías Diabéticas/fisiopatología , Antepié Humano/fisiología , Marcha/fisiología , Rango del Movimiento Articular/fisiología , Soporte de Peso/fisiología , Aceleración , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Equilibrio Postural/fisiología , Tiempo de Reacción/fisiología , Valores de Referencia , Caminata/fisiologíaRESUMEN
BACKGROUND: To date, detailed analyses of walking patterns using accelerometers during the 6-min walk test (6MWT) have not been performed in patients with chronic obstructive pulmonary disease (COPD). Therefore, it remains unclear whether and to what extent COPD patients have an altered walking pattern during the 6MWT compared to healthy elderly subjects. METHODOLOGY/PRINCIPAL FINDINGS: 79 COPD patients and 24 healthy elderly subjects performed the 6MWT wearing an accelerometer attached to the trunk. The accelerometer features (walking intensity, cadence, and walking variability) and subject characteristics were assessed and compared between groups. Moreover, associations were sought with 6-min walk distance (6MWD) using multiple ordinary least squares (OLS) regression models. COPD patients walked with a significantly lower walking intensity, lower cadence and increased walking variability compared to healthy subjects. Walking intensity and height were the only two significant determinants of 6MWD in healthy subjects, explaining 85% of the variance in 6MWD. In COPD patients also age, cadence, walking variability measures and their interactions were included were significant determinants of 6MWD (total variance in 6MWD explained: 88%). CONCLUSIONS/SIGNIFICANCE: COPD patients have an altered walking pattern during 6MWT compared to healthy subjects. These differences in walking pattern partially explain the lower 6MWD in patients with COPD.
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Marcha/fisiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Caminata/fisiología , Fenómenos Biomecánicos , Estudios de Casos y Controles , Humanos , Factores de TiempoRESUMEN
AIM: The purpose of the present study was to distinguish the effects of both diabetes mellitus type 2 (DM2) and diabetic polyneuropathy (DPN) on mobility, muscle strength and health related quality of life (HR-QoL). METHODS: DPN patients (n=98), DM2 patients without DPN (DC) (n=39) and healthy subjects (HC) (n=19) performed isometric and isokinetic lower limb muscle strength tests. Mobility was determined by a timed up and go test (TUGT), a 6 min walk test and the physical activity scale for the elderly questionnaire. HR-QoL was determined by the SF36 questionnaire. RESULTS: DPN patients had moderate polyneuropathy. In both DPN and DC patients leg muscle strength was reduced by 30-50% compared to HC. Muscle strength was correlated with mobility tests, and reduced muscle strength as well as impaired mobility were associated with a loss of HR-Qol (all p<0.05). We did not observe major differences in muscle strength, mobility (except for the TUGT, p<0.01) and HR-QoL between diabetic patients with and without DPN. CONCLUSION: DM2 patients, with and without DPN, have decreased maximal muscle strength in the lower limbs and impaired mobility. These abnormalities are associated with a loss of HR-QoL. The additional effect of moderate DPN was small in our patients.
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Diabetes Mellitus Tipo 2/fisiopatología , Neuropatías Diabéticas/fisiopatología , Limitación de la Movilidad , Calidad de Vida , Anciano , Estudios de Casos y Controles , Humanos , Extremidad Inferior/fisiopatología , Persona de Mediana Edad , Fuerza MuscularRESUMEN
In plantar pressure measurement, both peak pressure and pressure time integral are used as variables to assess plantar loading. However, pressure time integral shows a high concordance with peak pressure. Many researchers and clinicians use Novel software (Novel GmbH Inc., Munich, Germany) that calculates this variable as the summation of the products of peak pressure and duration per time sample, which is not a genuine integral of pressure over time. Therefore, an alternative calculation method was introduced. The aim of this study was to explore the relevance of this alternative method, in different populations. Plantar pressure variables were measured in 76 people with diabetic polyneuropathy, 33 diabetic controls without polyneuropathy and 19 healthy subjects. Peak pressure and pressure time integral were obtained using Novel software. The quotient of the genuine force time integral over contact area was obtained as the alternative pressure time integral calculation. This new alternative method correlated less with peak pressure than the pressure time integral as calculated by Novel. The two methods differed significantly and these differences varied between the foot sole areas and between groups. The largest differences were found under the metatarsal heads in the group with diabetic polyneuropathy. From a theoretical perspective, the alternative approach provides a more valid calculation of the pressure time integral. In addition, this study showed that the alternative calculation is of added value, along peak pressure calculation, to interpret adapted plantar pressures patterns in particular in patients at risk for foot ulceration.
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Pie/fisiología , Modelos Biológicos , Presión , Anciano , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/fisiopatología , Neuropatías Diabéticas/fisiopatología , Humanos , Persona de Mediana Edad , Programas Informáticos , Caminata/fisiologíaRESUMEN
INTRODUCTION: Type 2 diabetes mellitus (DM2) patients may have decreased muscle strength. This decline can have multiple causes, among them diabetic polyneuropathy (DPN). We sought to determine the effect of nerve deterioration on muscle strength in DM2 patients with and without DPN. METHODS: Nineteen DM2 patients with DPN (DPN group), 15 DM2 patients without DPN (DC group), and 18 healthy subjects (HC group) were recruited. We determined motor and sensory nerve function of the lower extremity. Isometric dynamometry was performed to determine maximum torque of the ankle joint. RESULTS: The DPN group had significantly diminished nerve function and muscle strength (P < 0.05) compared with both other groups. Only muscle strength was lower in DC subjects compared with HCs. No significant correlations were found between nerve function and muscle strength. CONCLUSION: These results indicate that reduced ankle joint torque in DM2 patients with and without DPN is independent of the presence of disturbed nerve function.
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Diabetes Mellitus Tipo 2/fisiopatología , Neuropatías Diabéticas/fisiopatología , Neuronas Motoras/fisiología , Debilidad Muscular/fisiopatología , Degeneración Nerviosa/fisiopatología , Anciano , Glucemia , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Células Receptoras Sensoriales/fisiologíaRESUMEN
Habitat-specific morphological variation, often corresponding to resource specialization, is well documented in freshwater fishes. In this study we used landmark based morphometric analyses to investigate morphological variation among threespine sticklebacks (Gasterosteus aculeatus L.) from four interconnected habitat types within a single lowland drainage basin in eastern England. These included the upper and lower reaches of the river, the estuary, a connected ditch network and a coastal salt marsh. We found significant habitat-specific differences in morphology, with three axes of variation describing differences in orbit diameter, body depth, caudal peduncle shape and pectoral fin positioning as well as variation in relative dorsal and pelvic spine size. Interestingly, the ditch system, an artificial and heavily managed habitat, is populated by sticklebacks with a characteristic morphology, suggesting that human management of habitats can in some circumstances lead to morphological variation among the animals that inhabit them. We discuss the mechanisms that conceivably underlie the observed morphological variation and the further work necessary to identify them. Finally, we consider the implications of habitat-specific body shape variation for the behavioural ecology of this ecologically generalist species.
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Ecosistema , Smegmamorpha/anatomía & histología , AnimalesRESUMEN
BACKGROUND: To provide outcome data relating to cleaning of rigid sigmoidoscopy equipment comparing commonly used techniques, allowing a framework for general guidelines for use in clinical practice. METHODS: A total of 104 rigid sigmoidoscopies were performed in the rooms of two colorectal surgeons using standard techniques. A three-way randomization was performed adopting the following variables: enzymatic washing versus steam sterilization of the light head, disposable versus reusable bellows and use with versus without an air filter. Aerosol from each system was collected on agar plates, and review of colony count numbers was performed. RESULTS: Gross faecal contamination of the rigid sigmoidoscope light head did not occur during any of the procedures. One plate grew a single-gram negative colony; all other contaminated plates showed environmental flora only. Reusable bellows in combination with an air filter showed lower mean colony counts (environmental flora) from the pre-procedure cultures as well as from the bellows' cultures. CONCLUSION: Enteric flora in this study was rarely aerosolized, and the use of an air filter may decrease this likelihood even further. There is no advantage in using disposable insufflation bellows when compared with the reusable type, allowing considerable cost saving. Washing the light head between procedures with enzymatic solution is a safe cheap and effective method of decontamination.
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Sigmoidoscopios , Esterilización/métodos , Descontaminación , Equipos Desechables , Contaminación de Equipos , Equipo ReutilizadoRESUMEN
BACKGROUND: People with diabetes or diabetic polyneuropathy often experience limitations in mobility and gait. These limitations are believed to be related to disturbed muscle function and sensory information. In previous studies on diabetic gait, results were confounded by a lower, preferred walking speed in people with diabetes or diabetic polyneuropathy. This study aimed to identify gait-velocity independent effects of diabetes and diabetic polyneuropathy on lower extremity kinematics and muscle activation patterns. METHODS: Eight people with diabetic polyneuropathy, 10 diabetic controls without polyneuropathy and ten healthy, age-matched controls walked at their preferred velocity and a standard velocity of 1.4 ms(-1). Muscle activation patterns of gluteus maximus, biceps femoris, rectus femoris, vastus medialis, gastrocnemius medialis, soleus, and tibialis anterior, and spatiotemporal and joint angles characteristics were analysed. FINDINGS: Independent of walking speed, muscle activation differed between groups. In diabetic polyneuropathy participants activation of ankle-joint dorsal flexors was prolonged by 5-10% of the stride cycle. Activity of monoarticular knee-joint extensors lasted about 10% longer in both diabetic groups compared to healthy elderly. Initiation of muscle activity did not differ between groups. If gait velocity was controlled, spatiotemporal characteristics were similar between groups. INTERPRETATION: The study showed that independent of the preferred lower gait velocity, people with diabetes or diabetic polyneuropathy adjust the timing of muscle activity. Contrarily, the concurrent changes in spatiotemporal characteristics occurred to be the result of changed velocity only. The delayed cessation of muscle activity suggested a reduced rate of force development underlying the adjusted timing of muscle activation.
Asunto(s)
Adaptación Fisiológica , Articulación del Tobillo/fisiopatología , Diabetes Mellitus/fisiopatología , Neuropatías Diabéticas/fisiopatología , Marcha , Articulación de la Rodilla/fisiopatología , Extremidad Inferior/fisiopatología , Músculo Esquelético/fisiopatología , Anciano , Análisis de Varianza , Articulación del Tobillo/inervación , Fenómenos Biomecánicos , Estudios de Casos y Controles , Electromiografía , Femenino , Humanos , Articulación de la Rodilla/inervación , Extremidad Inferior/inervación , Masculino , Persona de Mediana Edad , Limitación de la MovilidadRESUMEN
We describe here the Harvard integrated cavity output spectroscopy (ICOS) isotope instrument, a mid-IR infrared spectrometer using ICOS to make in situ measurements of the primary isotopologues of water vapor (H(2)O, HDO, and H(2) (18)O) in the upper troposphere and lower stratosphere (UTLS). The long path length provided by ICOS provides the sensitivity and accuracy necessary to measure these or other trace atmospheric species at concentrations in the ppbv range. The Harvard ICOS isotope instrument has been integrated onto NASA's WB-57 high-altitude research aircraft and to date has flown successfully in four field campaigns from winter 2004-2005 to the present. Off-axis alignment and a fully passive cavity ensure maximum robustness against the vibrationally hostile aircraft environment. The very simple instrument design permitted by off-axis ICOS is also helpful in minimizing contamination necessary for accurate measurements in the dry UTLS region. The instrument is calibrated in the laboratory via two separate water addition systems and crosscalibrated against other instruments. Calibrations have established an accuracy of 5% for all species. The instrument has demonstrated measurement precision of 0.14 ppmv, 0.10 ppbv, and 0.16 ppbv in 4 s averages for H(2)O, HDO, and H(2) (18)O, respectively. At a water vapor mixing ratio of 5 ppmv the isotopologue ratio precision is 50[per thousand] and 30[per thousand] for deltaD and delta(18)O, respectively.