Multicenter multidisciplinary training program for chronic low back pain: French experience of the Renodos back pain network (Réseau Nord-Pas-de-Calais du DOS)

AbstractObjectivesTo evaluate the short- and long-term effectiveness of the multidisciplinary training program (MTP). To show the benefits which the network organization brings to the treatment of chronic low back pain (CLPB).MethodsThe member centres of the Renodos back pain network included 748 subjects in the MTP. The centres used a common evaluation protocol including pain and quality of life visual analogue scales (VAS), fingertip-to-floor distance (FFD), muscle isometric endurance tests, Roland-Morris Disability Questionnaire (RDQ), the Dallas Pain Questionnaire (DPQ) and the Hospital Anxiety Depression (HAD) scale. Measurements were carried out before (T0) and immediately after (T1) the intervention, and at the 3-, 6-, 12-month (T3, T6, T12) follow-up visits.ResultsStatistically discernible improvement occurred for men and women on every outcome measure from before to after the MTP (T0–T1, p<0.0001). This improvement obtained at T1 was maintained for most of the outcome measures throughout the 12-month follow-up. However, the pain intensity and isometric muscle endurance times showed significant negative evolution. Significant differences between genders were found for the trunk flexibility measurement (FFD), the isometric endurance time of the quadratus lumborum muscle, the RDQ and the HAD depression. There was no time–gender interaction.ConclusionThe MTP was effective in reducing back pain intensity, functional disability, symptoms of anxiety and depression and in improving quality of life, flexibility and isometric muscle endurance time. It was possible to propose the MTP to both men and women. A network organization effectively contributes to the harmonization of evaluation methods and brings coherence to the treatment of CLBP patients

Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders.

Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT

The Relationship between Knee Valgus and Clinical Measures in Professional Basketball: A CART Analysis

Background/Purpose: Lower extremity injuries occur at an amplified rate in professional basketball. Evidence suggests that knee frontal plane valgus may be associated with risk of injury. The Landing Error Scoring System includes the assessment of maximum knee valgus during a countermovement jump. The investigation of interactions among linear and non-linear factors may help the understanding of the interdependence of various measures and poor performance on the knee valgus displacement (KVD) component of the LESS in professional basketball players. The purpose of this study was to investigate predictors of knee valgus displacement on the LESS. We hypothesize that a positive finding on the knee valgus displacement component of the LESS will be predicted by select clinical measures. Methods: 47 professional basketball players participated. Measurements were completed as part of preseason mobility screening prior to the 2015-16 and 2016-17 NBA seasons. Classification and Regression Tree Analysis (CART) were used to investigate linear and non-linear interactions among predictors and their influence on KVD in players who performed the LESS test. Results: Of the 47 players included in this study, 16 players did not test positive for KVD on the LESS test and 31 did. Pruning resulted in 4 splits (r2=0.507) demonstrating that KVD was predicted by total hip rotation range of motion, dominant leg hip external rotation, and standing arch height index measure. Predictive modeling, classified 18 of the 31 players with KVD and 8 of the 16 players who tested negative for KVD. The area under the ROC curve was .9183, suggesting that classification of players using this model was not random. Conclusion: KVD and performance on the LESS has been linked with injury. CART analysis captured linear and non-linear interactions between clinical measures suggesting that lower extremity biomechanical factors may be associated with predicting KVD during performance on the LESS. Clinical Relevance: KVD and the LESS test has been shown to be predictive of injury. Identifying which clinical measures may be linked with poor performance on this test may aide clinicians in determining appropriate interventions that may be associated with improved scores and minimize risk of injury.https://ecommons.udayton.edu/dpt_symposium/1000/thumbnail.jp

Iterative Estimation of Variance Components in the 2-Way Crossed Classification, Mixed Model, with Interaction, Using Unbalanced Data

24 pages, 1 article*Iterative Estimation of Variance Components in the 2-Way Crossed Classification, Mixed Model, with Interaction, Using Unbalanced Data* (Corbeil, R. R.; Searle, S. R.) 24 page

Translation Invariant Maximum Likelihood Estimators of Variance Components in the Mixed Model

19 pages, 1 article*Translation Invariant Maximum Likelihood Estimators of Variance Components in the Mixed Model* (Corbeil, R. R.; Searle, S. R.) 19 page

The Utility of Functional Movement Assessment on NBA Players

Professional basketball related injuries have not declined over the last decade despite improvements in training and conditioning or medical advancements in diagnostics, surgery, or rehabilitation. A descriptive epidemiological study of 80% of the National Basketball Association (NBA) teams over 17 years reported an injury incidence of 19.1 per 1000 athlete exposures, and 59,179 games missed due to injury. Starkey found that the there has been a 12.4% increase in game-related injuries in the NBA in a 10-year period from the 1988 - 1997 seasons. It is suspected that increased contact within the NBA along with improved player athleticism, size, power, and speed have contribute to the rise in injuries. The most commonly reported injuries in the NBA as reported via the greatest number of days missed include ankle sprains, patellofemoral inflammation, knee sprains, and lumbar strains. Recent trends involve less focus on specific physical or clinical measures and increased attention on the assessment of functional movement patterns for the purpose of predicting the likelihood of injury. The Functional Movement Screen (FMSTM) was introduced as a pre-participation examination intended to evaluate the quality of seven basic movement patterns that require a balance of both mobility and stability. The functional movements tested include: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up, and rotary stability. It is designed to assess the extremes of specific movements and positions for the purpose of identifying potential limitation, compensation, and asymmetry in individuals without obvious pathology. Recent literature has linked this screen to injury prediction in numerous populations that may be predisposed to injury, including professional football players, firefighters, collegiate female athletes, elite track and field athletes, military personnel. The majority of reliability studies conclude that the FMSTM has good intra-rater reliability. While some researchers conclude that reliability increases with additional training and clinical experience, others claim that the FMS intra-rater reliability was not improved with FMS certification. Inter- rater reliability was reported in recent studies to range from moderate and good to high. The Y-balance Test (YBT) is pre-participation assessment used to screen individuals who may have potential for lower extremity injury. This test involves the examination of dynamic balance and postural control. While research is still lacking regarding the validity and utility of the YBT-LQ, the SEBT has been reported to have a moderate to strong effect size and that this test was reliable and valid as a dynamic predictor to lower extremity injuries. No studies have investigated the outcomes of YBT as an injury predictor in professional basketball athletes or the relationship of these factors with functional movement screens.https://ecommons.udayton.edu/dpt_symposium/1011/thumbnail.jp

Human α2β1HI CD133+VE epithelial prostate stem cells express low levels of active androgen receptor

Stem cells are thought to be the cell of origin in malignant transformation in many tissues, but their role in human prostate carcinogenesis continues to be debated. One of the conflicts with this model is that cancer stem cells have been described to lack androgen receptor (AR) expression, which is of established importance in prostate cancer initiation and progression. We re-examined the expression patterns of AR within adult prostate epithelial differentiation using an optimised sensitive and specific approach examining transcript, protein and AR regulated gene expression. Highly enriched populations were isolated consisting of stem (α(2)β(1)(HI) CD133(+VE)), transiently amplifying (α(2)β(1)(HI) CD133(-VE)) and terminally differentiated (α(2)β(1)(LOW) CD133(-VE)) cells. AR transcript and protein expression was confirmed in α(2)β(1)(HI) CD133(+VE) and CD133(-VE) progenitor cells. Flow cytometry confirmed that median (±SD) fraction of cells expressing AR were 77% (±6%) in α(2)β(1)(HI) CD133(+VE) stem cells and 68% (±12%) in α(2)β(1)(HI) CD133(-VE) transiently amplifying cells. However, 3-fold lower levels of total AR protein expression (peak and median immunofluorescence) were present in α(2)β(1)(HI) CD133(+VE) stem cells compared with differentiated cells. This finding was confirmed with dual immunostaining of prostate sections for AR and CD133, which again demonstrated low levels of AR within basal CD133(+VE) cells. Activity of the AR was confirmed in prostate progenitor cells by the expression of low levels of the AR regulated genes PSA, KLK2 and TMPRSS2. The confirmation of AR expression in prostate progenitor cells allows integration of the cancer stem cell theory with the established models of prostate cancer initiation based on a functional AR. Further study of specific AR functions in prostate stem and differentiated cells may highlight novel mechanisms of prostate homeostasis and insights into tumourigenesis

Expression of the "stem cell marker" CD133 in pancreas and pancreatic ductal adenocarcinomas

<p>Abstract</p> <p>Background</p> <p>It has been suggested that a small population of cells with unique self-renewal properties and malignant potential exists in solid tumors. Such "cancer stem cells" have been isolated by flow cytometry, followed by xenograft studies of their tumor-initiating properties. A frequently used sorting marker in these experiments is the cell surface protein CD133 (prominin-1). The aim of this work was to examine the distribution of CD133 in pancreatic exocrine cancer.</p> <p>Methods</p> <p>Fifty-one cases of pancreatic ductal adenocarcinomas were clinically and histopathologically evaluated, and immunohistochemically investigated for expression of CD133, cytokeratin 19 and chromogranin A. The results were interpreted on the background of CD133 expression in normal pancreas and other normal and malignant human tissues.</p> <p>Results</p> <p>CD133 positivity could not be related to a specific embryonic layer of organ origin and was seen mainly at the apical/endoluminal surface of non-squamous, glandular epithelia and of malignant cells in ductal arrangement. Cytoplasmic CD133 staining was observed in some non-epithelial malignancies. In the pancreas, we found CD133 expressed on the apical membrane of ductal cells. In a small subset of ductal cells and in cells in centroacinar position, we also observed expression in the cytoplasm. Pancreatic ductal adenocarcinomas showed a varying degree of apical cell surface CD133 expression, and cytoplasmic staining in a few tumor cells was noted. There was no correlation between the level of CD133 expression and patient survival.</p> <p>Conclusion</p> <p>Neither in the pancreas nor in the other investigated organs can CD133 membrane expression alone be a criterion for "stemness". However, there was an interesting difference in subcellular localization with a minor cell population in normal and malignant pancreatic tissue showing cytoplasmic expression. Moreover, since CD133 was expressed in shed ductal cells of pancreatic tumors and was found on the surface of tumor cells in vessels, this molecule may have a potential as clinical marker in patients suffering from pancreatic cancer.</p