Musculoskeletal complaints and disability in a group of young adults with major congenital upper limb differences in The Netherlands

Purpose: To determine prevalence of musculoskeletal complaints (MSCs) in adults with major congenital upper limb differences (CoULD) compared to able-bodied controls, and to examine associations of MSCs and disability with various biopsychosocial factors. Materials and methods: Questionnaire-based cross-sectional study assessing MSCs, disability (using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH)), general and mental health status, physical work demands, and upper extremity range of motion. Results: Seventy-one individuals with CoULD (participation rate: 41%) and 71 controls matched on age, gender, and education were included (49% female, mean age 28.9 years). Year prevalence of MSCs was significantly higher in the CoULD group (35%) than in the control group (18%). The CoULD group was less often employed and had lower scores on all measures of upper limb range of motion and hand grip. MSCs were associated with higher DASH scores and higher reported work demands. Disability was associated with female gender, more joints with limited range of motion, unemployment, and lower general and mental health. Factors associated with disability did not differ between groups.Conclusions: MSCs are a frequent problem in young adults with major CoULD. To prevent or reduce MSC and disability, clinicians and researchers should be aware of the associated factors. Implications for rehabilitation The year prevalence of musculoskeletal complaints (MSCs) in those with major congenital upper limb differences (CoULD) was approximately double to that of the control group, implying a potential relationship between CoULD and MSCs. Rehabilitation professionals should develop personalized strategies to manage work demands in those with CoULD, considering the association between MSCs and higher reported work demands. Recognizing the impact of a negatively perceived body image on mental health, clinicians should integrate psychological counseling into rehabilitation treatments to support mental well-being and improve overall quality of life in those with CoULD. Rehabilitation professionals should educate individuals with CoULD about the potential associations between upper limb work demands, MSCs, and disability.</p

Effect of statins on mitochondrial function and contractile force in human skeletal and cardiac muscle

Objectives and Background: The success of statin therapy in reducing cardiovascular morbidity and mortality is contrasted by the skeletal muscle complaints, which often leads to nonadherence. Previous studies have shown that inhibition of mitochondrial function plays a key role in statin intolerance. Recently, it was found that statins may also influence energy metabolism in cardiomyocytes. This study assessed the effects of statin use on cardiac muscle ex vivo from patients using atorvastatin, rosuvastatin, simvastatin or pravastatin and controls. Methods: Cardiac tissue and skeletal muscle tissue were harvested during open heart surgery after patients provided written informed consent. Patients included were undergoing cardiac surgery and either taking statins (atorvastatin, rosuvastatin, simvastatin or pravastatin) or without statin therapy (controls). Contractile behaviour of cardiac auricles was tested in an ex vivo set-up and cellular respiration of both cardiac and skeletal muscle tissue samples was measured using an Oxygraph-2k. Finally, statin acid and lactone concentrations were quantified in cardiac and skeletal homogenates by LC-MS/MS. Results: Fatty acid oxidation and mitochondrial complex I and II activity were reduced in cardiac muscle, while contractile function remained unaffected. Inhibition of mitochondrial complex III by statins, as previously described, was confirmed in skeletal muscle when compared to control samples, but not observed in cardiac tissue. Statin concentrations determined in skeletal muscle tissue and cardiac muscle tissue were comparable. Conclusions: Statins reduce skeletal and cardiac muscle cell respiration without significantly affecting cardiac contractility

Mixed Feelings of Children and Adolescents with Unilateral Congenital Below Elbow Deficiency: An Online Focus Group Study

The existing literature is inconsistent about the psychosocial functioning of children and adolescents with Unilateral Congenital Below Elbow Deficiency (UCBED). The objective of this qualitative study was to explore the psychosocial functioning of children and adolescents with UCBED in terms of their feelings about the deficiency and what helps them to cope with those feelings. Additionally, the perspectives of prosthesis wearers and non-wearers were compared, as were the perspectives of children, adolescents, parents and health professionals. Online focus group interviews were carried out with 42 children and adolescents (aged 8–12, 13–16 and 17–20), 16 parents and 19 health professionals. Questions were asked about psychosocial functioning, activities, participation, prosthetic use or non-use, and rehabilitation care. This study concerned remarks about psychosocial functioning. Children and adolescents with UCBED had mixed feelings about their deficiency. Both negative and positive feelings were often felt simultaneously and mainly depended on the way people in the children’s environment reacted to the deficiency. People staring affected the children negatively, while support from others helped them to cope with the deficiency. Wearing a prosthesis and peer-to-peer contact were also helpful. Non-wearers tended to be more resilient than prosthesis wearers. Wearers wore their prosthesis for cosmetic reasons and to prevent them from negative reactions from the environment. We recommend that rehabilitation teams make parents aware of their great influence on the psychosocial functioning of their child with UCBED, to adjust or extend the currently available psychosocial help, and to encourage peer-to-peer contact

Number needed to treat with ursodeoxycholic acid therapy to prevent liver transplantation or death in primary biliary cholangitis

Objective: The clinical benefit of ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has never been reported in absolute measures. The aim of this study was to assess the number needed to treat (NNT) with UDCA to prevent liver transplantation (LT) or death among patients with PBC. Methods: The NNT was calculated based on the untreated LT-free survival and HR of UDCA with respect to LT or death as derived from inverse probability of treatment weighting-adjusted Cox proportional hazard analyses within the Global PBC Study Group database. Results: We included 3902 patients with a median follow-up of 7.8 (4.1-12.1) years. The overall HR of UDCA was 0.46 (95% CI 0.40 to 0.52) and the 5-year LT-free survival without UDCA was 81% (95% CI 79 to 82). The NNT to prevent one LT or death within 5 years (NNT5y) was 11 (95% CI 9 to 13). Although the HR of UDCA was similar for patients with and without cirrhosis (0.33 vs 0.31), the NNT5y was 4 (95% CI 3 to 5) and 20 (95% CI 14 to 34), respectively. Among patients with low alkaline phosphatase (ALP) (≤2× the upper limit of normal (ULN)), intermediate ALP (2-4× ULN) and high ALP (>4× ULN), the NNT5y to prevent one LT or death was 26 (95% CI 15 to 70), 11 (95% CI 8 to 17) and 5 (95% CI 4 to 8), respectively. Conclusion: The absolute clinical efficacy of UDCA with respect to LT or death varied with baseline prognostic characteristics, but was high throughout. These findings strongly emphasise the incentive to promptly initiate UDCA treatment in all patients with PBC and may improve patient compliance

Land surface evapotranspiration for water balance in the Kirindi Oya Watershed: a remote sensing approach. Paper 133 of Session 15

In International Irrigation Management Institute (IIMI). National Water Conference on Status and Future Directions of Water Research in Sri Lanka, BMICH, Colombo, Sri Lanka, 4-6 November 1998. Session 13: Watershed management II; Session 14: Rural water quality; Session 15: Precipitation and evapotranspiration. Research papers presente

Response to letter to the editor by videler et al.

We have read the valuable contribution of Videler et al. on signs of overwork weakness in patients with Charcot-Marie-Tooth (CMT). As in our study, overall, Videler et al. did not find a difference between the dominant and non-dominant hands in their CMT patients. This is in contrast with the study of Vinci et al., who, using manual muscle strength testing, found a stronger dominant hand in only 2 out of 212 muscles and a stronger non-dominant hand in 139 of these 212 muscles. When selecting only the more severely affected patients, Videler et al. did find in this group of 22 patients a small, but significantly stronger, non-dominant hand for the tripod pinch. We agree with Videler that the latter finding may fit with the hypothesis of overwork weakness. However, it should be noted that the difference in strength between both hands for the tripod pinch is relatively small and that the non-dominant hand is also severely weakened. Therefore, it is unclear if this difference is clinically relevant. As suggested by Videler et al., larger prospective cohort studies or interventions studies, preferably using more specific measures of intrinsic hand muscle function would be needed to conclude on the presence of overwork weakness.In summary, in the absence of a mechanism to explain overwork weakness in this population and in the absence of any data indicating that reducing activity would slow disease progression, we still feel that there is insufficient evidence to conclude that overwork weakness exists, and agree with Videler et al. that, at present, there are no grounds to advise patients to limit their activities

Response to letter to the editor by videler et al.

We have read the valuable contribution of Videler et al. on signs of overwork weakness in patients with Charcot-Marie-Tooth (CMT). As in our study, overall, Videler et al. did not find a difference between the dominant and non-dominant hands in their CMT patients. This is in contrast with the study of Vinci et al., who, using manual muscle strength testing, found a stronger dominant hand in only 2 out of 212 muscles and a stronger non-dominant hand in 139 of these 212 muscles. When selecting only the more severely affected patients, Videler et al. did find in this group of 22 patients a small, but significantly stronger, non-dominant hand for the tripod pinch. We agree with Videler that the latter finding may fit with the hypothesis of overwork weakness. However, it should be noted that the difference in strength between both hands for the tripod pinch is relatively small and that the non-dominant hand is also severely weakened. Therefore, it is unclear if this difference is clinically relevant. As suggested by Videler et al., larger prospective cohort studies or interventions studies, preferably using more specific measures of intrinsic hand muscle function would be needed to conclude on the presence of overwork weakness.In summary, in the absence of a mechanism to explain overwork weakness in this population and in the absence of any data indicating that reducing activity would slow disease progression, we still feel that there is insufficient evidence to conclude that overwork weakness exists, and agree with Videler et al. that, at present, there are no grounds to advise patients to limit their activities

Things that help children/adolescents with UCBED to cope with the deficiency.

<p>(+): frequently mentioned by participants; (+/−): mentioned once; (−): not mentioned.</p>a<p>Reported by both prosthesis wearers and non-wearers.</p

Characteristics of participants of online focus groups.

a<p>Number of subjects eligible to recruit, recruited, participated in study and response rate (%).</p>b<p>Number of participants across each of the 4 cooperating centres; the last number reflects the number of participants recruited through other centres/organisations.</p>c<p>Number of quotes concerning psychosocial functioning.</p>d<p>Characteristics of the children of participating parents.</p>e<p>Based on the characteristics of the three children/adolescents groups.</p