Effect of supervised exercise on physical function and balance in patients with intermittent claudication

Background The aim of the study was to identify whether a standard supervised exercise programme (SEP) for patients with intermittent claudication improved specific measures of functional performance including balance. Methods A prospective observational study was performed at a single tertiary vascular centre. Patients with symptomatic intermittent claudication (Rutherford grades 1–3) were recruited to the study. Participants were assessed at baseline (before SEP) and 3, 6 and 12 months afterwards for markers of lower-limb ischaemia (treadmill walking distance and ankle : brachial pressure index), physical function (6-min walk, Timed Up and Go test, and Short Physical Performance Battery (SPPB) score), balance impairment using computerized dynamic posturography with the Sensory Organization Test (SOT), and quality of life (VascuQoL and Short Form 36). Results Fifty-one participants underwent SEP, which significantly improved initial treadmill walking distance (P = 0·001). Enrolment in a SEP also resulted in improvements in physical function as determined by 6-min maximum walking distance (P = 0·006), SPPB score (P < 0·001), and some domains of both generic (bodily pain, P = 0·025) and disease-specific (social domain, P = 0·039) quality of life. Significant improvements were also noted in balance, as determined by the SOT (P < 0·001). Conclusion Supervised exercise improves both physical function and balance impairment

Nonlinear absorption reversing between an electroactive ligand and its metal complexes

We present the nonlinear absorption investigation of an electroactive ligand and two ruthenium and iron metal complexes under 532 nm, 30 ps laser excitation, by the open aperture Z-scan technique. Significant nonlinear optical parameters have in all cases been measured, while the nonlinear attribute has been found to change from saturable to reverse saturable absorption between the initial ligand and its complexes

Randomized clinical trial of percutaneous transluminalangioplasty, supervised exercise and combined treatment forintermittent claudication due to femoropopliteal arterial disease

Background:The aim was to compare percutaneous transluminal angioplasty (PTA), a supervisedexercise programme (SEP) and combined treatment (PTA plus SEP) for intermittent claudication dueto femoropopliteal arterial disease.Methods: Consenting patients with femoropopliteal arterial lesions were randomized to one of threetreatment arms: PTA, SEP, or PTA plus SEP. All patients received optimal medical treatment. Patientswere assessed at baseline and 1, 3, 6 and 12 months after intervention. Clinical (ankle pressures, walkingdistances, symptoms) and quality-of-life (QoL) outcomes (Short Form 36, VascuQol) were analysed.Results: A total of 178 patients (108 men, median age 70 years) were included. All three treatmentgroups demonstrated significant clinical and QoL improvements. One year after PTA (60 patients, 8withdrew), 37 patients (71 per cent) had improved (16 mild, 16 moderate, 5 marked), nine (17 per cent)showed no improvement and six (12 per cent) had deteriorated. After SEP (60 patients, 14 withdrew),32 patients (70 per cent) had improved (19 mild, 10 moderate, 3 marked), six (13 per cent) showed noimprovement and eight (17 per cent) had deteriorated. After PTA plus SEP (58 patients, 11 withdrew),40 patients (85 per cent) had improved (18 mild, 20 moderate, 2 marked), seven (15 per cent) showedno improvement and none had deteriorated. On intergroup analysis, PTA and SEP alone were equallyeffective in improving clinical outcomes, although the effect was short-lived. PTA plus SEP produced amore sustained clinical improvement, but there was no significant QoL advantage.Conclusion: For patients with intermittent claudication due to femoropopliteal disease, PTA, SEP,and PTA plus SEP were all equally effective in improving walking distance and QoL after 12 months.Registration number: NCT00798850 (http://www.clinicaltrials.gov)

PLM adoption in SMEs context

The increasing market needs and technologies evolution, push companies to develop competitive advantages based on adequate and intensive use of information technology and communication (ICT). However, SMEs do not realize the importance of ICT adoption, which becomes vital for the development, and are not always well equipped to adopt and integrate them to their activities. The paper focused on issues regarding the ICT adoption, especially PLM solutions by SMEs. By analyzing the PLM definitions and works done, we explored indicators that impact positively or negatively ICT and PLM adoption. This paper proposes a model, currently theoretical, with empirical validation proposal through a survey

Antibody-Directed Lentiviral Gene Transduction for Live-Cell Monitoring and Selection of Human iPS and hES Cells

The identification of stem cells within a mixed population of cells is a major hurdle for stem cell biology–in particular, in the identification of induced pluripotent stem (iPS) cells during the reprogramming process. Based on the selective expression of stem cell surface markers, a method to specifically infect stem cells through antibody-conjugated lentiviral particles has been developed that can deliver both visual markers for live-cell imaging as well as selectable markers to enrich for iPS cells. Antibodies recognizing SSEA4 and CD24 mediated the selective infection of the iPS cells over the parental human fibroblasts, allowing for rapid expansion of these cells by puromycin selection. Adaptation of the vector allows for the selective marking of human embryonic stem (hES) cells for their removal from a population of differentiated cells. This method has the benefit that it not only identifies stem cells, but that specific genes, including positive and negative selection markers, regulatory genes or miRNA can be delivered to the targeted stem cells. The ability to specifically target gene delivery to human pluripotent stem cells has broad applications in tissue engineering and stem cell therapies

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Introduction The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. Methods A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. Conclusions The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored

Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial

Background: Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD. Methods: This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation.Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research. Discussion: This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden. Trial registration: ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014