The role of gender in gait analysis in the elderly

The purpose of this study was to identify gender-related differences in the gait of functionally independent elderly men and women when walking at self selected walking velocity (SSWV). A quantitative gait analysis was conducted on 59 men (mean age 75.7, SD 5.8, range 69-91 years) and 127 women (mean age 75.2, SD 4.9, range 68-91 years) who could walk independently, regarded themselves to be in good health, and were independent in terms of activities of daily living. The analysis was based on foot placements in the sagittal plane recorded using a video camera. ANO VA gender comparisons revealed significant differences (p -0.0013) in all phases of walking, step length, standing height and knee length, but no significant differences in walking speed. Women were found to take shorter steps at greater frequency than men to attain the same walking velocity. When phase and step length variables were normalized to a percent of each individuals stride time (phase variables) and knee height as a measure of stature (step lengths), there were no significant gender differences. These findings suggest that at SSWV gait differences in older persons are due to stature and not to gender, and that the use of norms which are gender based may be inappropriate. Thus, the gait of elderly men and women walking at SSWV may be analysed together, provided that the step length data are normalized to stature and phase data to stride time

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Adult Gamma Camera Myocardial Perfusion Imaging: Diagnostic Reference Levels and Achievable Administered Activities Derived From ACR Accreditation Data

PURPOSE: The aim of this study was to glean from accreditation surveys of US nuclear medicine facilities the in-practice radiopharmaceutical diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult gamma camera myocardial perfusion imaging (MPI). METHODS: Data were collected from the ACR Nuclear Medicine Accreditation Program during one three-year accreditation cycle from May 1, 2012, to April 30, 2015. Data elements included radiopharmaceutical, administered activity, examination protocol, interpreting physician specialty, practice type, and facility annual examination volume. Facility demographics, DRLs, and AAAs were tabulated for analysis. RESULTS: The calculated DRLs and AAAs are consistent with previously published surveys, and they adhere to national societal guidelines. Facilities seeking ACR accreditation are nearly evenly split between hospital based with multiple gamma cameras and office based with single gamma cameras. The majority of facilities use single-day, low-dosage/high-dosage (99m)Tc-based protocols; a small minority use (201)TlCl protocols. Administered activities show a consistency across facilities, likely reflecting adoption of standard MPI protocols. CONCLUSIONS: This practice-based analysis provides DRL and AAA benchmarks that nuclear medicine facilities may use to refine gamma camera MPI protocols. In general, the protocols submitted for ACR accreditation are consistent with national societal guidelines. The results suggest that there may be opportunities to further reduce patient radiation exposure by using modified examination protocols and newer gamma camera software and hardware technologies

Self-regulation of Exercise Intensity in Cardiac Rehabilitation Participants

Purpose The purpose of this study was to determine if Phase III‐IV cardiac rehabilitation participants could accurately self‐monitor exercise intensity through the use of the heart rate (HR) palpation technique and the rating of perceived exertion scale (RPE) during their typical exercise routine and to determine if participants were exercising within their prescribed target heart rate (THR) range.Methods One hundred and sixty‐one (119 men, 42 women) cardiac rehabilitation participants (age = 64.8 ± 9.2 years) each performed their usual exercise routine on aerobic equipment for 20 min, while wearing a HR monitor. At 10 and 15min of exercise, participants reported their 10‐s palpated HR and RPE rating.Results No significant differences were found between mean palpated HRmin10 (100.8 ±18.6 beats per minute (BPM) and mean actual HRmin10 (102.7 ± 17.1 BPM) or mean palpated HRmin15 (105.9 ±19.2 BPM) and mean actual HRmin15 (106.4 ± 18.4 BPM). The correlations between actual HR and palpated HR at 10 and 15 min of exercise was 0.73 (p \u3c 0.0001, (Standard error of the estimate) SEE = 11.7 BPM) and 0.83 (p \u3c 0.0001, SEE = 10.3 BPM), respectively. When actual HR was compared with THR, 16 participants exceeded their prescribed THR (11–20 BPM), 82 participants fell below their THR (15–26 BPM), and 25 participants exercised within their THR, even though all reported a similar RPE (11–12).Conclusions The results of this study suggest that Phase III‐IV cardiac rehabilitation participants can accurately palpate their exercise pulse rates but their RPE did not appropriately reflect the intensity of their physical effort. Additionally, the majority of participants did not exercise within their prescribed THR range