A comparative study of the physiological costs of walking in ten bilateral amputees

The physiological cost of walking is greater in bilateral amputees (BA) than in both unilateral amputee and non-pathological gait. The aim of this study was to describe the physiological costs and other standard gait characteristics in a sample population of BA, walking at self-selected (comfortable) speeds. Amputees had bilateral trans-tibial, bilateral trans-femoral or trans-tibial/trans-femoral amputations as a result of trauma or congenital defects. All amputees wore their own prosthetic limbs which were either full-length prostheses or short non-articulating pylon prostheses (SNAPPs). The results were compared with a base line data set collected from a non-pathological control group. It was anticipated that amputees with high-level amputations would walk at the slowest speeds, have the highest physiological costs and lowest perception of walking ability. However, varying walking speeds resulted in varying exercise intensities, exercise heart rates and perceptions of walking that could not be directly related to amputation levels. It is therefore concluded that bilateral amputee gait is complex, varied and not easily categorized

A Novel 8-Predictors Signature to Predict Complicated Disease Course in Pediatric-onset Crohn’s Disease: A Population-based Study

International audienceBackground The identification of patients at high risk of a disabling disease course would be invaluable in guiding initial therapy in Crohn’s disease (CD). Our objective was to evaluate a combination of clinical, serological, and genetic factors to predict complicated disease course in pediatric-onset CD. Methods Data for pediatric-onset CD patients, diagnosed before 17 years of age between 1988 and 2004 and followed more than 5 years, were extracted from the population-based EPIMAD registry. The main outcome was defined by the occurrence of complicated behavior (stricturing or penetrating) and/or intestinal resection within the 5 years following diagnosis. Lasso logistic regression models were used to build a predictive model based on clinical data at diagnosis, serological data (ASCA, pANCA, anti-OmpC, anti-Cbir1, anti-Fla2, anti-Flax), and 369 candidate single nucleotide polymorphisms. Results In total, 156 children with an inflammatory (B1) disease at diagnosis were included. Among them, 35% (n = 54) progressed to a complicated behavior or an intestinal resection within the 5 years following diagnosis. The best predictive model (PREDICT-EPIMAD) included the location at diagnosis, pANCA, and 6 single nucleotide polymorphisms. This model showed good discrimination and good calibration, with an area under the curve of 0.80 after correction for optimism bias (sensitivity, 79%, specificity, 74%, positive predictive value, 61%, negative predictive value, 87%). Decision curve analysis confirmed the clinical utility of the model. Conclusions A combination of clinical, serotypic, and genotypic variables can predict disease progression in this population-based pediatric-onset CD cohort. Independent validation is needed before it can be used in clinical practice