Structural Equation Model of Disability in Low Back Pain

Study Design—The effects of participant characteristics along with descriptions of pain, and psychological involvement, such as fear avoidance, were assessed using structural equation modeling to identify relationships between these factors and disability as a result of low back pain. Objective—The aim of this study was to evaluate the relationship between factors related to pain description, participants’ characteristics, psychological involvement and disability through structural equation modeling. Summary of Background Data—Low back pain is a complex multifactorial condition that can lead to disability. Understanding which factors contribute to disability and how those factors interact is important for predicting and minimizing disability in patients with low back pain. Methods—We analyzed data from 156 participants (63% female) with low back pain. A stepwise structural equation model was built with patient characteristics, pain intensity, depression, anxiety and fear avoidance to predict disability in low back pain. Results—Participants were 23–84 (49.7±15.1) years of age and experienced 0.03–300 months duration (25.5±36.4) of current low back pain. The final model explained 62% of the variance in disability and included female gender, full-time employment, depression, and fear avoidance beliefs as significant predictors. Full-time employment was the only significant predictor that reduced disability; all other significant predictors increased disability in the model. Conclusions—Understanding the relationship between these predictors and disability provides a foundation for predicting and managing disability for individual patients who suffer from low back pain

Trunk Control Response to Unstable Seated Posture During Various Feedback Conditions in People with Chronic Low Back Pain

AIMS: People with chronic low back pain (CLBP) tend to have altered postural control. Visual biofeedback may be used to restore postural control. The purpose of this pilot study was to investigate the effect of visual biofeedback on seated postural trunk control in subjects with CLBP, and to investigate the relationship between the postural control parameters and clinical tests. METHODS: Ten CLBP subjects (8 female, 2 male; age 40.6±5 yrs; BMI 25.06±2.93) and 10 healthy matched controls (8 female, 2 male; age 41.2±5.88 yrs; BMI 24.61±3.17) underwent seated postural assessment. Center of pressure (COP) parameters were collected under three experimental conditions: eyes-open, visual biofeedback, and eyes-closed. RESULTS: The results revealed that COP velocity was significantly different between healthy and CLBP subjects for each condition, both healthy and CLBP subjects had no differences in COP parameters between eyes-open and visual biofeedback conditions, and in subjects with CLBP, the straight leg raise clinical test had a strong negative correlation with all COP parameters. CONCLUSIONS: Our results suggest that 30-second visual biofeedback training did not improve the seated postural control of CLBP subjects, potentially due to the short duration of training, and that hamstrings muscle tightness or decreased sciatic nerve mobility was associated with worse postural control. J Allied Health 2019; 48(1):54–60

Effect of Grade III Lumbar Mobilization on Back Muscles in Chronic Low Back Pain: A Randomized Controlled Trial

BACKGROUND: Lumbar mobilization is a standard intervention for lower back pain (LBP). However, its effect on the activity of back muscles is not well known. OBJECTIVES: To investigate the effects of lumbar mobilization on the activity/contraction of erector spinae (ES) and lumbar multifidus (LM) muscles in people with LBP. DESIGN: Randomized controlled study. METHODS: 21 subjects with LBP received either grade III central lumbar mobilization or placebo (light touch) intervention on lumbar segment level 4 (L4). Surface electromyography (EMG) signals of ES and ultrasound (US) images of LM were captured before and after the intervention. The contraction of LM was calculated from US images at L4 level. The normalized amplitude of EMG signals (nEMG) and activity onset of ES were calculated from the EMG signals at both L1 and L4 levels. RESULTS: Significant differences were found between the mobilization and placebo groups in LM contraction (p=0.03), nEMG of ES at L1 (p=0.01) and L4 (p=0.05), and activity onset of ES at L1 (p=0.02). CONCLUSION: Lumbar mobilization decreased both the activity amplitude and the activity onset of ES in people with LBP. However, the significant difference in LM contraction was small and may not have clinical significance

Shared and unique common genetic determinants between pediatric and adult celiac disease

Table S1. Functional profiles of the top non-HLA association signals identified in Paediatric CD and Adult CD among north Indians. Table S2. Test of heterogeneity (Breslow-Day test) for associated SNPs in PaediatricCD and AdultCD groups. Table S3. cis-eQTL evaluation of associated SNPs. Table S4. GRAIL analysis revealed seven genes with significant (p <0.05) interaction with 39 known non-HLA coeliac disease loci. These seven genes are from four loci identified in this study. (DOCX 26 kb

Novice Lifters Exhibit A More Kyphotic Lifting Posture Than Experienced Lifters In Straight-Leg Lifting

As torso flexion and repetitive lifting are known risk factors for low back pain and injury, it is important to investigate lifting techniques that might reduce injury during repetitive lifting. By normalizing lumbar posture to a subject’s range of motion (ROM), as a function of torso flexion, this research examined when subjects approached their range of motion limits during dynamic lifting tasks. For this study, it was hypothesized that experienced lifters would maintain a more neutral lumbar angle relative to their range of motion, while novice lifters would approach the limits of their lumbar ROM during the extension phase of a straight-leg lift. The results show a statistically significant difference in lifting patterns for these two groups supporting this hypothesis. The novice group maintained a much more kyphotic lumbar angle for both the flexion (74% of the lumbar angle ROM) and extension phases (86% of the lumbar angle ROM) of the lifting cycle, while the experienced group retained a more neutral curvature throughout the entire lifting cycle (37% of lumbar angle ROM in flexion and 48% of lumbar angle ROM in extension). By approaching the limits of their range of motion, the novice lifters could be at greater risk of injury by placing greater loads on the supporting soft tissues of the spine. Future research should examine whether training subjects to assume more neutral postures during lifting could indeed lower injury risks

Primary somatosensory cortex in chronic low back pain – a 1H-MRS study

The goal of this study was to investigate whether certain metabolites, specific to neurons, glial cells, and the neuronal-glial neurotransmission system, in the primary somatosensory cortex (SSC), are altered and correlated with clinical characteristics of pain in patients with chronic low back pain (LBP). Eleven LBP patients and eleven age-matched healthy controls were included. N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and glutamine/glutamate (Glx) were measured with proton magnetic resonance spectroscopy (1H-MRS) in left and right SSC. Differences in metabolite concentrations relative to those of controls were evaluated as well as analyses of metabolite correlations within and between SSCs. Relationships between metabolite concentrations and pain characteristics were also evaluated. We found decreased NAA in the left SSC (P = 0.001) and decreased Cho (P = 0.04) along with lower correlations between all metabolites in right SSC (P = 0.007) in LBP compared to controls. In addition, we found higher and significant correlations between left and right mI (P < 0.001 in LBP vs P = 0.1 in controls) and between left mI and right Cho (P = 0.048 vs P = 0.6). Left and right NAA levels were negatively correlated with pain duration (P = 0.04 and P = 0.02 respectively) while right Glx was positively correlated with pain severity (P = 0.04). Our preliminary results demonstrated significant altered neuronal-glial interactions in SSC, with left neural alterations related to pain duration and right neuronal-glial alterations to pain severity. Thus, the 1H-MRS approach proposed here can be used to quantify relevant cerebral metabolite changes in chronic pain, and consequently increase our knowledge of the factors leading from these changes to clinical outcomes

Hypervalent iodine mediated synthesis of the heterocyclyl-1,3,4-oxadiazoles

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Correlations between morphology, crystal structure and magnetization of epitaxial cobalt-platinum films grown with pulsed laser ablation

The effects of growth rate (G_r), deposition temperature (T_d), film thickness (t_F), and substrate induced strain (epsilon) on morphological, crystallographic and magnetic characteristics of equiatomic CoPt epitaxial films synthesized with PLD are investigated. The (001) substrates of MgO, STO and LAO provide different degree of epitaxial strain for growth of the disordered face centered cubic (fcc) and ordered face centered tetragonal (L1_0) phases of CoPt. The films deposited at T_d~600 ^0C on all three substrates are fcc with in-plane magnetization and a narrow hysteresis loop of width~200 Oe. The L1_0 phase, stabilized only at T_d~700 ^0C becomes predominantly c-axis oriented as T_d is increased to 800 ^0C. While the crystallographic structure of the films depends solely on the T_d, their microstructure and magnetization characteristics are decided by the growth rate. At the higher G_r (~1A/sec) the L1_0 films have a maze-like structure which converts to a continuous film as the t_F is increased from 20 to 50 nm. The H_c of these films increases as the L1_0 phase fraction grows with T_d and its orientation becomes out of the film plane. The evolution of microstructure with T_d is remarkably different at lower growth rate (~0.4A /sec). Here the structure changes from a self-similar fractal pattern to an assembly of nano-dots as the T_d is raised from 700 to 800 ^0C, and is understood in terms of the imbalance between strain and interfacial energies. MFM of such films reveals no distinct domain walls within the nano-islands while a clear contrast is seen between the islands of reversed magnetization. The simple picture of coherent rotation of moment appears incompatible with the time dependence of the remanent magnetization in these films.Comment: 10 figure

Assessment of therapeutic efficacy of chloroquine and sulphadoxine-pyrimethamine in uncomplicated falciparum malaria

A standardised protocol has been developed by World Health Organization (CDS/RBM/2002) toassess the efficacy of common antimalarials in the treatment of clinically manifested infection withuncomplicated P. falciparum malaria for areas with low to moderate transmission. The therapeuticefficacy protocol is based on clinical and parasitological responses of the patients and it has thepurpose of determining the practical efficacy of the drug regimen in study areas with the ultimateobjective of ascertaining its continued usefulness or the necessity for replacing it in the routinetreatment. Present study has been conducted at seven sites—Kathiatali and Simonabasti of DistrictNowgaon, Assam; Sonapur and Boko of District Kamrup, Assam; Keonjhar Town, Padampur andBasudebpur of District Keonjhar, Orissa. In order to reduce the patient recruitment time, health centreclose to well-defined community was identified to conduct the activities at peak malaria seasonby selecting local pockets and organising mobile clinics. Microscopically confirmed cases of P. falciparumwere enrolled according to the criteria for inclusion and exclusion. Treatment with recommendeddrug was given under supervision and a follow-up schedule at various intervals for 28days was maintained. In chloroquine (CQ) study areas, wherever patients showed treatment failure,they were treated with second line drug—sulphadoxine-pyrimethamine (SP) combination and thenfollowed-up as per study protocol. It was observed that 30% cases showed treatment failure to CQin District Nowgaon, where revised drug policy has already been introduced. In Kamrup district,treatment failure with CQ was found to be less than 25%, which denotes the said regimen is still effective.Almost all the patients from Padampur and Basudebpur of District Keonjhar responded toCQ, treatment failure was noticed only in two patients (3%). The antifolate combination found to befully effective as second line and also as first line wherever revised drug policy has been introduced