The path curvature of the body centre of mass during walking as an index of balance control in patients with Multiple Sclerosis

BACKGROUND AND AIM: The path curvature of the centre of mass (CM), mechanically representative of the whole body system, may provide hints to detection of fall risk during walking. Here, an example is taken from results of an ongoing controlled study. It shows the comparison between the CM path in a healthy subject and in a fully autonomous patient with Multiple Sclerosis (MS). METHODS: A representative healthy subject (woman, 26 years, 1.55 m tall) and a MS patient (woman, 34 years, 1.65 m tall, with very mild left hemiparesis) are presented. Subjects walked on a force-sensorized treadmill (1) at 0.6 m/s. Data were averaged across 6 subsequent strides. The 3D displacements of the CM were computed via double integration of the ground reaction forces (Cavagna's Method). The path curvature of the CM during one stride was computed according to the Frenet-Serret formula (2). The instantaneous efficiency of the kinetic-potential, pendulum-like energy transfer of the CM was also computed (percent recovery, R: 100%=complete recovery, i.e. fully passive CM translation) (3). RESULTS: The left and right panels refer to the control and the MS subject, respectively. In the upper set of panels the human sketches on top of the figure help identifying the stride phases (% cycle) and give a frontal and a sagittal perspectives. The first and second rows of curves from the top give the instantaneous R and the path curvature of the CM during one stride. Each step begins with the single stance of the front leg (R=right; L=left). The horizontal bars under the curves mark the double and the single stance phases (continuous and dashed lines, respectively; grey tract=left step). The lower set of panels (closed curves) gives the planar projections of the CM path during the same stride. The space-time correspondence between the 2 sets of curves is facilitated by the shared A-D labeling of peak curvatures and the shared graphic conventions (dashed line=single stance; gray tract=left step). In both steps the curvature is peaking when R suddenly drops from 100 to 0, demonstrating that the passive pendulum-like mechanism of translation is briskly substituted by a short lasting, fully muscle-driven, propulsion. The highest peaks (A and C) are coincident with the lateral redirection during single stance. Of note, the patient's CM path is characterized by a 10-fold higher C peak (single stance, paretic-to-unaffected side redirection). This may be interpreted as a feature of "escape" limp, barely perceivable by clinical observation, when seen from the perspective of the body CM on the horizontal plane (bottom curves). CONCLUSIONS: Increased curvature peaks may reveal the attempt to shorten the stance on the affected side yet, placing at risk the lateral stability of the body. REFERENCES:[1] Tesio L, Rota V, Am J Phys Med Rehabil 2008;87:515-526 [2] Tesio L et al, J Biomech 2011;44:732-740 [3] Cavagna GA, J Appl Physiol 1975;39:174-179

Measuring through questionnaires : Rasch analysis as a tool for keeping the same meaning across different patients

Whole-person variables may describe behaviours, perceptions, knowledges, attitudes. These are the outcomes of the most various health-care interventions. Such variables can only be observed through samples of representatives behaviours (items in questionnaires). The amount of the variables is usually inferred through counts of the scores arbitrarily assigned to the various items. Rasch Analysis (RA) is a novel statistical method allowing the estimate of true linear measures of item difficulty and subject ability subtended by raw counts. This also allows the estimate of stability of the items hierarchy (which item is more difficult, which is less) across time, raters and diagnostic or cultural subgroups. If this hierarchy is unstable (Differential Item Functioning \u2013 DIF) the same questionnaire actually depicts qualitatively distinct, non comparable, conditions. RA may help to either detect the problem, or re-calibrate the subject measures by accounting for DIF. This may warrant real metric equivalence across medical questionnaires applied to different diagnostic groups and/or different linguistic/cultural contests, thus fostering multicentric, international trials

Citizens' perception of the Cohesion Policy and support for the European Union

Using a novel database, this study assesses the impact of the perception of the personal benefits of the EU Cohesion Policy on support for the European project. The results show that the gap in support between people who claim to have benefited from the Cohesion Policy and those who feel they have not vanished once differences in individual traits and reverse causality are taken into account. This means that, despite the significant positive effect that the intensity of the Cohesion Policy in the region exerts on the perception of the policy, it does not stimulate support for the EU

Autologous Microfragmented Adipose Tissue Reduces the Catabolic and Fibrosis Response in an in Vitro Model of Tendon Cell Inflammation

Background. Mesenchymal stem cells (MSCs) emerged as a promising therapy for tendon pathologies. Microfragmented adipose tissue (\u3bcFAT) represents a convenient autologous product for the application of MSC-based therapies in the clinical setting. In the present study, the ability of \u3bcFAT to counteract inflammatory processes induced by IL-1\u3b2 on human tendon cells (TCs) was evaluated. Methods. Cell viability and proliferation were evaluated after 48 hours of transwell coculture of TCs and autologous \u3bcFAT in the presence or absence of IL-1\u3b2. Gene expression of scleraxis, collagen type I and type III, metalloproteinases-1 and -3, and cyclooxygenase-2 was evaluated by real-time RT-PCR. The content of VEGF, IL-1Ra, TNF\u3b1, and IL-6 was evaluated by ELISA. Results. IL-1\u3b2-treated TCs showed augmented collagen type III, metalloproteases, and cyclooxygenase-2 expression. \u3bcFAT was able to reduce the expression of collagen type III and metalloproteases-1 in a significant manner, and at the same time, it enhanced the production of VEGF, IL-1Ra, and IL-6. Conclusions. In this in vitro model of tendon cell inflammation, the paracrine action of \u3bcFAT, exerted by anti-inflammatory molecules and growth factors, was able to inhibit the expression of fibrosis and catabolic markers. Then, these results suggest that the application of \u3bcFAT may represent an effective conservative or adjuvant therapy for the treatment of tendon disorders

Mirna reference genes in extracellular vesicles released from amniotic membrane-derived mesenchymal stromal cells

Human amniotic membrane and amniotic membrane-derived mesenchymal stromal cells (hAMSCs) have produced promising results in regenerative medicine, especially for the treatment of inflammatory-based diseases and for different injuries including those in the orthopedic field such as tendon disorders. hAMSCs have been proposed to exert their anti-inflammatory and healing potential via secreted factors, both free and conveyed within extracellular vesicles (EVs). In particular, EV miRNAs are considered privileged players due to their impact on target cells and tissues, and their future use as therapeutic molecules is being intensely investigated. In this view, EV-miRNA quantification in either research or future clinical products has emerged as a crucial paradigm, although, to date, largely unsolved due to lack of reliable reference genes (RGs). In this study, a panel of thirteen putative miRNA RGs (let-7a-5p, miR-16-5p, miR-22-5p, miR-23a-3p, miR-26a-5p, miR-29a-5p, miR-101-3p, miR-103a-3p, miR-221-3p, miR-423-5p, miR-425-5p, miR-660-5p and U6 snRNA) that were identified in different EV types was assessed in hAMSC-EVs. A validated experimental pipeline was followed, sifting the output of four largely accepted algorithms for RG prediction (geNorm, NormFinder, BestKeeper and \u394Ct method). Out of nine RGs constitutively expressed across all EV isolates, miR-101-3p and miR-22-5p resulted in the most stable RGs, whereas miR-423-5p and U6 snRNA performed poorly. miR-22-5p was also previously reported to be a reliable RG in adipose-derived MSC-EVs, suggesting its suitability across samples isolated from different MSC types. Further, to shed light on the impact of incorrect RG choice, the level of five tendon-related miRNAs (miR-29a-3p, miR-135a-5p, miR-146a-5p, miR-337-3p, let-7d-5p) was compared among hAMSC-EVs isolates. The use of miR-423-5p and U6 snRNA did not allow a correct quantification of miRNA incorporation in EVs, leading to less accurate fingerprinting and, if used for potency prediction, misleading indication of the most appropriate clinical batch. These results emphasize the crucial importance of RG choice for EV-miRNAs in hAMSCs studies and contribute to the identification of reliable RGs such as miR-101-3p and miR-22-5p to be validated in other MSC-EVs related fields

High Levels of Circulating Type II Collagen Degradation Marker (CTx-II) Are Associated with Specific VDR Polymorphisms in Patients with Adult Vertebral Osteochondrosis

Both vitamin D and collagen have roles in osteocartilaginous homeostasis. We evaluated the association between the circulating 25-hydroxyvitamin D (25(OH)D) type I and II collagen degradation products (CTx-I, and CTx-II), and four vitamin D receptor gene (VDR) polymorphisms, in Italian males affected by low back pain (LBP) due to herniation/discopathy and/or vertebral osteochondrosis. FokI, BsmI, ApaI, and TaqI VDR-polymorphisms were detected through PCR-restriction fragment length polymorphism (RFLP), and circulating 25(OH)D, CTx-I and CTx-II were measured by immunoassays in 79 patients (of which 26 had osteochondrosis) and 79 age-, sex- and body mass index (BMI)-matched healthy controls. Among all 158 subjects, carriers of FF and Ff genotypes showed lower 25(OH)D than ff, which suggested a higher depletion of vitamin D in F allele carriers. Higher CTx-I concentrations were observed in TT versus Tt among controls, and Tt versus tt among LBP cases, which suggested a higher bone-cartilaginous catabolism in subjects bearing the T allele. Higher CTx-II concentrations were observed in patients with osteochondrosis bearing FF, bb, TT, or Aa genotypes in comparison with hernia/discopathy patients and healthy controls. Vertebral osteochondrosis shows peculiar genotypic and biochemical features related to vitamin D and the osteocartilaginous metabolism. Vitamin D has roles in the pathophysiology of osteochondrosis

Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

OBJECTIVE: To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. METHODS: A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34 months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen's kappa (k) statistics and rated according to Landis and Koch's criteria. RESULTS: Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k = 0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k = 0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k = 0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k = 0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have "undefined responsiveness." SIGNIFICANCE: Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be "drug-resistant" were classified by the EP as having "undefined responsiveness.

final safety tolerability and seizure outcomes in patients with focal epilepsy treated with adjunctive perampanel for up to 4 years in an open label extension of phase iii randomized trials study 307

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Measuring mobility in people with lower limb amputation: Rasch analysis of the mobility section of the prosthesis evaluation questionnaire

Objective: To assess the psychometric properties of the Mobility Section of the Prosthesis Evaluation Questionnaire (PEQ-MS). Design: A postal survey, including self-report assessment of prosthetic capability and performance with the PEQ-MS and the Locomotor Capabilities Index, and of other variables associated with prosthetic wear and use. The PEQ-MS data underwent Rasch analysis for rating scale diagnostics and a reliability and validity study. Patients: A total of 123 subjects (mean age 54 years) who had undergone lower limb amputation in the previous 5 years and who had completed rehabilitation and a prosthetic training programme. Results: According to Rasch analysis and expert review, some response categories of the PEQ-MS (13 items, 11-level numeric rating scale) were collapsed and one item was deleted. The remaining 12 items fitted to the Rasch model and created a revised scale with a 5-level response format, the PEQ-MS12/5. The PEQ-MS12/5 demonstrated good reliability (person-separation reliability = 0.95, item-separation reliability = 0.98) and internal construct validity. Moreover, the correlation with the Locomotor Capabilities Index (r(s) = 0.78) and with prosthetic wear and use (r(s) range 0.41-0.59) supported the convergent validity of the PEQ-MS 12/5. Conclusion: The new PEQ-MS12/5 presents good psychometric characteristics for measuring mobility in people with lower limb amputations. These preliminary results provide an already applicable instrument and a solid basis for further validation studies