Assessing the Benefits of a Teleassessment Solution Using a FVM Perspective

The recent COVID-19 pandemic has served to highlight the benefits of digital health in general and telehealth in particular. One area of telehealth that is particularly important is that of teleassessment. Currently, we are witnessing an exponential growth in total knee and total hip replacements (TKR) (THR) due to an aging population coupled with longer life expectancy which is leading to a high likelihood of an unsustainable burden for healthcare delivery in Australia. To address this imminent challenge, the following proffers a tele-assessment solution, ARIADNE (Assist foR hIp AnD kNEe), that can provide high quality care, with access for all and support for high value outcomes. A fit viability assessment is provided to demonstrate benefits of the proffered solution

THE EFFECT OF TRAINING THROUGH PARTIAL RANGE OF MOTION

INTRODUCTION: A full range of motion (ROM) is necessary for effective motor functioning. However, rehabilitation often commences with resistance training (RT) through partial ROM (PROM) in order to minimize the risk of re-injury. Studies on specificity of RT with regard to joint ROM based on isometric training and testing support the contention that strength gains are greater at the angular position at which RT is performed than at other positions. (Morrisey et al., 1995). Data regarding the specificity of PROM dynamic RT are scarce. The purpose of this study was to evaluate the effect of PROM isokinetic RT of the knee flexors on full ROM. METHODS: Four healthy subjects (Ss) trained their right knee flexors for 6 weeks with a Cybex II at 60°.sec-1 and a ROM of 40°-70°. Ss worked out 3 times per week performing 3 sets of 10 or 15 repetitions during the first 3 and the last 3 weeks respectively. Ss were instructed to perform both flexion and extension at maximal effort with an emphasis on the flexors. Pre- and post-training tests included 5 consecutive cycles of knee extension and flexion at 60°.sec-1 at a ROM of 5°-85°. The last 4 trials were used for analysis. The full ROM was divided into three sectors: 5°-40°, 40°-70°, 70°-85°. The size effect of the changes in strength was evaluated in two ways: a) The percentage changes relative to the pre training values, and b) The ratio between the mean gain and the pre training standard deviations (s.d). The work output of each sector was subjected to a two way ANOVA (4 trials by pre-post). Conclusions from this analysis are limited to the current sample. Further generalization requires a more extensive and representative sample. RESULTS: Results are displayed in Table 1. The gains in all sectors were significant (

Steatosis-induced proteins adducts with lipid peroxidation products and nuclear electrophilic stress in hepatocytes

AbstractAccumulating evidence suggests that fatty livers are particularly more susceptible to several pathological conditions, including hepatic inflammation, cirrhosis and liver cancer. However the exact mechanism of such susceptibility is still largely obscure. The current study aimed to elucidate the effect of hepatocytes lipid accumulation on the nuclear electrophilic stress. Accumulation of intracellular lipids was significantly increased in HepG2 cells incubated with fatty acid (FA) complex (1mM, 2:1 oleic and palmitic acids). In FA-treated cells, lipid droplets were localized around the nucleus and seemed to induce mechanical force, leading to the disruption of the nucleus morphology. Level of reactive oxygen species (ROS) was significantly increased in FA-loaded cells and was further augmented by treatment with moderate stressor (CoCl2). Increased ROS resulted in formation of reactive carbonyls (aldehydes and ketones, derived from lipid peroxidation) with a strong perinuclear accumulation. Mass-spectroscopy analysis indicated that lipid accumulation per-se can results in modification of nuclear protein by reactive lipid peroxidation products (oxoLPP). 235 Modified proteins involved in transcription regulation, splicing, protein synthesis and degradation, DNA repair and lipid metabolism were identified uniquely in FA-treated cells. These findings suggest that steatosis can affect nuclear redox state, and induce modifications of nuclear proteins by reactive oxoLPP accumulated in the perinuclear space upon FA-treatment

Distinct ground reaction forces in gait between the paretic and non-paretic leg of stroke patients: a paradigm for innovative physiotherapy intervention

This case report study aims to identify the differences in the ground reaction forces (GRF) placed on the forefoot, hindfoot, and entire foot between the paretic and non-paretic legs in two stroke patients to identify potential targets for improved physiotherapy treatment. A digital gait analysis foot pressure insole was fitted inside the participants’ shoes to measure the percentage of body weight taken during the stance phase, and the vertical GRF of the two subjects are reported in this paper. Both patients presented noteworthy differences in gait parameters individually and between their paretic and non-paretic legs. The trend shows a decreased percentage of body weight on the paretic forefoot and hindfoot, although the percentage bodyweight placed on the entire foot remained similar in both feet. The gait patterns shown were highly individual and indicated that both legs were affected to some degree. These findings identify key motion targets for an improved physiotherapy treatment following a stroke, suggesting that physiotherapy treatment should be targeted and individually tailored and should include both extremities

A safe model for implementing live streaming of surgery to improve surgical education

BackgroundLive surgery broadcasting has had increasing use in medical education, especially in distributed education models. However, there have been several concerns raised regarding its safety and ethics with many surgical colleges banning its use.AimsOur study aimed to implement a model of live surgery broadcasting of Orthopaedic surgery that utilised its educational benefits whilst addressing the current concerns.Methods A telemedicine system using a one-way transmission microphone was installed in a tertiary public hospital to securely transmit live Orthopaedic surgery broadcasting from an operating theatre to a lecture theatre holding either medical students, surgical nurses or musculoskeletal physiotherapists. We performed common Orthopaedic operations on patients that were known to the surgeon within their routine time limits. An evaluation survey was administered at the end of each live surgery session using a 5-point Likert scale and open answers. Questions addressed the quality and usefulness of this education model for each discipline.Results Five live surgery broadcasting sessions were conducted and 179 survey responses received. 38% of medical students had never attended theatre with 71% having never seen a common Orthopaedic operation. Most surgical nurses and musculoskeletal physiotherapists had also never seen common orthopaedic procedures. There was a statistically significant benefit in the improvement of educational experience gained by live surgery broadcasting for all five sessions (p < 0.01). Over 80% of all cohorts would like to expand this model to include other surgical specialties.ConclusionLive surgery broadcasting can successfully provide educational benefit to medical students, surgical nurses and musculoskeletal physiotherapists without infringing upon patient safety

CCAAT/Enhancer-Binding Protein Homologous (CHOP) Protein Promotes Carcinogenesis in the DEN-Induced Hepatocellular Carcinoma Model

Background and Aims C/EBP homologous protein (CHOP) plays pro-apoptotic roles in the integrated stress response. Recently, a tumor suppressive role for CHOP was demonstrated in lung cancer via regulation of tumor metabolism. To explore the role of CHOP in hepatocarcinogenesis, we induced hepatocellular carcinoma (HCC) in wild type (wt) and CHOP knockout (KO) mice using the carcinogen N-diethylnitrosamine (DEN). Results: Analysis of tumor development showed reduced tumor load, with markedly smaller tumor nodules in the CHOP KO animals, suggesting oncogenic roles of CHOP in carcinogen-induced HCC. In wt tumors, CHOP was exclusively expressed in tumor tissue, with minimal expression in normal parenchyma. Analysis of human adenocarcinomas of various origins demonstrated scattered expression of CHOP in the tumors, pointing to relevance in human pathology. Characterization of pathways that may contribute to preferential expression of CHOP in the tumor identified ATF6 as a potential candidate. ATF6, a key member of the endoplasmic reticulum stress signaling machinery, exhibited a similar pattern of expression as CHOP and strong activation in wt but not CHOP KO tumors. Because HCC is induced by chronic inflammation, we assessed whether CHOP deficiency affects tumor-immune system crosstalk. We found that the number of macrophages and levels of IFNγ and CCL4 mRNA were markedly reduced in tumors from CHOP KO relative to wt mice, suggesting a role for CHOP in modulating tumor microenvironment and macrophage recruitment to the tumor. Conclusion: Our data highlights a role for CHOP as a positive regulator of carcinogen-induced HCC progression through a complex mechanism that involves the immune system and modulation of stress signaling pathways

Gait training with real-time augmented toe-ground clearance information decreases tripping risk in older adults and a person with chronic stroke

Falls risk increases with ageing but is substantially higher in people with stroke. Tripping-related balance loss is the primary cause of falls, and Minimum Toe Clearance (MTC) during walking is closely linked to tripping risk. The aim of this study was to determine whether real-time augmented information of toe-ground clearance at MTC can increase toe clearance, and reduce tripping risk. Nine healthy older adults (76 ± 9 years) and one 71 year old female stroke patient participated. Vertical toe displacement was displayed in real-time such that participants could adjust their toe clearance during treadmill walking. Participants undertook a session of unconstrained walking (no-feedback baseline) and, in a subsequent Feedback condition, were asked to modify their swing phase trajectory to match a "target" increased MTC. Tripping probability (PT) pre- and post-training was calculated by modeling MTC distributions. Older adults showed significantly higher mean MTC for the post-training retention session (27.7 ± 3.79 mm) compared to the normal walking trial (14.1 ± 8.3 mm). The PT on a 1 cm obstacle for the older adults reduced from 1 in 578 strides to 1 in 105,988 strides. With gait training the stroke patient increased MTC and reduced variability (baseline 16 ± 12 mm, post-training 24 ± 8 mm) which reduced obstacle contact probability from 1 in 3 strides in baseline to 1 in 161 strides post-training. The findings confirm that concurrent visual feedback of a lower limb kinematic gait parameter is effective in changing foot trajectory control and reducing tripping probability in older adults. There is potential for further investigation of augmented feedback training across a range of gait-impaired populations, such as stroke

Voluntary postural sway control and mobility in adults with low back pain

IntroductionLow back pain (LBP) is associated with altered somatosensory perception, which is involved in both involuntary and voluntary control of posture. Currently, there is a lack of methods and tools for assessing somatosensory acuity in patients with LBP. The purpose of this study was (1) to assess the reliability of the sway discrimination apparatus (SwayDA) (2) to evaluate the differences in somatosensory acuity between patients with LBP and pain-free individuals, and (3) to examine relationships between somatosensory acuity, severity of LBP, and mobility in patients with LBP.MethodsTwenty participants (10 patients with LBP and 10 matched asymptomatic controls) were recruited in a test–retest reliability test. Another 56 participants were recruited for this study with 28 individuals presenting with LBP and a further twenty-eight being asymptomatic. The SwayDA was custom-built to measure somatosensory perception during voluntary anterior–posterior (SwayDA-AP), medial-lateral to the dominant side (SwayDA-ML-D), and non-dominant side (SwayDA-ML-ND) postural sway control. Participants also completed mobility tests, including 10 times and 1-min sit-to-stand tests (10-STS, 1 m-STS). The area under the receiver operating characteristic curve (AUC) was calculated to quantify somatosensory acuity in discriminating different voluntary postural sway extents.ResultsThe ICC (2.1) for the SwayDA-AP, SwayDA-ML-D, and SwayDA-ML-ND were 0.741, 0.717, and 0.805 with MDC95 0.071, 0.043, and 0.050. Patients with LBP demonstrated significantly lower SwayDA scores (tSwayDA-AP = −2.142, p = 0.037; tSwayDA-ML-D = -2.266, p = 0.027) than asymptomatic controls. The AUC values of the SwayDA-AP test were significantly correlated with ODI (rSwayDA-AP-ODI = −0.391, p = 0.039). Performances on the 1 m-STS and the 10-STS were significantly correlated with the AUC scores from all the SwayDA tests (−0.513 ≤ r ≤ 0.441, all p &lt; 0.05).DiscussionThe SwayDA tests evaluated showed acceptable reliability in assessing somatosensory acuity during voluntary postural sway. Somatosensory acuity was diminished in patients with LBP compared to asymptomatic controls. In patients with LBP, lower somatosensory acuity was associated with increased LBP-related disability. Future research could focus on investigating the factors contributing to the decreased somatosensory perception and mobility in individuals with LBP