Musculoskeletal Outcomes Among Older Adults Following Hospitalization For Covid-19: A Pilot Study

Background Older individuals are at high risk for musculoskeletal impairment following hospitalization due to decreased neuromuscular function and bone mineral density (BMD) arising from illness itself, and external factors such as immobilization and changes in nutritional status. To address the knowledge gap regarding the longitudinal impact of COVID-19 on musculoskeletal outcomes, this thesis aimed to study the relationship between COVID-19 severity and physical functional, incidence of falls and fractures in older adults. Secondarily, in a subset of patients we examined the relationship between COVID-19 severity and osteoporosis- and sarcopenia-related measures. Methods This study analyzed data from the VALIANT study and VALIANT MSK Sub-study. The VALIANT study included individuals who were over 60 years old and were hospitalized due to COVID-19 in the Yale New Haven Hospital System (YNHHS) from July 2020-July 2021. Virtual interviews were performed at the time of hospitalization, and 1, 3, and 6-months post-hospitalization and measured a range of sociodemographic, clinical and general health-related characteristics, physical function domains relevant to musculoskeletal health and mobility, and incident falls and fractures. Patients who consented to be re-contacted were invited to participate in the VALIANT MSK Sub-study and presented for an in-patient visit which included a survey, serum sample collection, a dual-energy x-ray absorptiometry test, the short physical performance battery and grip strength assessment. Descriptive statistics were used to evaluate primary and secondary outcomes, stratified by COVID-19 severity as defined by SOFA score, inpatient level of care, and inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) at baseline and 6 months. Results Among 341 participants enrolled in the VALIANT parent study, the median age was 70.0 years (IQR 12) , with 49% female, and 72.5% White individuals while among the 62 participants in the VALIANT MSK Sub-Study, the median age was 67.0 years (IQR 10), with 49% females, and 64.2% White individuals. In the VALIANT cohort, when physical function status at 6 months was stratified by COVID-19 severity, multiple domains emerged as being significantly different. A higher proportion of patients who had a higher SOFA score (≥3) reported being unable to independently bathe (9.2% vs 2.4%, p\u3c0.001), get in and out of a chair (5.8% vs 1.7%, p=0.017), use the toilet (3.8% vs 0.3%, p=0.006), shop (20.1% vs 11.6%, p=0.011), or walk flight of stairs (15.4% vs 8.2%, p=0.016). A significantly higher proportion of VALIANT participants with high inpatient hsCRP levels during hospitalization (≥97 mg/L) were unable to independently do housework (31.7% vs 21.1%, p= 0.013), shop (33.1% vs 19.7%, p=0.043), walk a quarter mile (28.5% vs 24.2%, p=0.009) and walk flights of stairs (37.0% vs 15.9%. p= 0.0114). In the VALIANT MSK Sub-study, a similar general trend was observed with a higher proportion of patients with SOFA scores ≥3 or hsCRP≥97 mg/L reporting that they were unable to independently perform certain physical function tasks. At baseline, 101/339 (29.8%) VALIANT participants reported a fall in the past year before COVID-19 compared with 15/62 (24.2%) of VALIANT MSK Sub-Study participants. At 6 months, 24.3% of VALIANT participants reported having an incident fall since COVID infection compared with 19.4% of VALIANT MSK participants. When participants of both groups were categorized based on COVID severity no significant differences were seen in the proportion of new falls in the 6 months. Seven participants overall reported having a fracture following COVID-19 hospitalization. Among the VALIANT MSK participants, 3 participants (5.2%) had osteoporosis and 22 participants (37.9%) had osteopenia. Mean femoral neck (FN) BMD was lower among patients with hsCRP ≥97 (0.79 vs 0.21, p\u3c0.001). Five participants (8.1%) met criteria for probable sarcopenia. No participants met criteria for sarcopenia or severe sarcopenia. When examining individual sarcopenia assessment components, there was no statistically significant difference when categorized based on COVID severity. Conclusions Our study shows that a greater proportion of older adults presenting with severe COVID-19 as defined by SOFA, inpatient level of care, or high hsCRP and high IL-6 had worse physical functional status and lower FN BMD at six months. Further multivariable analyses should explore whether these associations remain when adjusted for key musculoskeletal health-related covariates, and how baseline status is associated with outcomes at 6 months. Attention to the rehabilitation needs of patients following COVID-19 hospitalization is important, as well as consideration for osteoporosis and sarcopenia screening for those with more severe disease

A New Look at Trigger Point Injections

Trigger point injections are commonly practised pain interventional techniques. However, there is still lack of objective diagnostic criteria for trigger points. The mechanisms of action of trigger point injection remain obscure and its efficacy remains heterogeneous. The advent of ultrasound technology in the noninvasive real-time imaging of soft tissues sheds new light on visualization of trigger points, explaining the effect of trigger point injection by blockade of peripheral nerves, and minimizing the complications of blind injection

THE EFFECT OF GAMIFIED MHEALTH APP ON EXERCISE MOTIVATION AND PHYSICAL ACTIVITY

In this study, we propose a research model to assess the effect of a mobile health (mHealth) app on exercise motivation and physical activity of individuals based on the design and self-determination theory. The research model is formulated from the perspective of motivation affordance and gamification. We will discuss how the use of specific gamified features of the mHealth app can trigger/afford corresponding users’ exercise motivations, which further enhance users’ participation in physical activity. We propose two hypotheses to test the research model using a field experiment. We adopt a 3-phase longitudinal approach to collect data in three different time zones, in consistence with approach commonly adopted in psychology and physical activity research, so as to reduce the common method bias in testing the two hypotheses

Integration of Random Forests and MM-Wave FMCW Radar Technology for Gait Recognition

Technologies that identify and monitor walking, and other charac-teristics could support detection, evaluation, and monitoring of pa-rameters related to changes in mobility, cognition, and frailty. Inte-grating with a Random Forests classifier, we develop an ultrahigh-frequency FMCW (frequency modulated continuous wave) radarsensor that can distinguish walking from other activities

Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?

BACKGROUND: Wealth quintiles derived from household asset indices are routinely used for measuring socioeconomic inequalities in the health of women and children in low and middle-income countries. We explore whether the use of wealth deciles rather than quintiles may be advantageous. METHODS: We selected 46 countries with available national surveys carried out between 2003 and 2013 and with a sample size of at least 3000 children. The outcomes were prevalence of under-five stunting and delivery by a skilled birth attendant (SBA). Differences and ratios between extreme groups for deciles (D1 and D10) and quintiles (Q1 and Q5) were calculated, as well as two summary measures: the slope index of inequality (SII) and concentration index (CIX). RESULTS: In virtually all countries, stunting prevalence was highest among the poor, and there were larger differences between D1 and D10 than between Q1 and Q5. SBA coverage showed pro-rich patterns in all countries; in four countries the gap was greater than 80 pct points. With one exception, differences between extreme deciles were larger than between quintiles. Similar patterns emerged when using ratios instead of differences. The two summary measures provide very similar results for quintiles and deciles. Patterns of top or bottom inequality varied with national coverage levels. CONCLUSION: Researchers and policymakers should consider breakdowns by wealth deciles, when sample sizes allow. Use of deciles may contribute to advocacy efforts, monitoring inequalities over time, and targeting health interventions. Summary indices of inequalities were unaffected by the use of quintiles or deciles in their calculation

Novosti u artroskopskoj kirurgiji ručnog zgloba: od resekcije do rekonstrukcije

One of the major advances in wrist arthroscopy is the development of various therapeutic procedures since the 90’s. Therapeutic procedures are no longer restricted to resection. More specific repair procedures and functional reconstruction involving replenishment of tissue defect and augmentation of vital structures are seen with proven value. In particular, wrist arthroscopy performed under local anaesthetic setting without tourniquet and sedation markedly reduces the risk and cost. This article highlights the common indications and applications of wrist arthroscopy, with emphasis on the latest and significant innovations in reconstructive arthroscopic surgery in Hong Kong. On the resection aspect, common procedures include joint debridement, synovectomy, ganglionectomy, capsular release and osteotomies. Reparative surgery includes ligament repair, arthroscopic assisted reduction and fixation of fracture dislocation and chondroplasty for small chondral lesions. Reconstructive surgery embraces surgical solutions tackling on osseous, soft tissue and cartilage problems. Scaphoid nonunion can be treated by arthroscopic bone grafting and percutaneous fixation with union rate of over 90 %. Partial wrist fusion can be achieved arthroscopically to maximize motion and to enhance union by preserving soft tissue and vascularity. Arthroscopic assisted reconstruction of the radio-ulnar ligaments with tendon graft can be performed to treat chronic distal radioulnar joint instability through bone tunnels in sigmoid notch and ulnar fovea. In chronic scapholunate (SL) instability, the dorsal and palmar portion of the SL interosseous ligament is reconstituted anatomically through arthroscopically assisted reconstruction with tendon graft in a box-like structure. In cartilage reconstruction, post–traumatic chondral lesion can be treated with arthroscopic osteochondral transplant.Od uvođenja artroskopije ručnog zgloba 90-ih godina prošloga stoljeća počinje razvoj i uvođenje brojnih novih terapijskih postupaka. Zahvati više nisu ograničeni samo na resekcije, već se počinje s razvojem reparacijskih i funkcionalnih rekonstrukcija, kao što su popunjavanje defekata i augmentacija vitalnih struktura. Artroskopija ručnog zgloba izvedena u lokalnoj anesteziji i bez Torniquetove poveske značajno smanjuje i cijenu zahvata. U ovom radu istaknute su najčešće indikacije i primjena artroskopija ručnog zgloba s naglaskom na najnoviji zahvat artroskopske rekonstrukcije ručnog zgloba u Hong Kongu. Glede resekcija, najčešći zahvati uključuju debridman zgloba, sinovijektomiju, ganglionekotimiju, opuštanje zglobne čahure i oteotomiju. Reparativni zahvati uključuju rekonstrukcije ligamenata, artroskopski asistirane repozicije i fiksacije prijeloma i luksacija te hondroplastike. Rekonstruktivni zahvati obuhvaćaju zahvate na kostima, mekim tkivima i hrskavici. Nesraštanje skafoidne kosti može se liječiti artroskopski s koštanim presadcima i perkutanim fiksacijama, a uspješnost cijeljenja je veća od 90 %. Djelomične artrodeze mogu se provesti artroskopski kako bi se očuvala pokretljivost ostalih dijelova i pojačalo cijeljenje očuvanjem mekih tkiva i vaskularizacije. Artroskopski asistirana rekonstrukcija radioularnih ligamenata s tetivnim transplantatima može se izvoditi pri kroničnim nestabilnostima distalnog radioulnarnog zgloba. Pri kroničnoj skafolunatnoj nestabilnosti, dorzalni i palmarni dio SL ligamenta mogu se anatomski rekonstruirati tetivnim presadcima. Posttraumatska hrskavična oštećenja mogu se liječiti artroskopski primjenom koštano-hrskavičnih transplantata

Combination of a Collagen Scaffold and an Adhesive Hyaluronan-Based Hydrogel for Cartilage Regeneration: A Proof of Concept in an Ovine Model

Objective Hyaluronic acid–transglutaminase (HA-TG) is an enzymatically crosslinkable adhesive hydrogel with chondrogenic properties demonstrated in vitro and in an ectopic mouse model. In this study, we investigated the feasibility of using HA-TG in a collagen scaffold to treat chondral lesions in an ovine model, to evaluate cartilage regeneration in a mechanically and biologically challenging joint environment, and the influence of the surgical procedure on the repair process. Design Chondral defects of 6-mm diameter were created in the stifle joint of skeletally mature sheep. In a 3-month study, 6 defects were treated with HA-TG in a collagen scaffold to test the stability and biocompatibility of the defect filling. In a 6-month study, 6 sheep had 12 defects treated with HA-TG and collagen and 2 sheep had 4 untreated defects. Histologically observed quality of repair tissue and adjacent cartilage was semiquantitatively assessed. Results HA-TG adhered to the native tissue and did not cause any detectable negative reaction in the surrounding tissue. HA-TG in a collagen scaffold supported infiltration and chondrogenic differentiation of mesenchymal cells, which migrated from the subchondral bone through the calcified cartilage layer. Additionally, HA-TG and collagen treatment led to better adjacent cartilage preservation compared with empty defects ( P < 0.05). Conclusions This study demonstrates that the adhesive HA-TG hydrogel in a collagen scaffold shows good biocompatibility, supports in situ cartilage regeneration and preserves the surrounding cartilage. This proof-of-concept study shows the potential of this approach, which should be further considered in the treatment of cartilage lesions using a single-step procedure

Nutrition and Reproductive Condition of Wild and Cultured New Zealand Scallops (Pecten novaezelandiae)

The New Zealand native scallop, Pecten novaezelandiae, is a species with a high economic value as a wild catch and has good potential for cultivation. As a mean to enhance the future of this growing shellfish industry, this thesis set out to investigate the nutritional requirements of P. novaezelandiae in relation to reproductive conditions, and determined the physical and biological factors that affect the condition of this scallop species in the wild and cultivated environments. Adult scallops (Pecten novaezelandiae) were sampled from six populations in the Hauraki Gulf (Auckland, New Zealand) in the spawning season (October 2014), in order to evaluate the scallop reproductive condition and nutritional state across the populations. Results showed a spatial variation in reproduction condition (VGI and gonad index), with a higher number of mature scallops in populations closer to the shoreline, where higher food availability may be found. Conversely, nutrient content in scallop somatic tissues (adductor muscle carbohydrates and digestive gland lipids) did not vary across the populations, but was strongly associated with reproductive status of individual scallops (VGI). Nutrient (carbohydrates, proteins and lipids) storage and utilization were investigated within scallops from two sites in the Hauraki Gulf, bi-monthly over a year (2012−2013). In addition, sediment samples were also taken to evaluate the potential for re-suspended nutrients as a food source for scallops. Water samples were collected for seston and chlorophyll a analyses. Isotope analyses (carbon and nitrogen) and proximate analyses were conducted for the gonad, adductor muscle and digestive gland of wild P. novaezelandiae, sediment samples and the seston (1.2−5μm, >5μm). Isotope analyses revealed distinctly different signatures in suspended sediment and scallop tissues, indicating that re-suspended nutrients were unlikely to contribute to the diet of scallops. Nevertheless, seston (particularly the small fractions) signatures were closely related to scallop tissue samples, suggesting that it is likely to be the main food source for the wild P. novaezelandiae. Scallops from the two sampling sites exhibited similar reproductive cycles and utilization of nutrients. Gametogenesis started in winter, and took place at the expense of carbohydrates stored in adductor muscles. Spawning events were recorded in spring (October−November) and summer (January−March), and the energy demand required during spawning events was supported by digestive gland protein. Gonad re-maturation between spring and summer spawnings were supported by the utilization of digestive gland lipids. The reproductive condition and nutrient content of scallops were then studied during the spawning season (October 2013) in wild populations and within experimental conditions (fed with a commercial microalgal diet; Shellfish Diet 1800®) in an aquaculture laboratory, in order to identify condition and nutrient requirements for scallop cultivation in New Zealand. Field scallops (feeding on natural food sources) spawned just before the end of the experiment, while experimental animals reached gonad maturity at the end of the experiment, but did not spawn. The trend in gonad maturation for field and experimental animals indicates that there was a lag time of about 2 weeks, and that this lag is likely due to nutritional stress associated with the shift from natural food sources to the mixed microalgal formulated diet provided in the laboratory. Results indicate that experimental scallops had lower nutrient (carbohydrates, protein, lipids and total energy) reserves stored in adductor muscle tissues compared to wild animals, but both field and experimental animals utilized muscular reserves (especially carbohydrates and protein) to support reproductive activity. The fatty acid profiles revealed that polyunsaturated fatty acids (PUFA) were found in significantly lower quantities in gonad tissues of scallops from the laboratory compared to those in the field. This thesis shows that P. novaezelandiae utilizes energy reserves from both adductor muscle and digestive gland to cover the full cost of gametogenesis. In addition, cultivation environments using microalgal diets are conducive to condition P. novaezelandiae, but the optimal nutrient requirements for an efficient aquaculture production of this species needs further investigation. It is recommended by this thesis that future investigation on the conditioning requirements for P. novaezelandiae will be the next step for New Zealand scallop fisheries