Pulmonary Lipid-Laden Macrophages and Vaping Maddock, Sean D; Cirulis, Meghan M; Callahan, Sean J ...
The New England journal of medicine,
10/2019, Letnik:
381, Številka:
15
Journal Article
Chronic graft-
-host disease occurs in 20-50% of allogeneic hematopoietic cell transplant survivors. We surveyed patients about their quality of life, symptoms, health status, comorbid conditions and ...medications. Instruments included the Short-Form-36 (SF-36), the Patient-Reported Outcomes Measurement Information System (PROMIS) Global and PROMIS-29 scales and the Lee Chronic Graft-
-Host Disease Symptom Scale. Functional status was measured by self-reported Karnofsky performance status and work status. Of 3027 surveys sent to recipients surviving one or more years after transplantation, 1377 (45%) were returned. Among these, patients reported that their chronic graft-
-host disease was mild (n=257, 18.7%), moderate (n=110, 8.0%) or severe (n=25, 1.8%). Another 377 (27.4%) had never had chronic graft-
-host disease and 280 (20.3%) had had chronic graft-
-host disease but it had resolved. We excluded 328 (23.8%) patients who did not answer the questions about chronic graft-
-host disease. Patients who reported moderate or severe chronic graft-
-host disease reported worse quality of life, lower performance status, a higher symptom burden and were more likely to be taking prescription medications for pain, anxiety and depression compared to those with resolved chronic graft-
-host disease. Self-reported measures were similar between patients with resolved chronic graft-
-host disease and those who had never had it. Our data suggest that the PROMIS measures may be able to replace the SF-36 in the assessment of chronic graft-
-host disease. Between 26.7-39.4% of people with active chronic graft-
-host disease were unable to work due to health reasons, compared with 12.1% whose chronic graft-
-host disease had resolved and 15.4% who had never had chronic graft-
-host disease. Mouth, eye and nutritional symptoms persisted after resolution of chronic graft-
-host disease. These results show that better prevention of and treatment for chronic graft-
-host disease are needed to improve survivorship after allogeneic transplantation.
The Army Combat Fitness Test (ACFT), consisting of deadlift, standing power throw, hand release push-up, sprint-drag-carry, leg tuck or plank, and 2-mile run, is the United States Army's new fitness ...test. The ACFT is designed to measure multiple fitness components required to perform combat tasks. One critical task is the tactical foot march (TFM), where soldiers cover long distances while carrying loads comprised of mission-essential equipment. As the ACFT is meant to predict soldier task performance, determining the relationships between the ACFT and the TFM is important. Data from 29 cadets (♂ = 20, ♀ = 9) from one university Reserve Officers' Training Corps program were analyzed. The ACFT was recorded in raw and scaled scores. The TFM was performed over 6.44 km, with time recorded. Cadets carried a 15.88-kg rucksack, fighting load carrier, 3-L hydration pack, and replica M4 carbine. Independent samples t-tests evaluated ACFT and TFM between-sex differences. Partial correlations, controlling for sex, determined ACFT event and TFM relationships. Male cadets outperformed females in all ACFT tasks (
≤ 0.039), except the push-up. ACFT total score, leg tuck, 2-mile run, and sprint-drag-carry showed large correlations with the TFM (
= ±0.463-0.531,
≤ 0.026). Aerobic and anaerobic capacity and upper body/trunk strength were important fitness components for cadet TFM performance.
Proper functioning of the intrinsic foot musculature (IFM) is essential in maintaining the integrity of the medial longitudinal arch (MLA). Improper functioning of the IFM leads to excessive ...pronation of the foot, which has been linked to various pathologies. Therefore, training the IFM to avoid excessive pronation may help prevent some of these pathologies; however, it is not clear how to train these muscles optimally.
To investigate the effects of 2 different types of IFM training on the height of the MLA and static- and dynamic-balance task performance.
Randomized controlled trial, repeated-measures mixed-model design.
University biomechanics laboratory for testing and a home-based training program.
24 healthy, university-age volunteers (3 groups of 8) with no history of major lower limb pathology or balance impairment.
One experimental group performed 4 wk of the short-foot exercise (SFE) and the other performed 4 wk of the towel-curl exercise (TCE). Participants were asked to perform 100 repetitions of their exercise per day.
Navicular height during weight bearing, the total range of movement of the center of pressure (COP) in the mediolateral (ML) direction for a static-balance test and a dynamic-balance test.
There were no differences in the navicular height or static-balance tests. For the dynamic-balance test, all groups decreased the ML COP movement on the dominant limb by a small amount (~5 mm); however, the SFE group was able to decrease COP movement much more than the TCE group in the nondominant limb.
The SFE appeared to train the IFM more effectively than the TCE; however, there were differing results between the dominant and nondominant legs. These imbalances need to be taken into consideration by clinicians.
Frontal and sagittal plane landing biomechanics differ between sexes but reported values don’t account for simultaneous segment or joint motion necessary for a coordinated landing. Frontal and ...sagittal plane coordination patterns, angles, and moments were compared between 28 males and 28 females throughout the landing phase of a drop vertical jump. Females landed with less isolated thigh abduction (p = 0.018), more in-phase motion (p < 0.001), and more isolated shank adduction (p = 0.028) between the thigh and shank in the frontal plane compared with males. Females landed with less in-phase (p = 0.012) and more anti-phase motion (p = 0.019) between the thigh and shank in the sagittal plane compared with males. Females landed with less isolated knee flexion (p = 0.001) and more anti-phase motion (p < 0.001) between the sagittal and frontal plane knee coupling compared with males. Waveform and discrete metric analyses revealed females land with less thigh abduction from 20 % to 100 % and more shank abduction from 0 to 100 % of landing, smaller knee adduction at initial contact (p = 0.002), greater peak knee abduction angles (p = 0.015), smaller knee flexion angles at initial contact (p = 0.035) and peak (p = 0.034), greater peak knee abduction moments (p = 0.024), greater knee abduction angles from 0 to 13 % and 19 to 30 %, greater knee abduction moments from 19 to 25 %, and smaller knee flexion moments from 3 to 5 % of landing compared with males. Females utilize greater frontal plane motion compared with males, which may be due to different inter-segmental joint coordination and smaller sagittal plane angles. Larger knee abduction angles and greater knee adduction motion in females are due to aberrant shank abduction rather than thigh adduction.
Golf participation has increased dramatically in the last several years. With this increase in participation, clinicians need better evidenced based strategies to advise those golfers with different ...pathologies when it is safe to return to the game. Golf teaching professionals also need to understand how to alter golf mechanics to protect injured and/or diseased joints in golfers to allow them to play pain free and avoid further injury. This study used a 3-dimensional link segment model to calculate the net joint moments on the large lower limb joints (knee and hip) during golf (lead and trail leg) and two commonly studied activities of daily living (gait and sit-to-stand) in 22 males, healthy, adult golfers. It also examined the correlations between these knee and hip joint loads and club head speed. The external valgus knee moment and the internal hip adduction moment were greater in the lead leg in golf than in the other activities and were also correlated with club head speed. This indicates a strategy of using the frontal plane GRF moment during the swing. The internal hip extension and knee flexion moment were also greater in the golf swing as compared with the other activities and the hip extension moment was also correlated with club head speed. This emphasizes the importance of hip extensor (i.e., gluteus maximus and hamstring) muscle function in golfers, especially in those emphasizing the use of anterior-posterior ground reaction forces (i.e., the pivoting moment). The golf swing places some loads on the knee and the hip that are much different than the loads during gait and sit-to-stand tasks. Knowledge of these golf swing loads can help both the clinician and golf professional provide better evidence-based advice to golfers in order to keep them healthy and avoid future pain/injury.
Force attenuation during landing requires coordinated motion of the ankle, knee, hip, and trunk, and strategies may differ between sexes. Sagittal plane coordination of the ankle/knee, knee/hip, and ...knee/trunk, and lower extremity and trunk kinematics and kinetics was compared throughout landing between 28 males and 28 females. Coordination was assessed with a modified vector coding technique and binning analysis. Total support moments (TSM), each joint's percent contribution, and timing of the TSM were compared. Females landed with less isolated knee flexion in the ankle/knee, knee/hip, and knee/trunk couplings, but more simultaneous ankle/knee flexion, less simultaneous knee flexion/hip extension, and more simultaneous trunk/knee flexion. Females landed with larger plantarflexion angles from 0-16% and smaller trunk flexion angles from 0-78%. In females, absolute TSM were larger from 0-6% and smaller from 42-100%, and normalized TSM were larger from 0-8% and 26-42%. Females had greater ankle contribution to the TSM from 14-15% and 29-35%, smaller absolute peak TSM, and the peak TSM occurred earlier. Females compensated for less isolated knee flexion with greater simultaneous ankle/knee flexion early in landing and knee/trunk flexion later in landing. Coordination and TSM differences may influence force attenuation strategies and have implications for knee injury disparity between sexes.
The foot progression angle (FPA) influences knee loading during gait, but its determinants are unclear. The purpose of this study was to compare FPA between males and females and also examine the ...association between lower extremity kinematics during gait, hip strength, and the FPA. 25 males and 25 females completed 5 gait trials while FPA and frontal and transverse plane hip and knee angles were calculated from the dominant limb during the foot flat portion of stance. Hip extensor/flexor, abductor/adductor, and internal/external rotator strength were evaluated using maximum voluntary isometric contractions. One-way MANOVAs compared gait and strength outcomes. Stepwise regression assessed the association between FPA, and MVIC and kinematics after accounting for speed in males and females. There was no difference in FPA between sexes (p > 0.05), but females had greater frontal and transverse plane hip angles compared with males (all p < 0.05). Greater hip abduction (p = 0.02) strength was associated with greater FPA, but only in males. In males, greater hip abductor strength may contribute to a more neutral position of the foot during gait, which could help maintain an equal knee loading distribution. Our results suggest that there are sex specific control strategies to achieve a similar FPA during gait.
Alterations of foot rotation angles have successfully reduced external knee adduction moments during walking and running. However, reductions in knee adduction moments may not result in reductions in ...knee joint reaction forces. The purpose of this study was to examine the effects of internal and external foot rotation on knee, hip, and ankle joint reaction forces during running. Motion capture and force data were recorded of 19 healthy adults running at 3.35 m/s during three conditions: (1) preferred (normal) and with (2) internal and (3) external foot rotation. Musculoskeletal simulations were performed using opensim and the Rajagopal 2015 model, modified to a two degree-of-freedom knee joint. Muscle excitations were derived using static optimization, including muscle physiology parameters. Joint reaction forces (i.e., the total force acting on the joints) were computed and compared between conditions using one-way analyses of variance (ANOVAs) via statistical parametric mapping (SPM). Internal foot rotation reduced resultant hip forces (from 18% to 23% stride), while external rotation reduced resultant ankle forces (peak force at 20% stride) during the stance phase. Three-dimensional and resultant knee joint reaction forces only differed at very early and very late stance phase. The results of this study indicate, similar to previous findings, that reductions in external knee adduction moments do not mirror reductions in knee joint reaction forces.
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