•First study on muscle coordination in people with FSHD during ADL arm tasks.•People with FSHD have very diverse muscle coordination patterns compared to controls.•Assistive device does not reduce ...muscle coordination diversity in people with FSHD.
This study's objective is to understand the effect of muscular weakness in persons with facioscapulohumeral dystrophy as well as the effect of a dynamic arm support on muscle coordination and activity performance, during activities of daily living. People with facioscapulohumeral dystrophy (n=12, 56.0±14.5 years) and healthy controls (n=12, 55.5±13.4 years) performed five simulated daily activity tasks, while unsupported and supported by the Gowing dynamic arm support. Surface electromyography, kinematics, and maximum force output were recorded. Outcomes were calculated for muscle coordination (muscle synergies), maximum muscle activity, movement performance indicators, and upper limb muscular weakness (maximum force output). Muscle coordination was altered and less consistent in persons with facioscapulohumeral dystrophy compared with healthy controls. The dynamic arm support alleviated muscle efforts and affected muscle coordination in both populations. While populations became more similar, the internal consistency of persons with facioscapulohumeral dystrophy remained unaffected and lower than that of healthy controls. Furthermore, the support affected movements’ performance in both groups. The maximum force outputs were lower in persons with facioscapulohumeral dystrophy than controls. Muscle coordination differences were presumably the result of individual-specific in muscle weakness and compensatory strategies for dealing with gravity compensation and movement constraints.
We determined muscle fiber type–specific hypertrophy and changes in satellite cell (SC) content following a 12-week resistance training program in 13 healthy, elderly men (72 ± 2 years). Leg strength ...and body composition (dual-energy X-ray absorptiometry and computed tomography) were assessed, and muscle biopsy samples were collected. Leg strength increased 25%–30% after training (p < .001). Leg lean mass and quadriceps cross-sectional area increased 6%–9% (p < .001). At baseline, mean fiber area and SC content were smaller in the Type II versus Type I muscle fibers (p < .01). Following training, Type II muscle fiber area increased from 5,438 ± 319 to 6,982 ± 503 μm2 (p < .01). Type II muscle fiber SC content increased from 0.048 ± 0.003 to 0.084 ± 0.008 SCs per fiber (p < .001). No changes were observed in the Type I muscle fibers. In older adults, skeletal muscle tissue is still capable of inducing SC proliferation and differentiation, resulting in Type II muscle fiber hypertrophy.
Abstract Accelerometers enable us to analyse gait outside conventional gait laboratories. Before these devices can be used in large scale studies and in clinical settings a thorough evaluation of ...their performance in different populations is required. The aim of this study was to present an acceleration-based reference database for healthy gait. The repeatability and inter-observer reliability of acceleration-based gait analysis was investigated. The sensitivity was tested on different age groups and the effect of gender was studied. A comprehensive set of gait parameters (i.e. cadence, speed, asymmetry and irregularity) were studied in 60 women and 60 men. Basic gait parameters showed high repeatability (VCcadence 1.51%, ICCcadence 0.996) and inter-observer reliability (ICCcadence 0.916), while asymmetry and irregularity showed lower repeatability (VCasym 47.88%, ICCasym 0.787) and inter-observer reliability (ICCasym 0.449). The effects of age and gender on gait parameters were found to be consistent with those reported in studies using other methodologies. These findings and the advantages of the device support the application of AGA for routine clinical use and in daily life.
Our objective was to assess the incidence of drug bioaccumulation in critically ill COVID-19 patients with AKI receiving intermediate dose nadroparin for thrombosis prophylaxis. We conducted ...a Prospective cohort study of critically ill COVID-19 patients. In patients on intermediate dose nadroparin (5700 IU once daily) we assessed the incidence of bioaccumulation (trough anti-Xa level > 0.2 IU/mL) stratified according to presence of AKI. We quantified this association using multilevel analyses. To assess robustness of our observations, we explored the association between AKI and anti-Xa activity in patients receiving high dose nadroparin (> 5700 IU). 108 patients received intermediate dose nadroparin, of whom 24 had AKI during 36 anti-Xa measurements. One patient with AKI (4.2% 95%CI 0.1-21%) and 1 without (1.2% 95%CI 0.03-6.5%) developed bioaccumulation (p = 0.39). Development of AKI was associated with a mean increase of 0.04 (95%CI 0.02-0.05) IU/ml anti-Xa activity. There was no statistically significant association between anti-Xa activity and AKI in 51 patients on high dose nadroparin. There were four major bleeding events, all in patients on high dose nadroparin. In conclusion, Bioaccumulation of an intermediate dose nadroparin did not occur to a significant extent in critically ill patients with COVID-19 complicated by AKI. Dose adjustment in AKI may be unnecessary.
Summary
Background
von Willebrand factor (VWF) levels in healthy individuals are influenced by variations in genetic loci other than the VWF gene, whose contribution to VWF levels in patients with ...von Willebrand disease (VWD) is largely unknown.
Objectives
To investigate the association between single‐nucleotide polymorphisms (SNPs), VWF levels, and bleeding phenotype.
Patients/Methods
In 364 type 1 VWD and 240 type 2 VWD patients from the nationwide cross‐sectional ‘Willebrand in The Netherlands’ (WiN) study, we studied the association between eight SNPs in STXBP5, SCARA5, ABO, VWF, STAB2, STX2, TC2N, and CLEC4M, and VWF antigen (VWF:Ag), VWF activity (VWF:Act), and bleeding phenotype as assessed with the Tosetto bleeding score.
Results
In type 1 patients, STXBP5 was associated with a lower VWF:Ag level (adjusted difference of −3.0 IU dL−1 per allele; 95% confidence interval CI −6.0 to 0.1) and CLEC4M with both a lower VWF:Ag level (−4.3 IU dL−1 per allele; 95% CI −7.9 to −0.6) and lower VWF:Act (−5.7 IU dL−1 per allele; 95% CI −10.9 to −0.5). In type 2 patients, none of the SNPs was associated with VWF levels. None of the genetic variants was associated with bleeding score.
Conclusions
Genetic variations in STXBP5 and CLEC4M are associated with VWF level variation in type 1 VWD, but not in type 2 VWD. This study increases our understanding of the pathophysiology of VWD, and provides a further indication of the involvement of STXBP5 and CLEC4M in determining VWF levels in VWD.
Fatigue during walking is a common complaint in cerebral palsy (CP). The primary purpose of this study is to investigate muscle fatigue from surface electromyography (sEMG) measurements after a ...treadmill-based fatigue protocol with increasing incline and speed in children with CP with drop foot. The secondary purpose is to investigate whether changes in sagittal kinematics of hip, knee and ankle occur after fatigue. Eighteen subjects with unilateral spastic CP performed the protocol while wearing their ankle-foot orthosis and scored their fatigue on the OMNI scale of perceived exertion. The median frequency (MF) and root mean square (RMS) were used as sEMG measures for fatigue and linear mixed effects model were applied. The MF was significantly decreased in fatigued condition, especially in the affected leg and in the tibialis anterior and peroneus longus muscle. The RMS did not change significantly in fatigued condition, while the OMNI fatigue score indicated patients felt really fatigued. No changes in sagittal kinematics of hip, knee and ankle were found using statistical non-parametric mapping. In conclusion, the current fatigue protocol seems promising in inducing fatigue in a population with CP with drop foot and it could be used to expand knowledge on muscle fatigue during walking in CP.
Running‐related injuries remain problematic among recreational runners. We evaluated the association between having sustained a recent running‐related injury and speed, and the strike index (a ...measure of footstrike pattern, SI) and spatiotemporal parameters of running. Forty‐four previously injured and 46 previously uninjured runners underwent treadmill running at 80%, 90%, 100%, 110%, and 120% of their preferred running speed. Participants wore a pressure insole device to measure SI, temporal parameters, and stride length (Slength) and stride frequency (Sfrequency) over 2‐min intervals. Coefficient of variation and detrended fluctuation analysis provided information on stride‐to‐stride variability and correlative patterns. Linear mixed models were used to compare differences between groups and changes with speed. Previously injured runners displayed significantly higher stride‐to‐stride correlations of SI than controls (P = 0.046). As speed increased, SI, contact time (Tcontact), stride time (Tstride), and duty factor (DF) decreased (P < 0.001), whereas flight time (Tflight), Slength, and Sfrequency increased (P < 0.001). Stride‐to‐stride variability decreased significantly for SI, Tcontact, Tflight, and DF (P ≤ 0.005), as did correlative patterns for Tcontact, Tstride, DF, Slength, and Sfrequency (P ≤ 0.044). Previous running‐related injury was associated with less stride‐to‐stride randomness of footstrike pattern. Overall, runners became more pronounced rearfoot strikers as running speed increased.
Metabolic health in people with obesity is determined by body composition. In this study, we examined the influence of a combined strength exercise and motivational programme -embedded in the school ...curriculum- on adolescents body composition and daily physical activity.
A total of 695 adolescents (11-15y) from nine Dutch secondary schools participated in a one year cluster randomised controlled trial (RCT). In the intervention schools, physical education teachers were instructed to spend 15-30 min of all physical education lessons (2× per week) on strength exercises. Monthly motivational lessons were given to stimulate students to be more physically active. Control schools followed their usual curriculum. The primary outcome measure was body composition assessed by the deuterium dilution technique. Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome.
After 1 year, a 1.6% fat mass difference was found in favour of the intervention group (p = .007). This reflected a 0.9 kg difference in fat free mass (intervention>control; p = .041) and 0.7 kg difference in fat mass (intervention<control; p = .054). Daily physical activity decreased from baseline to posttest in both groups, but less so in the intervention group (p = .049). After 1 year, a difference of 0.4% was found for moderate to vigorous physical activities in favour of the intervention group (p = .046). No differences in sedentary behaviour, or light physical activity were found between groups.
In 11-15 year olds, the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level. TRIAL REGISTRATION ID: ( NTR5676 - retrospectively registered 8 February 2016; enrolment of first participant: 2 March 2015).
Physical capacity (PC) and physical activity (PA) are associated physical performance measures, and combined, PC and PA are used to categorize physical performance in the “can do, do do” framework. ...We aimed to explore physical performance of patients attending the fracture liaison service (FLS). In this cross-sectional study, PC was measured by 6-min-walking-test (can’t do/can do) and PA by accelerometer (don’t do/do do). Following quadrants were defined based on predefined cut-off scores for poor performance: (1) “can’t do, don’t do”; (2) “can do, don’t do”; (3) “can’t do, do do”; (4) “can do, do do”. Odds ratios (OR) were calculated and fall and fracture risk factors were assessed between quadrants. Physical performance of 400 fracture patients was assessed (mean age 64; female 70.8%). Patients performed as follows: 8.3% “can’t do, don’t do”; 3.0% “can do, don’t do”; 19.3% “can’t do, do do”; 69.5% “can do, do do”. For the “can’t do” group the OR for low PA was 9.76 (95% CI: 4.82–19.80). Both the “can’t do, don’t do” and “can’t do, do do” group differed significantly compared to the “can do, do do” group on several fall and fracture risk factors and had lower physical performance. The “can do, do do” framework is able to identify fracture patients with an impaired physical performance. Of all FLS patients 20% “can’t do, but “do do” while having a high prevalence of fall risk factors compared to persons that “can do, do do”, which may indicate this group is prone to fall.
Background: The efficacy and safety of vitamin K antagonists for the prevention of thromboembolism are dependent on the time for which the International Normalized Ratio (INR) is in the therapeutic ...range. The objective of our study was to determine the effect of introducing a simple two‐step dosing algorithm, as compared with dosing by anticoagulation clinic staffs on the basis of their experience, on time in therapeutic range (TTR) of warfarin therapy. Methods: We compared TTRs of all clinic patients before and after the introduction of a simple two‐step dosing algorithm at a single anticoagulation clinic in Canada, between 1 August 2006 and 24 December 2008. TTR was calculated using the linear interpolation method of Rosendaal. Results: We included 873 patients in the ‘before’ phase and 1088 patients in the ‘after’ phase. Introduction of the dosing algorithm significantly increased TTR of patients with a therapeutic INR range of 2–3 from 67.2% to 73.2% (P < 0.001), and that of patients with a therapeutic INR range of 2.5–3.5 from 49.8% to 63.8% (P < 0.001). Conclusions: The introduction of a simple two‐step warfarin‐dosing algorithm in place of dosing by experienced anticoagulation clinic staff significantly improved mean TTR for patients in a tertiary‐care anticoagulation clinic. This inexpensive and widely applicable algorithm has the potential to improve warfarin control.
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