Abstract
BACKGROUND:
Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling.
OBJECTIVE:
To evaluate ...symptomatic RF after posterior instrumented fusion for adult spinal deformity.
METHODS:
A multicenter, retrospective review of RF in adult spinal deformity was performed. Inclusion criteria were spinal deformity, age older than 18 years, and more than 5 levels posterior instrumented fusion. Rod failures were divided into early (⩽12 months) and late (>12 months).
RESULTS:
Of 442 patients, 6.8% had symptomatic RF. RF rates were 8.6% for titanium alloy, 7.4% for stainless steel, and 2.7% for cobalt chromium. RF incidence after pedicle subtraction osteotomy (PSO) was 15.8%. Among patients with a PSO and RF, 89% had RF at or adjacent to the PSO. Mean time to early RF (63%) was 6.4 months (range, 2-12 months). Mean time to late RF (37%) was 31.8 months (range, 14-73 months). The majority of RFs after PSO (71%) were early (mean, 10 months). Among RF cases, mean sagittal vertical axis improved from preoperative (163 mm) to postoperative (76.9 mm) measures (P < .001); however, 16 had postoperative malalignment (sagittal vertical axis >50 mm; mean, 109 mm).
CONCLUSION:
Symptomatic RF occurred in 6.8% of adult spinal deformity cases and in 15.8% of PSO patients. The rate of RF was lower with cobalt chromium than with titanium alloy or stainless steel. Early failure was most common after PSO and favored the PSO site, suggesting that RF may be caused by stress at the PSO site. Postoperative sagittal malalignment may increase the risk of RF.
In patients with transfusion-dependent thalassemia (TDT), pulmonary function impairment has been reported but data are conflicting. Moreover, it remains unclear whether pulmonary dysfunction is ...associated with iron overload. This study aimed to evaluate the pulmonary function in patients with TDT and to investigate the associations between pulmonary dysfunction and iron overload. It was a retrospective observational study. 101 patients with TDT were recruited for lung function tests. The most recent ferritin levels (pmol/L) and the magnetic resonance imaging (MRI) measurements of the myocardial and liver iron status, as measured by heart and liver T2* relaxation time (millisecond, ms) respectively, were retrieved from the computerized medical records. Only data within 12 months from the lung function measurement were included in the analysis. The serum ferritin, and the cardiac and liver T2* relaxation time were the surrogate indexes of body iron content. The threshold of abnormality in lung function was defined as under 80% of the predicted value. 101 subjects were recruited with a mean age of 25.1 years (standard deviation (SD) 7.9 years). Thirty-eight (38%) and five (5%) demonstrated restrictive and obstructive lung function deficits, respectively. A weak correlation of FVC %Predicted and TLC %Predicted with MRI myocardial T2* relaxation time (rho = 0.32, p = 0.03 and rho = 0.33, p = 0.03 respectively) was observed. By logistic regression, MRI cardiac T2* relaxation time was negatively associated with restrictive lung function deficit (B - 0.06; SE 0.03; Odds ratio 0.94; 95% confidence interval (CI) 0.89-0.99; p = 0.023) after adjusting for age, sex and body mass index. Restrictive pulmonary function deficit was commonly observed in patients with TDT, and the severity potentially correlates with myocardial iron content. Monitoring of lung function in this group of patients, particularly for those with iron overload, is important.
Background
Falls are a devastating condition in older individuals. Identifying potentially modifiable risk factors such as hearing loss would provide a substantial public health benefit.
Objective
To ...evaluate the current evidence for an association between hearing loss and falls risk.
Data Sources
A systematic search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Web of Science, and Cochrane databases was performed in July 2014.
Study Eligibility
Studies were eligible for inclusion if they were published in the peer‐reviewed literature. All studies used a predetermined definition of hearing loss. Main outcomes and measurements were fall hospitalization records or self‐reports of falls by structured interview or validated questionnaires.
Study Appraisal and Synthesis
Two investigators independently reviewed the literature related to hearing loss, falls, and older adults. We pooled effect sizes from across the studies and performed a meta‐analysis to compute an overall effect size.
Results and Limitations
Twelve eligible studies were identified. The odds of falling were 2.39 times greater among older adults with hearing loss than older adults with normal hearing (pooled odds ratio 2.39, 95% confidence interval CI: 2.11‐2.68). In sensitivity analyses, we restricted the meta‐analysis to studies where hearing loss was audiometrically defined (N = 6) and observed hearing loss to be associated with a 69% increase in the odds of falling (pooled odds ratio 1.69, 95% CI: 1.18‐2.19). When we further limited to studies that also performed multivariate regression analyses (N = 4), the overall effect size did not appreciably change (pooled odds ratio 1.72, 95% CI: 1.07‐2.37). We observed a potential positive publication bias in the literature. Limitations of the systematic review and meta‐analysis are the cross‐sectional designs of most studies and the heterogeneity across studies (Q = 631, P < .05, I2 = 98.1%).
Conclusions and Relevance
In the published literature, hearing loss is associated with a significantly increased odds of falling in older adults. These findings need to be interpreted in light of the potential for positive publication bias in the literature on this topic.
Level of Evidence
NA Laryngoscope, 126:2587–2596, 2016
•We define dynamic IT capability (DITC), a first-order dynamic capability.•We define nine ordinary capabilities that are reconfigured by three DITC components.•We present a DITC framework based on an ...extensive review of related literature.•We describe how DITC can be measured.•We provide a foundation for future DITC studies.
In a digital world, information technology (IT) units routinely update their capabilities to cope with changing business requirements and frequent technology releases. Extending the dynamic capabilities literature, this article presents the concept of dynamic IT capability, a multidimensional first-order dynamic capability that enables IT units to assist firms in appropriating business value from IT resources by influencing a set of IT-related ordinary capabilities. Scholars currently lack a dynamic capabilities framework that explains, from an IT unit’s perspective, how IT resources can be acquired, deployed, integrated, and reconfigured to fulfill business objectives. To bridge this research gap, we develop a high-level framework that highlights three constituent components of dynamic IT capability: dynamic digital platform capability, dynamic IT management capability, and dynamic IT knowledge management capability. Through an extensive literature review, we identify and summarize the set of ordinary capabilities that each dynamic IT capability component creates and reconfigures. We then offer guidance on future instrument development. To encourage further exploration of this critical construct, we close by highlighting future avenues for dynamic IT capability research.
To identify the most commonly used patient-reported outcome (PRO) measures in clinical vestibular research, and to assess their test characteristics and applicability to the study of age-related ...vestibular loss in clinical trials.
We performed a systematic review of the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases from 1950 to August 13, 2013.
PRO measures were defined as outcomes that capture the subjective experience of the patient (eg, symptoms, functional status, health perceptions, quality of life). Two independent reviewers selected studies that used PRO measures in clinical vestibular research. Disparities were resolved with consensus between the reviewers. Of 2260 articles initially found in the literature search, 255 full-text articles were retrieved for assessment. Of these, 104 met inclusion criteria for data collection.
PRO measures were identified by 2 independent reviewers. The 4 most commonly used PROs were evaluated for their applicability to the condition of age-related vestibular loss. Specifically, for these 4 PROs, data were collected pertaining to instrument test-retest reliability, item domains, and target population of the instrument.
A total of 50 PRO instruments were identified. The 4 most frequently used PROs were the Dizziness Handicap Inventory, Activities-specific Balance Confidence scale, Vertigo Symptom Scale-short form, and visual analog scale. Of these 4 PROs, 3 were validated for use in patients with vestibular disease and 1 was validated in community-dwelling older individuals with balance impairments. Items across the 4 PROs were categorized into 3 domains based on the International Classification of Functioning, Disability and Health: activity, participation, and body functions and structures.
None of the most commonly used PRO instruments were validated for use in community-dwelling older adults with age-related vestibular loss. Nevertheless, the 3 common domains of items identified across these 4 PRO instruments may be generalizable to older adults and provide a basis for developing a PRO instrument designed to evaluate the effectiveness of interventions targeted toward age-related vestibular loss.
To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke (C-SATIS-Stroke) in people with chronic stroke.
Forward and backward translations were ...performed in accordance with available guidelines. We administered the C-SATIS-Stroke to 101 people with stroke and 50 healthy older adults. We assessed the test-retest and internal reliability, measurement error, known-group validity, correlations with other outcome measures, optimal cut-off score and ceiling and floor effects.
C-SATIS-Stroke demonstrated excellent internal consistency (Cronbach's α = 0.959) and good test-retest reliability (intraclass correlation coefficient
3,1
= 0.913). Compared with healthy controls, people with chronic stroke had lower C-SATIS-Stroke scores. The mean C-SATIS-Stroke score was significantly correlated with the mean scores of the Activities-specific Balance Confidence Scale, Stroke Impact Scale, Community Integration Measure and Survey of Activities and Fear of Falling in the Elderly. The cut-off score to distinguish the levels of satisfaction with activity and participation between people with chronic stroke and healthy older adults was 80 out of 108 (sensitivity: 77%; specificity: 72%). C-SATIS-Stroke exhibited ceiling effects but not floor effects.
C-SATIS-Stroke is a reliable and valid measure for assessing satisfaction with social participation among Chinese people with chronic stroke.
IMPLICATIONS FOR REHABILITATION
Satisfactory semantic, idiomatic, cultural, and conceptual equivalence of the C-SATIS-Stroke are in line with those of the original English version of the SATIS-Stroke
Excellent reliability and validity of the C-SATIS-Stroke are also in line with those of the original English version of the SATIS-Stroke
The C-SATIS-Stroke can be used to assess the subjective satisfaction feeling in terms of social participation among Chinese people with chronic stroke
To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic ...stroke survivors.
A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (
= 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS.
Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (
= 0.544-0.687,
< 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores.
Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.
To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke.
Systematic review and meta-analysis were completed. Methodological ...quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence.
A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference SMD, 1.89 1.52-2.26) and ES alone (SMD, 0.42 0.11-0.73) with low quality of evidence, or MT alone (SMD, 0.470.04-0.89) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 1.92-11.01) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log.
MT with ES may be effective in improving upper limb motor recovery in people with stroke.
Programmed cell death is a fundamental requirement for embryogenesis, organ metamorphosis and tissue homeostasis. In mammals, release of mitochondrial cytochrome c leads to the cytosolic assembly of ...the apoptosome-a caspase activation complex involving Apaf1 and caspase-9 that induces hallmarks of apoptosis. There are, however, mitochondrially regulated cell death pathways that are independent of Apaf1/caspase-9. We have previously cloned a molecule associated with programmed cell death called apoptosis-inducing factor (AIF). Like cytochrome c, AIF is localized to mitochondria and released in response to death stimuli. Here we show that genetic inactivation of AIF renders embryonic stem cells resistant to cell death after serum deprivation. Moreover, AIF is essential for programmed cell death during cavitation of embryoid bodies-the very first wave of cell death indispensable for mouse morphogenesis. AIF-dependent cell death displays structural features of apoptosis, and can be genetically uncoupled from Apaf1 and caspase-9 expression. Our data provide genetic evidence for a caspase-independent pathway of programmed cell death that controls early morphogenesis.
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