To evaluate the intra- and inter-examiner reliability of neck active joint position sense measurements in different head movements.
Participants had to reproduce actively a specific angle-target in ...all movements (flexion, right/left rotation, right/left side flexion) from two initial positions, sitting and standing by using a 3D ultrasound-based motion analysis device. Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. Absolute error (AE) and variable error (VE) indices were used to assess the repositioning accuracy. Intraclass correlation coefficient (I.C.C.
(1,1)), standard error of measurement (S.E.M.), smallest detectable difference (S.D.D.) indices were calculated for the analysis of the results.
Both AE and VE yielded poor to moderate I.C.C.s in any movement and position (−0.01 to 0.50 and 0.01–0.25, respectively). AE presented higher I.C.C.s estimates than the VE but the S.D.D.s were similar for both indices. Regarding the AE, the standing position yielded higher I.C.C. estimates (0.15–0.68) than the sitting position (−0.01 to 0.43) but the S.E.M. (1.2–3.0° and 1.5–3.5°, respectively) and S.D.D. values (123.3–191.8% and 139.9–203.8%, respectively) showed no specific trend in favour of any position. The VE reliability indices showed that standing position was more reliable with less error than sitting. The inter-examiner data showed similar results to the intra-examiner study.
The statistical analysis of the present experiments showed that the method employed for measuring cervical joint position sense is unreliable. However, it needs further research to identify the discriminatory power of these tests or if they are clinically unacceptable.
The aim of this study was to evaluate the intra- and inter-examiner reliability and validity of neck range of motion (ROM) measurements. Thirty-five healthy subjects were assessed in all neck ...movements from two initial positions, sitting and standing, actively (open and closed eyes) and passively by using a 3D ultrasound-based motion analysis device (Zebris). Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. X-rays in neck flexion and extension were used to validate the Zebris system. The standing position yielded higher intraclass correlation coefficient (ICC) values (>0.86) with less error smallest detectable difference (SDD) < 13.8% than sitting (ICC > 0.79, SDD < 14%). Passive assessment of neck ROM presented better reproducibility than active assessment with open or closed eyes in both positions. The inter-examiner reliability was moderate (ICC = 0.43-0.68). The correlation between the Zebris system and X-rays was high in both flexion and extension movements. The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. The measurements were well validiated against X-rays and the experience of the investigators must be considered before any comparison among studies is employed.
The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods.
To establish between-days reliability, ...33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC
(1,1), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson’s correlation co-efficient were calculated for the analysis of the results.
Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC
(1,1)
=
0.28–0.61; SEM
=
0.33–0.60%/s; SDD
=
132.7–703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC
(1,1)
=
0.64–0.81; SEM
=
2.8–8.8
Hz; SDD
=
19.9–38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD
=
29.2–136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue (
r
=
−0.01–0.39).
The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area.
There is little information regarding the effect of aerobic exercise on physical and neuromotor performance in older adults. The aim of this randomized, controlled trial was to determine the effects ...of a 12-wk aerobic exercise program on functional and neuromotor performance in inactive healthy older adults.
A total of 22 inactive healthy older adults, aged 60-75 yrs, voluntarily participated in the study and were randomly assigned to a progressively increased high-intensity aerobic exercise group (n = 12) or to a control group (n = 10). The aerobic exercise group exercised three times per week for 12 wks on nonconsecutive days. Both groups were evaluated before and after the exercise period in the one-repetition maximum of knee extensors and flexors, 6-min walk distance, chair-rising time, and whole-body reaction time.
Multivariate analysis of variance repeated measures (2 x 2) revealed significant (P < 0.05) time by group interaction for one-repetition maximum knee extension and flexion strength, 6-min walk distance, chair-rising time, and whole-body reaction time. For the aerobic exercise group, the following variables improved significantly (P < 0.05) after the exercise period: the one-repetition maximum knee extensors (12%) and flexors (19%) muscle strength, 6-min walk distance (17%), chair-rising time (8%), and whole-body reaction time (20%). No significant differences were observed in the control group.
The results of the present study show that short-term progressively increased high-intensity aerobic exercise improved the physical and neuromotor performance in inactive healthy older adults. These findings suggest that the participation in a progressively increased high-intensity aerobic exercise program may improve mobility and ability to carry out activities of daily living in older adults.
Summary Mammalian target of rapamycin (mTOR) is a key protein kinase controlling signal transduction from various growth factors and upstream proteins to the level of mRNA and ribosome with a ...regulatory effect on cell cycle progression, cellular proliferation and growth. TOR genes were discovered rather serendipitously while investigating the cause of resistance to immunosuppressant rapamycin in yeast. In normal cells, mTOR controls brilliantly the load of signals from its effectors resulting in a normal cell function. On the contrary, in various diseases and mainly in cancer this balance is lost due to mutations or overactivation of upstream pathways leading to a persistent proliferation and tumor growth. What makes mTOR attractive to researchers seems to be its key position which is on the crossroad of various signal pathways (Ras, PI3K/Akt, TSC, NF-κB) towards mRNA, ribosome, protein synthesis and translation of significant molecules, the uncontrolled production of which may lead to tumor proliferation and growth. Inhibition of mTOR by rapamycin (a natural product) or its analogs aims to prevent the deleterious effects of the abnormal signaling, regardless at which point of the signal pathway has the abnormality launched. Here, we will review the physiological functions of mTOR, its association to carcinogenesis and the latest evidence regarding the use of mTOR inhibitors in cancer treatment as well as future trends and aims of research.
Pancreatic cancer is a deadly malignancy with still high mortality and poor survival despite the significant advances in understanding, diagnosis, and access to conventional and novel treatments. ...Though cytotoxic chemotherapy based on the purine analogue gemcitabine remains the standard approach in adjuvant and palliative setting the need for novel agents aiming at the main pathophysiological abnormalities and molecular pathways involved remains soaring. So far, evidence of clinical benefit, though small, exists only from the addition of the targeted agent erlotinib on the standard gemcitabine chemotherapy. Apart from the popular monoclonal antibodies and small molecules tyrosine kinase inhibitors, other novel compounds being tested in preclinical and clinical studies target mTOR, NF-κB, proteasome and histone deacetylase. These new drugs along with gene therapy and immunotherapy, which are also under clinical evaluation, may alter the unfavorable natural course of this disease. In this review we present the main pathophysiological alterations met in pancreatic cancer and the results of the florid preclinical and clinical research with regards to the targeted therapy associated to these abnormalities.
