bluuebunny/crossref_metadata_2025 huggingface dataset:
Teratoma of the pericardium revealed by seronegative polyarthritis: A case report
Authors: F. IRINEU ETIENE  , H. LACHRAF  , I. PAULINO  , M. KHADIJA  , B. SAHAR  , B. CHKIRATE  , A. BENTAHILA
Published: May 2024

Introduction: Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease with preferential involvement of the synovium in the proximal joints of the hands and feet. Formerly known as chronic progressive polyarthritis or chronic rheumatoid arthritis, its course is characterised by joint erosion and destruction. Coronary heart disease and strokes, the consequences of atheromatous disease, are part of rheumatoid arthritis and are responsible for the increased morbidity and mortality observed in this disease. Cardiac tumours in children are rare. The frequent use of echocardiography has helped to detect them earlier and with greater sensitivity. Most cardiac tumours in children are congenital, primary and benign. Most are discovered in children under one year of age. The aim of this study is to report the discovery of this type of tumour in a 10-year-old child being treated for seronegative polyarthritis. Observation: We report the observation of a 10-year-old girl, from a non-consanguineous marriage, with a history of systemic arthritis on difal 25mg *2/d + MTX 0.8mg/kg/week. Present since the age of 3 with recurrent arthralgias, admitted for polyarthralgias, fever with chest pain and whose examination found swelling, pain and limitation of passive and active movement of the left knee joint and elbow joint. Biological work-up revealed inflammatory microcytic hypochromic anaemia, normal ferritin, elevated CRP and ESR, ECBU, stool culture, ASLO serology, sputum BK, sputum TB PCR, Gene Xpert in sputum, Quantiiferon, SAM work-up and rheumatoid factors (RF) were negative, antinuclear antibodies (ANA) positive. EX. Ophthalmology and abdominal ultrasound normal, chest X-ray reveals cardiomegaly (ICT 0.6), X-ray of the spine + knee + elbow showed a discreet increase in the transparency of the bone structure. ETT found an oval mass measuring 20/25mm at the level of the junction between OD and VD not managing the reflux of the tricuspid valve and THORACIC CT in favour of a mass adherent to the pericardium evoking in the first instance a teratoma. Conclusion: Cardiac tumours in children are rare, and pericardial teratomas are often benign. In this study, we emphasise the importance of looking for underlying cardiac disease in the presence of recurrent episodes of arthralgia in children. Early positive diagnosis of the disease and the therapeutic implications are vital.
Vaginal Rhabdomyosarcome: Case Report
Authors: FETIENE IRINEU  , MPAPIS  , NANSARI  , XMUSSET  , A KILI  , MKABABRI
Published: May 2024

Introduction: Rhabdomyosarcoma is a soft tissue sarcoma, most common in children, localised in the female genital tract and therefore rare in adults. Among its subtypes, it is most often distinguished as embryonal. It is an aggressive tumour, difficult to diagnose, is usually detected by CT or MRI and the diagnosis is confirmed by biopsy and treatment involving surgical excision, radiotherapy and chemotherapy. The authors present a case of embryonal rhabdomyosarcoma localised in the vagina, highlighting relevant aspects of the subject. Observation: We report the observation of a girl aged 2 years and 8 months, with no notable antecedents, from a 2nd degree consanguineous marriage. For 1 month she presented with a rapidly progressive vaginal mass associated with bleeding. Examination revealed a reddish, grape-like mass in the vulva. Abdomino-pelvic ultrasound revealed a vaginal tumour, abdomino-pelvic MRI revealed an endovaginal mass delivered through the vulva, suggesting a botryoid rhabdomyosarcoma, and biopsy of the vaginal mass with morphological appearance and immunohistochemical profile of an embryonal rhabdomyosarcoma. The extension work-up showed a vulvovaginal lesional process, with no secondary location on the thoraco-abdominal CT scan. The patient was classified as group C according to the RMS 2005 protocol and received 6 courses of IVA + vaginal brachytherapy + 3 courses of IVA with a good clinical and biological evolution. Conclusion: In view of the diagnostic difficulties and the risk of progression and rapid worsening of rhabdomyosarcoma, early positive diagnosis means that treatment can be started at an early stage with chemotherapy, surgery and radiotherapy.
Fire emergency response system at PT X based on International Safety Rating System (ISRS)
Authors: Kharolina Fatimah  , Meirina Ernawati
Published: May 2024

Fire is the unwanted occurrence of fire. Preparedness in the face of catastrophic fire events is part of the Occupational Safety and Health (K3) standards that must be implemented in the company. PT X is a company engaged in concrete manufacturing. In the production process, many potential hazards, such as fires, can cause losses. This research aims to study the fire emergency response system at PT X. The method used is descriptive research, with data collection done cross-sectionally. The analysis was carried out descriptively by clearly and thoroughly describing the condition of the object of study and comparing it with the applicable regulatory standards. The results showed that PT X had implemented a fire emergency response system and efforts to prevent and overcome fire hazards. PT X's efforts include forming a firefighting team providing fire hazard management facilities such as fire extinguishers, fire blankets, first aid kits, evacuation stretchers, and other infrastructure facilities. PT X has conducted fire emergency response and first-aider training for employees and workers. This research concludes that PT X has implemented an emergency response system well and refers to the International Safety Rating System.
Frenectomy management for Ankyloglossia in a 1-Year-old patient under general anesthesia: A case report
Authors: Vira Indah Permatasari Desjayanti Noviardi  , A.A. Sagung Dyah Karuniadewi  , Lely Indriasari  , Soegeng Wahluyo
Published: May 2024

Introduction: Ankyloglossia is defined as a congenital disorder that alters tongue mobility and function. It is listed as one of the possible reasons behind breastfeeding issues. The WHO currently recommends mothers to breastfeed exclusively up to 6 months of age, emphasizing the importance of promptly identifying any breastfeeding obstacles and determining the root cause of the problems as the primary focus. The purpose of writing this article is to describe a frenectomy as a surgical procedure that addresses ankyloglossia by excising the lingual frenulum with general anesthesia. Case History: A 1-year-old male patient presented at Dr. Saiful Anwar Regional General Hospital with complaints of difficulty in breastfeeding and consuming complementary foods, as well as prolonged pain experienced by the mother during breastfeeding. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. The patient was uncooperative (Frankl scale number 1). After analyzing the ankyloglossia, the choice of frenectomy with general anesthesia was chosen to treat this case. Discussion: Dental examinations and treatments for uncooperative 1-year-old children can be challenging in regular dental offices. Effective behavioral management, such as general anesthesia (GA), is required for safe and efficient treatment. GA involves a multidisciplinary team to oversee the procedure stages, allowing for one-visit treatment, reduced anxiety, and a safer, less painful dental experience. Conclusion: Frenectomy procedure under GA has been performed as an option to facilitate restorative therapy, improve nutritional intake, and quality of life.
Hematocolpos- variations: Case report
Authors: E. Soldatou  , D. Mavroeidi  , N. Perdikari  , P, A.Nikolopoulou  , St. Rokkos  , Gr. Hadjopoulos
Published: May 2024

Hemato/hydrocolpos is an obstruction of the menstrual flow due to an anomaly of the genital tract, with imperforate hymen being the most common one, which is found in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed due to its rare incidence and nonspecific symptoms (usually misdiagnosed as constipation. In case of late diagnosis/ misdiagnosis and/or delay in treatment, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.
Cultural factors contributing to gender-based violence in Zambian societies
Authors: Chanda Chansa Thelma
Published: May 2024

Overview: This study examined the intricate cultural dynamics underlying the prevalence of gender-based violence (GBV) within Zambian societies. Despite legislative efforts and international campaigns to combat GBV, its persistence underscores the need for a deeper understanding of the cultural underpinnings that perpetuate such violence. Body of Knowledge: Through qualitative and quantitative analysis, this study sought to identify key cultural elements such as patriarchal structures, beliefs about masculinity and femininity, and the role of family and community dynamics in shaping attitudes and behaviors related to gender-based violence. Additionally, this study delves into the multifaceted ways in which cultural norms, beliefs, and practices intersect with gender dynamics to foster environments conducive to GBV. Methods: The population comprised of government officials at the district level who had some responsibility for GBV, police officers from VSU, and Members of the community. The total target population was 1000. The sample size involved a total of 100 respondents which is 10% of the target population. The study used purposive sampling to select government officials and police officers while simple random sampling was used to selected community members. This study used descriptive design to analyze the data. Interviews, ethnographic observation, and questionnaires were used to collect data. Qualitative and Quantitative techniques of data analysis was used, and data was presented on the analytical tools such as tables, figures and charts. Results: Initial findings revealed that traditional gender roles deeply entrenched in Zambian culture play a pivotal role in perpetuating GBV. The patriarchal structure of society often assigns men dominance and control over women, leading to power imbalances that facilitate violence. Furthermore, beliefs surrounding masculinity, including expectations of aggression and dominance, contribute to a culture of impunity surrounding GBV. Men are often socialized to perceive violence as a legitimate means of asserting authority, while women may internalize norms of submission and silence. Recommendation: This study underscores the urgent need for culturally sensitive interventions that address the root causes of GBV in Zambia. By engaging communities in dialogue and challenging harmful cultural norms, sustainable solutions can be developed to promote gender equality and create safer environments for all individuals.
Some aspects of clinical trial of the drug “Vetmicoderm”
Authors: Ogloblina M. V  , Bushueva I. V  , Martynyshyn V. P  , Hunchak V. M  , Parchenko V. V
Published: May 2024

Our aim was to conduct some clinical trials of the drug «Vetmikoderm» and compare its effectiveness with the well-known agent «Triosan». Clinical trials to determine the therapeutic effectiveness of the drug «Vetmikoderm» were carried out at the veterinary clinic «BEST» (Zaporizhzhia) on two groups of dogs, formed by gradual recruitment (based on the owners' referral to the clinic). To determine the etiological factors contributing to the development of dermatosis, we conducted a study of skin microflora. The sensitivity of microorganisms and fungi to the action of the «Vetmikoderm» preparation was determined by the disc-diffusion method. In the process of diagnostic research, including microbiological studies, it was established that conditionally pathogenic microflora from affected areas of dogs' skin was represented by both microorganisms and fungi. At the same time, fungi prevailed in the microbiocenosis of the selected skin samples. It is worth noting that «Vetmikoderm» has a better fungicidal effect, while «Triosan» is evidently more effective in treating dermatoses with predominantly microbial contamination. It has been proven that the combined use of both drugs has a better influence on the recovery process in animals.
Pathogenicity islands in bacteria of upper respiratory tract infection
Authors: Rawaa B. J. Al Daamee  , Rana H. Raheema  , Qasim Dawood Yasir Altameemi  , Maan M.N. AL-Naqeeb
Published: May 2024

Children's upper respiratory tract infections (URTIs)—infections of the upper respiratory tract without symptoms of pneumonia—represent a significant socioeconomic and epidemiological issue. The study of microbial pathogenicity, which is a complex multifactorial process complicated by the coordinated activity of genetic regions linked to virulence and resistance determinants, has accelerated due to increased awareness of infectious diseases in humans caused by microbial pathogens. Pathogenicity islands and resistance islands are essential to the evolution of pathogens and seem to work in tandem during the bacterial infection process. While pathogenicity islands encourage the development of illness, Additionally, pathogenicity islands are part of a vast array of genomic islands that play a vital role in the transmission of bacterial genes. They encode essential characteristics such as virulence, antibiotic resistance, and other supplementary functions.
Screening of phosphate solubilizing Aspergillus spp. from soil samples
Authors: Barate D. L  , Gawai D. R
Published: May 2024

Phosphorus (P) is a naturally existing element crucial for plant growth among the 17 essential elements. It's integral to various biomolecules like nucleic acids, coenzymes, phosphoproteins, and phospholipids, playing key roles in cellular processes and structural integrity. Its presence is fundamental for sustaining healthy plant growth and ecosystem balance. Rhizosphere soil samples from medicinal plants at Shree Shivaji College Akola were collected aseptically. Phosphate Solubilizing Fungi (PSF) were isolated using Pikovskya’s agar medium, characterized microscopically, and screened for phosphate solubilization potentials. % Solubilization Efficiency was determined, and quantitative estimation of phosphate solubilization was conducted by ammonium molybdate method by using KH2PO4 as standard for determination. Fourteen Aspergillus spp. isolates from soil were screened for phosphate solubilization on PVK medium. Results showed varied solubilization indices and efficiencies across different time intervals, with pH changes observed during solubilization. Optical density measurements provided insights into concentration variations among isolates.
Analysis of biological organic extract of plants in suppressing aphid (Myzus persicae) infestations
Authors: Rahmah Khan  , Newton Paul
Published: May 2024

Myzus persicae commonly known as the peach-potato aphid, poses a significant threat to agricultural productivity, particularly in potato cultivation, where infestations lead to substantial yield losses and quality degradation. In this study, we investigated the potential of botanical extracts from neem (Azadirachta indica), clove (Syzygium aromaticum), black pepper (Piper nigrum), and bay leaf (Laurus nobilis) in controlling Myzus persicae infestations. Experimental trials were conducted to assess the mortality effects of these botanical extracts on Myzus persicae populations. Results revealed that neem extract exhibited the highest mortality effect, with an impressive 97.7% mortality rate. Clove and black pepper extracts followed closely, demonstrating mortality rates of 92.2% and 77.7%, respectively. In contrast, bay leaf extract exhibited the least mortality effect, with only 48.8% mortality observed.
Effect of methanol stem bark extract of Ochna schweinfurthiana (Ezeata) on liver enzymes in Wistar rats
Authors: Kosi Emmanuel Ifemenam  , Cornelius Maduabuchi Nwozor  , Dennis Chukwujekwu Adinnu  , Cynthia Ebelechukwu Iwuamadi  , Anthonia Kanayo Ezeh
Published: May 2024

1 Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Amaku, Awka. Anambra State. Nigeria. 2 Department of Physiology, Faculty of Basic Medical Sciences, Chukwuemeka Odumegwu Ojukwu University, Uli campus. Anambra State. Nigeria. 3 Department of General Medicine, Faculty of Clinical Medicine, Royal Bournemouth Hospital (University Hospital Dorset NHS Foundation Trust) Bournemouth, England, BH7 7DW United Kingdom. 4 Department of Gastroenterology, Faculty of Clinical Medicine, Royal Bournemouth Hospital (University Hospital Dorset NHS Foundation Trust) Bournemouth, England, BH7 7DW United Kingdom. 5 Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, Abia StateUniversity Teaching Hospital, Aba. Abia State. Nigeria.
Alzheimer Disease
Authors: Uzer Altaf Shaikh  , Sanket P. Shinde
Published: May 2024

Alzheimer's disease (AD) is typified by memory deficiencies that worsen with time, along with cognitive and behavioral abnormalities that eventually result in dementia. AD is one of the most difficult diseases to treat because of its prevalence, high cost of care, effects on patients and caregivers, and lack of mechanism-based therapies. The malfunction and loss of neurons in particular circuits and locations, especially in the populations of nerve cells supporting memory and cognition, causes the AD condition.The neuropathology of AD is characterized by intracellular and extracellular protein aggregation accumulations. In the neuronal perikarya and dystrophic neurites, abnormally phosphorylated tau forms paired helical filaments (PHFs) that combine to form neurofibrillary tangles (NFTs). The extracellular deposition of β-pleated assemblies of Aβ peptide, which result in widespread and neuritic senile plaques, is the second pathogenic hallmark.
A Clinical Scoring System and Impact of Athymic Nude Mouse Age on Corynebacterium bovis Clinical Disease
Authors: Manuel Christopher A , Pugazhenthi Umarani , Fink Michael K , Habenicht Lauren M , Fong Derek L , Leszczynski Jori K , Schurr Michael J
Published: May 2024

Corynebacterium bovis infection in biomedical research is synonymous with skin hyperkeratosis of athymic nude mice. This clinical sign can be obvious and is the namesake for ‘scaly skin disease.’ Other clinical signs that accompany scaly skin, including early presentation, duration, and rate of resolution, are less well known. The goal of this study was to characterize the clinical signs of C. bovis infection in nude mice under experimental conditions and develop a quantifiable scoring system. For the development, prospective trial, and application of this clinical scoring system, 93 naïve Hsd:Athymic Nude mice were used, of which 81 were exposed to soiled bedding from clinically ill C. bovis-infected NSG mice. The emergence of clinical signs was monitored and scored daily for 14 d. We identified 3 categories of clinical signs including skin hyperemia, skin hyperkeratosis, and surrogate indicators of overall health. Each of these defined categories appeared consistently and progressed and regressed temporally. We subsequently used this scoring system to determine if the age of Hsd:Athymic Nude mice (6 compared with 10 wk) at time of infection affects clinical severity. Our findings demonstrate that 6-wk-old mice demonstrate more severe clinical signs. Ten-week-old mice showed less skin hyperemia and no skin hyperkeratosis and were less affected by the infection based on surrogates of overall health. Here we show the utility of this novel scoring system and the impact of nude mouse age at the time of infection on C. bovis clinical disease.
Determine Multilayers Coating Dispersive Properties Using Statistical Parameters
Authors: Mohammad Elham Jasim
Published: May 2024

Many studies about the multilayer coating have indicated the effects of reflection phase, reflection group delay (GD), and reflection group delay dispersion (GDD) characteristics. Some overlook the importance of studying complex statistical coefficients and their role in comparing the results of optical designs and realize how important information is in analyzing data. In statistics, one can learn various techniques for working with data. This paper goes into a detailed study of multilayer stacks’ dispersive properties for two mirror designs depending on MATLAB programs based on statistical parameters to evaluate the reflectance for the ZnS/MgF$${}_{2}$$ mirror. Two samples with a quarter wavelength optical thickness were prepared, specially designed for 632.8 nm He-Ne laser mirrors. For the designed mirror, the value of the reflectivity of the thirteen-layer ZnS/MgF$${}_{2}$$ mirror is 99.34$$\%$$, while for the seven-layer ZnS/MgF$${}_{2}$$ mirror is 96.57$$\%$$. This study presents greater detail on statistics and realized data topics when designing multilayer coating, including mean, median, mode, and standard deviation (STD). The reliability and accuracy of the data can be verified by calculating the standard deviation.
Gaps in Teacher Education: Defining, Developing and Diverting on the Path to an Equity Stance
Authors: Dismuke Sherry , Snow-Gerono Jenn
Published: May 2024

Heeding the call for equity and transformative praxis in teacher education, teacher education programs often focus on equity and justice in mission statements and program design. This bounded case study explores how the construct of equity stance is framed by one teacher education program and then how the enactment of an equity stance is actualized in clinical field experiences. Feedback from clinical supervisors during observation cycles along with focus group interviews, surveys, and the examination of addressing an equity stance in teacher education are the focus of this article. Findings documented a continuum of equity enacted practices building from inclusive pedagogy to a heightened awareness of inequities, and the development of more equitable teaching practices. We recognize that both teacher candidates and teacher educators need to continue development of an equity stance moving from awareness to action within educational contexts.
The Trouble with ‘Delivering Feedback’: Reflections of a Supervision Scholar
Authors: Hazi Helen M.
Published: May 2024

As a scholar of supervision and after years of teaching principals, I have begun to rethink what it means for principals to deliver feedback to improve teachers’ instruction. I realized that I held many troubling assumptions. In this essay, I describe the contexts within which my assumptions had taken root, then use selected literature to look more closely at each. In the final section, I address the question: What do principals do if they no longer deliver feedback? This inquiry helped me understand that commonly held assumptions about “delivering feedback” promote an oversimplified view of teaching and its improvement, keep teachers in a dependent relationship, and fail to help them develop their own understanding of accountability.
Annual ring widths in the arctic-alpine dwarf-shrub species Betula Nana — Dataset from long-term alpine ecosystem research in Central Norway (LTAER-NO)
Authors: Albrecht Eike Corina , Dobbert Svenja , Keturka Karolis , Kühnapfel Mira , Francon Loïc , Pape Roland , Wundram Dirk , Löffler Jörg
Published: May 2024

Here we present a Data Paper with microscopically measured data on ring widths of the arctic-alpine dwarf shrub species Betula nana L. from Central Norway. We intend to continuously update the dataset in the future with further ring width measurements of this widespread shrub species.
THE RELIABILITY AND VALIDITY OF THE BALANCE MAT
Authors: Raj Dr Isaac Selva , Nosaka Prof Ken
Published: May 2024

BACKGROUND

Reliable and accurate postural sway assessment tools are important for monitoring the postural stability of individuals so that interventions can be evaluated, and balance ability is better assessed. The Balance Mat (PSI, ACT, Australia) is a new postural sway assessment device that is relatively cheap and highly portable, but it is yet to be scientifically validated and its reliability tested. Therefore, the aims of this project were to assess the test-retest reliability and validity of the Balance Mat (BM).

METHODS

Seventeen participants (age range 18 – 67) were recruited, and they performed nine balance tests. The reference method for obtaining balance measurements was the AMTI AccuSway-Optimized force platform (Advanced Mechanical Technology, Inc., MA, USA), which was placed below the BM so that force plate and BM data were collected simultaneously. Each participant performed two trials for each test, which were 20 seconds in duration each. From the BM software, the sway variance, mean sway distance, sway range, sway velocity, and sway path were obtained for each trial. From the force platform, the following centre of pressure (COP) measurements were obtained: standard deviation of the radial displacement of the COP; mean radial displacement of the COP; 95% confidence ellipse area; average velocity of the COP; and COP path length. Spearman’s rank-order correlation coefficient was used to test the validity and reliability of the BM.

RESULTS

For the comparison between BM and force plate data, correlation coefficients ranged from 0.63 to 0.79 (p<0.001). For the test-retest reliability analyses, correlation coefficients ranged from 0.77 to 0.85 (p<0.001) among the nine tests.

CONCLUSIONS

The strong to very strong positive correlations suggest that the BM is a valid and reliable tool for assessing postural sway.
CHRONIC LOW BACK PAIN: BARRIERS AND ENABLERS OF EXERCISE-BASED CLINICIANS TO IMPLEMENTING EVIDENCE-BASED PRACTICE
Authors: Walker Ms Emily , Gibbs Dr Mitchell T. , Natoli Mr Andrew , Jones Matthew D
Published: May 2024

INTRODUCTION

Chronic low back pain (CLBP) is the leading cause of years lived with disability. Exercise, integrated with a biopsychosocial framework, is a first-line treatment for CLBP. Exercise physiologists and physiotherapists are allied health clinicians trained to provide exercise treatment through evidence-based practice (EBP). Research indicates the implementation of EBP remains low, impacting the quality of care provided to patients, which can perpetuate the impacts of CLBP. Given the role of exercise physiologists and physiotherapists in CLBP treatment, it is necessary to investigate their perceived barriers and enablers to implementing best quality care through EBP.

METHODS

Participants completed a pre-interview questionnaire, which gathered data about demographics, further education, biomedical/biopsychosocial beliefs and two patient vignettes. This data was analysed using descriptive statistics. Semi-structured interviews investigated participants’ barriers and enablers to implementing EBP. This data was analysed through reflexive thematic analysis.

RESULTS

Exercise physiologists and physiotherapists misunderstand the definition of EBP. Barriers and enablers existed at clinician-patient, workplace, and system levels, often overlapping. Barriers comprised of unpacking inaccurate messages from other healthcare professionals, patient expectations and beliefs, profit-focused business models, insufficient clinician education, and inadequate funding. Enablers encompassed upskilling with further education, a collaborative community, clinician autonomy, extended consultations, and support from other healthcare professionals.

CONCLUSIONS

Multi-level barriers and enablers affect exercise physiologists and physiotherapists use of EBP. Similar barriers and enablers between professions suggest systemic influences outweigh profession-specific influences. To improve the implementation of EBP, both clinician factors and deeper systemic factors must be addressed.
THE PHYSICAL AND MENTAL HEALTH BENEFITS OF PARTICIPATING IN A LUNGS IN ACTION COMMUNITY EXERCISE MAINTENANCE PROGRAM FOLLOWING REHABILITATION
Authors: Grainger Ms Kristal , Cooke A/Prof Julie , Halloran Ms Emma , Spencer A/Prof Lissa , Cox Dr Narelle , Adsett Dr Julie , Roberts Ms Mary , Williams Associate Professor Andrew
Published: May 2024

INTRODUCTION AND AIM

Lungs in Action (LIA), a signature program of Lung Foundation Australia (LFA) is a community exercise program for people with chronic lung and cardiac conditions. Facilitated by Exercise Physiologists, Physiotherapists and Fitness Instructors, LIA supports patients to maintain the benefits achieved in pulmonary or cardiac rehabilitation. This research aimed to determine the holistic health benefits of participation in LIA through a national participant evaluation, concurrently with functional outcome measures over a 3-month period.

METHODS

A convenience sample of LIA participants completed an online health questionnaire (Qualtrics) that incorporated the EQ-5D-5L Health Questionnaire, demographics and structured health and wellbeing questions at baseline. A follow-up health questionnaire was undertaken 3-months post baseline. Concurrently, LIA Instructors conducted functional assessments of muscular strength (30sec Sit to Stand (30STS)), mobility, and balance (Timed Up and Go (TUG)) at baseline and 3-months post, to assess if physiological adaptations were evident.

RESULTS

108 LIA participants (60±8 years; F=72) consented to complete the baseline questionnaire with n=61 (60±7 years; F=41) completing the 3-month post questionnaire. There were significant improvements in EQ-5D-5L anxiety domain (MD±SD; 0.18±0.22; p=0.04) and overall health rating (EQ-VAS) (MD±SD; 5.62±2.72; p=0.02). 74 participants (60±7 years; F=52) who attended an average of 11±6 classes over the 3-month interval, completed functional testing at both timepoints. There was a significant decrease in time to complete the TUG (MD±SD; -0.81±1.41 sec; p<0.0001) and increase in repetitions for the 30sSTS (MD±SD; 1.68±2.76 reps; p<0.0001).

CONCLUSION

Results indicate an increase in functional capacity, overall health, and a decrease in anxiety over the 3-month period. These benefits may relate to improved independence and activities of daily living.
A RANDOMIZED CONTROLLED TRIAL ASSESSING A BRACE-FREE AND ACCELERATED WEIGHT-BEARING PROTOCOL AFTER SURGICAL REPAIR OF ACUTE PROXIMAL HAMSTRING TENDON AVULSIONS
Authors: Ebert Dr Jay , Edwards Dr Peter , Cecchi Dr Steven , Aujla Mr Randeep , Annear Mr Peter , Ricciardo Mr Brendan , D’Alessandro Mr Peter
Published: May 2024

INTRODUCTION & AIMS

Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair advocated. After surgery, limited data exists regarding the optimal rehabilitation regime with extensive variation in published protocols. This study investigated patient outcomes following a traditionally conservative (CR) versus accelerated (AR) rehabilitation regimen after proximal hamstring tendon repair.

METHODS

This prospective randomized controlled trial (RCT) allocated 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25). Patients were evaluated pre-operatively and at 3, 6 and 12 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). The single (SHD), triple (THD) and triple crossover (TCHD) hop tests were assessed at 6 and 12 months, as was peak isometric hamstring strength and peak isokinetic knee extensor and flexor torque.

RESULTS

All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), as well as a lower severity of hamstring pain at 12 months (p=0.032), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). While the AR group demonstrated significantly better (p=0.009) limb symmetry for the THD at 6 months, no other hop test differences were seen between groups. Three re-injuries have been observed (CR=2, AR=1).

CONCLUSION

After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen were largely comparable to a traditionally conservative
A RANDOMIZED CONTROLLED TRIAL OF AUTOLOGOUS TENOCYTE INJECTION VERSUS CORTICOSTEROID INJECTION FOR SYMPTOMATIC PARTIAL THICKNESS ROTATOR CUFF TEARS
Authors: Ebert Dr Jay , Edwards Dr Peter , Zheng Prof Ming Hao , Fitzpatrick Dr Jane , Hughes Mr Jeff , Breidahl Dr William , Wang Prof Allan
Published: May 2024

BACKGROUND

Symptomatic supraspinatus tears are difficult to treat, causing persistent subacromial impingement symptoms. Clinical studies of Autologous Tenocyte Injection (ATI) have shown that cultured tenocytes can synthesize extracellular matrix and facilitate healing of damaged tendon tissue. This randomized controlled trial (RCT) investigated the efficacy of ATI compared to corticosteroid injection (CS), combined with a graded rehabilitation program, in patients with symptomatic tendinopathy and partial thickness cuff tears.

METHODS

Eligible participants with a duration of symptoms >6 months were recruited and randomized to receive ATI to the interstitial tear or CS to the subacromial bursa in a 2:1 ratio, under ultrasound guidance, followed by a rehabilitation protocol. Assessments were undertaken pre-treatment and at 1, 3, 6 and 12 months post-treatment, including the Constant Score, Visual Analogue Pain Scale (VAS) and American Shoulder and Elbow Surgeons Assessment (ASES). Magnetic resonance imaging (MRI) was performed at baseline, 6 and 12 months.

RESULTS

Thirty participants were enrolled (ATI=19, CS=11). The ATI group performed significantly better in the Constant Score at 1 (p=0.020, ATI=81.8, CS=67.6), 6 (p=0.026, ATI=84.9, CS=71.1) and 12 (p=0.024, ATI=86.5, CS=65.4) months, reported better (p<0.05) VAS scores at all post-treatment timepoints and reported better ASES scores at all timepoints including 6 (p=0.012, ATI=88.6, CS=74.0) and 12 (p<0.01, ATI=93.3, CS=62.9) months. A total of 7 of 11 CS participants withdrew from the trial between 6 and 12 months due to worsening pain. These patients were subsequently offered and underwent ATI, with 6 and 12 month improvements similar to the primary ATI group.

CONCLUSION

ATI resulted in a significantly better and sustained reduction in pain, and improvement in shoulder function, compared with CS. This is the first Level 1 study using ATI to treat supraspinatus tears.
AN INVESTIGATION OF SEX-BASED DIFFERENCES IN PHYSICAL AND PSYCHOLOGICAL RECOVERY, AND RETURN TO SPORT, FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Kneebone Miss Liza , Ebert Dr Jay , Edwards Dr Peter , Blackah Mr Nic
Published: May 2024

INTRODUCTION & AIMS

Despite the increasing rate of anterior cruciate ligament (ACL) tears and surgical reconstruction (ACLR), little is known about the post-operative recovery in males versus females. Understanding differences in the recovery between sexes will assist in better tailoring rehabilitation, return to sport (RTS) and counselling pathways. This study investigated sex-based differences in the physical and psychological recovery of both females and males after ACLR.

METHODS

This study recruited 104 patients (49 females, 55 males) undergoing ACLR. Patients were assessed pre-operatively and at 6, 12 and 24 months post-surgery, via patient-reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) form, the Tegner Activity Scale (TAS) and the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Patients embarked on an assessment of peak isokinetic knee extensor (PKET) and flexor (PKFT) torque and a 4-hop performance battery. Limb Symmetry Indices (LSIs) were calculated. The incidence of RTS was investigated.

RESULTS

All PROMs significantly improved (p<0.05), though females reported significantly lower ACL-RSI (p=0.002) and IKDC (p=0.007) scores. While no sex-based differences were observed in hop test LSIs, males demonstrated significantly higher mean LSIs for PKET at 6 (p=0.037) and 24 (0.047) months, and PKFT at 6 (p=0.007) and 12 (p=0.002) months. At 24-months post-surgery, a significantly greater (p=0.030) percentage of male patients had returned to pivoting sports.

CONCLUSION

This study demonstrates the disparity between sexes in physical and psychological recovery, as well as RTS status, in community-level patients undergoing ACLR. The development and implementation of enhanced post-operative patient-centered care may be warranted tailored to sex, encompassing rehabilitation, education, and counseling after ACLR to promote increased engagement in rehabilitation.
A RANDOMIZED CONTROLLED TRIAL EVALUATING AN ACCELERATED WEIGHT-BEARING REHABILITATION PATHWAY AFTER MATRIX-INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION FOR SYMPTOMATIC KNEE CARTILAGE DEFECTS
Authors: Ebert Dr Jay , Edwards Dr Peter , Zheng Prof Ming Hao , Klinken Dr Sven , Wood Prof David , Janes Mr Greg
Published: May 2024

INTRODUCTION & AIMS

Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging outcomes in treating symptomatic knee cartilage lesions which, if untreated, can progress toward early osteoarthritis. Rehabilitation is imperative to optimize outcome, though has been traditionally conservative. This study investigated the long-term outcomes of an accelerated return to full weight bearing (WB) after MACI.

METHODS

This prospective randomized controlled trial (RCT) allocated 35 patients (37 knees) to a 6-week (n=18) or 8-week (n=19) return to full WB after MACI. Patients were evaluated pre-operatively and at 1, 2, 5 and ≥10 years, via patient-reported outcome measures (PROMs) including the Knee Osteoarthritis Outcome Score (KOOS). Single limb hop capacity and peak knee extensor and flexor torque were assessed, with limb symmetry indices (LSIs) calculated. Magnetic resonance imaging (MRI) evaluated repair tissue, while a validated MRI composite graft score was calculated.

RESULTS

While the 6-week WB group reported significantly better 1-year KOOS Quality of Life scores, no other differences (p>0.05) in PROMs existed. The peak knee extensor torque LSI significantly improved (p<0.0001) over time, with mean LSIs of 100.8 (6-week) and 99.1 (8-week) at ≥10 years. No group differences (p>0.05) were observed in hop LSIs. A non-significant decline (p>0.05) was observed for the MRI composite score from 1-year to final ≥10-year review and, apart from a significant group effect (p=0.028) for graft tissue intensity in favor of the 6-week group suggesting repair tissue more reflective of native cartilage, no other MRI-based differences (p>0.05) existed. At ≥10-years, no grafts on MRI had failed, though 3 patients (6-week n=1, 8-week n=2) had progressed toward knee arthroplasty.

CONCLUSION

The 6-week accelerated rehabilitation program provided comparable clinical and MRI-based outcomes beyond 10 years post-surgery, without jeopardizing the graft.
A RANDOMIZED CONTROLLED TRIAL INVESTIGATING FUNCTIONAL RECOVERY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING A SINGLE VERSUS DOUBLE TENDON HARVEST
Authors: Ebert Dr Jay , Edwards Dr Peter , Lawless Dr Adam , Leys Mr Toby , D’Alessandro Mr Peter
Published: May 2024

INTRODUCTION & AIMS

Anterior cruciate ligament (ACL) tears are common. While surgical reconstruction (ACLR) is commonly advocated and a hamstring autograft is the popular choice, hamstring tendon harvest has been linked to reduced hamstring strength and ongoing donor site pain. While traditional surgical techniques required a harvest of both semitendinosus/gracilis tendons, modern harvesting and fixation methods permit a shorter, broader harvest of semitendinosus only. This study investigated donor site pain, strength and functional recovery in patients undergoing ACLR via a single (ST) versus dual (DT) tendon hamstring harvest.

METHODS

This prospective randomized controlled trial (RCT) allocated 138 patients to ACLR with one of the two hamstring tendon graft options (ST=71, DT=67) followed by a structured rehabilitation program. Patients were assessed pre-surgery and at 3, 6, and 12 months, with a range of patient-reported outcome measures (PROMs) including a validated donor-site morbidity score. Graft laxity, peak isokinetic knee extensor and flexor strength and a 6-hop performance battery were assessed. Limb Symmetry Indices (LSIs) were calculated.

RESULTS

All PROMs significantly improved (p<0.0001) and were largely similar between groups (p>0.05), apart from significantly less graft morbidity reported in the ST group (p=0.001). No group differences were observed for knee laxity or LSIs for hop measures (p>0.05), nor the LSIs for peak knee flexor (p=0.113) or extensor (p=0.286) torque.

CONCLUSION

While the ST ACLR group reported significantly less harvest site morbidity, no other subjective or functional differences were observed in patients undergoing ACLR with either a single or dual hamstring tendon autograft harvest.
“ANYTHING WOULD BE A WIN IF YOU’RE STRUGGLING.” – EXPLORING EXERCISE AND PHYSICAL ACTIVITY IN PEOPLE LIVING WITH IDIOPATHIC HYPERSOMNIA
Authors: Doukakis Mr Jeff , Rooney Associate Professor Kieron , Sivam Dr Sheila , Yee Professor Brendon , Saini Professor Bandana , Machan (Cayanan) Dr Elizabeth
Published: May 2024

INTRODUCTION

Idiopathic hypersomnia (IH) is a debilitating sleep condition characterised by excessive daytime sleepiness. The potential to moderate symptoms through lifestyle factors such as physical activity has not been explored, and current management focuses on medication. Exercise reduces fatigue and increases energy in the general population, and while some publications note physical activity as a potential avenue to manage symptoms of IH, there is no specific evidence related to exercise in this condition. The aim of this project was to explore the experiences of people living with IH in relation to: self-efficacy and exercise, exercise for symptom management, diagnosis related sources of information to support exercise, perceived ideal exercise prescription and the interaction between exercise and current management strategies and treatment approaches.

METHODS

Qualitative data was collected through semi-structured interviews with 14 participants. This was transcribed and analysed using a modified codebook analysis to construct overarching themes and subthemes.

RESULTS

Three overarching themes were constructed. The first theme described a lack of exercise advice, outlined the interaction between exercise and condition management strategies and symptoms and outlined the diverse range of activities people with IH engage with. The second theme explored the positive and negative factors of exercise self-efficacy, as well as reported barriers and facilitators of exercise. The third theme “A consumer-led exercise prescription” details a best practice (FITT) potential exercise prescription informed by the opinions and experiences of people with IH.

DISCUSSION

This is the first study exploring exercise and physical activity in people living with IH. It provides valuable insight regarding potential future exercise interventions for clinicians, future researchers and people living with IH.
PATIENTS WITH FEMOROACETABULAR IMPINGEMENT SYNDROME OBTAIN SIGNIFICANT AND SUSTAINED IMPROVEMENT FOLLOWING A COMBINED HIP INJECTION AND REHABILITATION PROGRAM
Authors: Woodhouse Ms Jen , Ebert Dr Jay , Edwards Dr Peter , Aujla Mr Randeep , D’Alessandro Mr Peter
Published: May 2024

INTRODUCTION

Initial treatment recommendations for symptomatic femoroacetabular impingement syndrome include non-surgical therapies such as injections and rehabilitation. However, many patients undergo isolated injections or a rudimentary exercise regime. This study investigated the benefit of a combined intra-articular hip injection and structured exercise rehabilitation program in patients with FAIS.

METHODS

Participants were recruited and underwent a guided intra-articular injection of corticosteroid and local anaesthetic, followed by a 12-week rehabilitation program. Patients were assessed pre-and post-injection(8 weeks, 4, 6, 12 and 24 months) via patient-reported outcome measures including the 33-item International Hip Outcome Tool and Hip Outcome score. Hip ROM and peak isometric hip strength in all planes were assessed, along with single-limb hop capacity. Limb Symmetry Indices were calculated. The percentage of patients transitioning toward surgery over the period was evaluated.

RESULTS

A total of 44 patients underwent the injection and completed the initial 8-week rehabilitation component. A significant improvement (p<0.05) in all PROMs was observed, with 93% of patients satisfied. A significant increase (p<0.05) in all active hip ROM and isometric strength measures was observed, sustained over the 24-month period. Bilateral improvements in hop capacity were observed, with all hop test LSIs significantly improving (p<0.05). Overall, 14 patients (32%) progressed toward surgical intervention over the 24-month post-injection period. These patients reported significantly worse (p<0.05) PROMs pre-surgery and more pain within the first 4 weeks post-injection.

CONCLUSION

This is the first study seeking to implement and comprehensively assess a best-practice, multimodal non-operative program consisting of an intra-articular injection and a structured exercise program. Most patients with symptomatic FAIS demonstrated significant improvement in symptoms.
POTENTIAL IMPACT OF EXERCISE UPON SYMPTOM BURDEN IN ADOLESCENTS AND YOUNG ADULTS UNDERGOING CANCER TREATMENT
Authors: Munsie Dr Claire , Ebert Dr Jay , Joske Professor David , Collins Jo , Ackland Prof Tim
Published: May 2024

INTRODUCTION

Adolescents and young adults (AYAs) experience vast symptom burden resulting from cancer treatment-related toxicities (TRTs). Evidence supports exercise to mitigate several TRTs in other cohorts, however evidence in AYAs is lacking. Conventional reporting of TRTs adopts a maximum grade approach failing to recognise the trajectory over time or lower grade toxicities. Alternatively, longitudinal analysis of toxicities over time (ToxT) may provide clinically meaningful summaries of this data. We evaluated the longitudinal impact of an exercise intervention on TRTs in AYAs undergoing cancer treatment.

METHODS

A prospective, randomised trial allocated participants to a 10-week exercise intervention (EG) or control group (CG) undergoing usual care. Detailed information on TRTs was collected throughout the intervention. All TRTs were graded per the Common Terminology Criteria for Adverse Events (CTCAE v5.0).

RESULTS

Forty-three (43) participants (63% male, mean age 21.1 years) were enrolled. When categorised to reflect the maximal worst grade experienced (Grade 0, Grade 1-2 and ≥Grade 3), the CG reported an increased incidence of severe fatigue (≥Grade 3) compared with the EG (p=0.05). No other differences between groups were evident (p>0.05). ToxT analysis of the four most common toxicities (fatigue, pain, nausea and mood disturbances) demonstrated no difference in the mean grade of each over time (p>0.05). Additionally, area under the curve (AUC) analysis revealed trends towards a higher magnitude of fatigue (mean AUC 12.5 vs 11.1 p=0.11) and mood disturbances (mean AUC 7.2 vs 5.7 p=0.28) over time in the CG. No differences were evident for pain and nausea between groups (p>0.05).

CONCLUSION

A 10-week exercise intervention reduces the severity of fatigue in AYAs undergoing treatment. While the ToxT approach provided insight into the toxicity profile, adequately powered studies are needed to better understand these differences within a homogeneous sample