Retrospective case series of vertebral artery injuries associated with cervical spine trauma.

BACKGROUND: Vertebral artery injuries (VAI) can occur due to cervical spine trauma. VAI can prove a serious complication and potentially compromise vascular supply to the posterior aspect of the brain. Currently, there is a paucity of evidence with regards to incidence, management, and outcomes for these patients. The purpose of this study is to investigate and elucidate the incidence of VAI associated with cervical trauma at a national tertiary referral centre for spinal pathology, their respective management, and associated outcomes. METHODS: A retrospective review was conducted from 2012 to 2021 to identify patients with VAI secondary to cervical spine trauma. Demographic, clinical, and radiological data was collected to identify common traits in injury characteristics and management. RESULTS: 1013 spine patients presented to our institution across the 10-year period. 739/1013 (72.9 %) were trauma patients. 42/739 (5.7 %) were imaged for suspected VAI secondary to trauma. There were 14/739 (1.9 %) confirmed VAI. All patients had CT-angiography for diagnosis. Four of the confirmed VAI patients (28.6 %) had additional MR-angiography imaging. Right-side was the most common side of VAI injury (7/14; 50 %), followed by left (5/14; 35.7 %) and bilateral (2/14; 14.3 %) injuries. 8/14 (57.1 %) patients were prescribed anti-thrombotic therapy. Acute mortality within 3-months was noted to be 2/14 (14.3 %) and occurred at 49 days and 57 days respectively. CONCLUSION: VAI associated with cervical spine injury is rare in occurrence. However, it can be associated with high morbidity and mortality. As such, a multi-disciplinary approach to care is integral to ensuring good outcomes in these patients.

Short-duration peripherally inserted central catheters do not alter viscoelastic parameters in healthy dogs.

Objective: To determine if short-duration peripherally inserted central catheters (PICCs) cause a hypercoagulable state in healthy dogs, based on point-of-care viscoelastic coagulation monitor (VCM). Animals: Ten beagle dogs were randomly and equally allocated into control and PICC groups. Procedure: Control dogs had VCM analysis on whole blood following direct venipuncture before sedation (T0) and 2 h after sedation (T2). In the experimental group, a PICC was placed (medial saphenous or femoral vein) under sedation and removed after 4 h, with measurements before placement (T0) and 2 and 6 h after placement (T2 and T6, respectively). Parametric data were analyzed using 1-way ANOVA with Holm-Sídák test for multiple comparisons and paired or unpaired Student's t-test. Nonparametric data were analyzed using Friedman test with Dunn multiple comparison test for Wilcoxon matched-pairs signed-rank test, and Mann-Whitney U test for PICC group, control group, and to compare PICC versus control groups, respectively. Results: Clot formation time was longer at T2 versus T6 (P = 0.0342, but not clinically relevant) in the PICC group, with no significant differences between the PICC and control groups. Conclusion and clinical relevance: Short-term placement of a PICC line did not alter viscoelastic endpoints in healthy beagles.

L'utilisation de courte durée d'un cathéter central inséré par voie périphérique n'affecte pas les paramètres viscoélastiques chez les chiens sains. Objectif: Déterminer si les cathéters centraux insérés par voie périphérique (CCIP) pour une courte durée provoque un état d'hypercoagulabilité chez des chiens en bonne santé sur la base des mesures du Viscoelastic Coagulation Monitor (VCM) au point de soins. Animaux: Dix chiens sains de race beagle ont été choisis et répartis de façon égale et aléatoire dans un groupe témoin et un groupe de CCIP. Procédure: Les chiens témoins ont eu une prise de sang et analyse par VCM avant sédation (T0) et 2 heures après la sédation (T2). Dans le groupe expérimental, un CCIP a été mis en place (veines saphènes ou fémorales médiales) sous sédation et retiré après 4 heures. Les mesures viscoélastiques sur le sang frais ont été effectuées avant la pose du CCIP (T0), 2 heures après la pose (T2) et 2 heures après le retrait/6 heures après la pose du cathéter (T6). L'analyse statistique des données paramétriques a été faite par le test ANOVA à un facteur avec un test de comparaisons multiples de Holm-Sídák pour le groupe CCIP, un test t de Student apparié pour le groupe témoin, et un test t de Student non apparié pour comparer les groupes CCIP et témoin. Les données non paramétriques ont été analysées à l'aide du test de Friedman avec un test de comparaison multiple de Dunn pour le groupe CCIP, du test de rang signé de Wilcoxon pour le groupe témoin et du test de Mann-Whitney U pour comparer les groupes CCIP et témoin. Résultats: Pour le groupe CCIP, le temps de formation du caillot à T2 était plus long mais non cliniquement pertinent. comparativement à T6 (P = 0,0342) et il n'y avait aucune différence significative entre les groupes CCIP et témoin. Conclusion et pertinence clinique: La pose d'un CCIP pour une courte durée n'a pas modifié les variables viscoélastiques chez les chiens beagle en bonne santé.(Traduit par les auteurs).

The-state-of-the-art of soft robotics to assist mobility: a review of physiotherapist and patient identified limitations of current lower-limb exoskeletons and the potential soft-robotic solutions.

BACKGROUND: Soft, wearable, powered exoskeletons are novel devices that may assist rehabilitation, allowing users to walk further or carry out activities of daily living. However, soft robotic exoskeletons, and the more commonly used rigid exoskeletons, are not widely adopted clinically. The available evidence highlights a disconnect between the needs of exoskeleton users and the engineers designing devices. This review aimed to explore the literature on physiotherapist and patient perspectives of the longer-standing, and therefore greater evidenced, rigid exoskeleton limitations. It then offered potential solutions to these limitations, including soft robotics, from an engineering standpoint. METHODS: A state-of-the-art review was carried out which included both qualitative and quantitative research papers regarding patient and/or physiotherapist perspectives of rigid exoskeletons. Papers were themed and themes formed the review's framework. RESULTS: Six main themes regarding the limitations of soft exoskeletons were important to physiotherapists and patients: safety; a one-size-fits approach; ease of device use; weight and placement of device; cost of device; and, specific to patients only, appearance of the device. Potential soft-robotics solutions to address these limitations were offered, including compliant actuators, sensors, suit attachments fitting to user's body, and the use of control algorithms. CONCLUSIONS: It is evident that current exoskeletons are not meeting the needs of their users. Solutions to the limitations offered may inform device development. However, the solutions are not infallible and thus further research and development is required.

High-Pressure Raman and Calorimetry Studies of Vanadium(III) Alkyl Hydrides for Kubas-Type Hydrogen Storage.

Reversible hydrogen storage under ambient conditions has been identified as a major bottleneck in enabling a future hydrogen economy. Herein, we report an amorphous vanadium(III) alkyl hydride gel that binds hydrogen through the Kubas interaction. The material possesses a gravimetric adsorption capacity of 5.42 wt % H2 at 120 bar and 298 K reversibly at saturation with no loss of capacity after ten cycles. This corresponds to a volumetric capacity of 75.4 kgH2 m(-3) . Raman experiments at 100 bar confirm that Kubas binding is involved in the adsorption mechanism. The material possesses an enthalpy of H2 adsorption of +0.52 kJ mol(-1) H2 , as measured directly by calorimetry, and this is practical for use in a vehicles without a complex heat management system.

Thermodynamically neutral Kubas-type hydrogen storage using amorphous Cr(III) alkyl hydride gels.

In this paper we present amorphous chromium(III) hydride gels that show promise as reversible room temperature hydrogen storage materials with potential for exploitation in mobile applications. The material uses hydride ligands as a light weight structural feature to link chromium(III) metal centres together which act as binding sites for further dihydrogen molecules via the Kubas interaction, the mode of hydrogen binding confirmed by high pressure Raman spectroscopy. The best material possesses a reversible gravimetric storage of 5.08 wt% at 160 bar and 25 °C while the volumetric density of 78 kgH2 m(-3) compares favourably to the DOE ultimate system goal of 70 kg m(-3). The enthalpy of hydrogen adsorption is +0.37 kJ mol(-1) H2 as measured directly at 40 °C using an isothermal calorimeter coupled directly to a Sieverts gas sorption apparatus. These data support a mechanism confirmed by computations in which the deformation enthalpy required to open up binding sites is almost exactly equal and opposite to the enthalpy of hydrogen binding to the Kubas sites, and suggests that this material can be used in on-board applications without a heat management system.

User perspectives on the future of mobility assistive devices: Understanding users' assistive device experiences and needs.

Introduction: Current assistive devices are inadequate in addressing the needs of some people living with impaired mobility. This study explored the experiences of living with impaired mobility in relation to how wearable assistive adaptive and rehabilitative technologies may improve their quality of life. Methods: A cross-case study approach was adopted; the case being defined as the experience of impaired mobility. Semi-structured interviews were utilised. The sample (n = 8) was purposefully selected to have impaired mobility due to stroke, age-related frailty, or lower limb amputation. From the interview transcripts, in-depth case illustrations were written to provide personal stories and thematic analysis was carried out to provide a cross-case analysis. Results: There were two overarching themes: lifestyle changes; and wishes and desires for assistive devices. There were shared experiences across participant groups, such as falls and fear of falling. All participants identified a wish for increased speed of walking. However, the reasons for their difficulties differed depending on personal factors and their condition. Participants wanted devices to be adjustable to their perceived ability on a day-to-day basis. Conclusions: Although common concerns and impacts of living with impaired mobility were apparent, individuals have unique requirements that should inform the design of assistive technology devices.

Patient acceptability of the physiotherapy first contact practitioner role in primary care: A realist informed qualitative study.

BACKGROUND: Approximately 30% of general practitioner (GP) consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat MSKDs and provide an alternative to GP consultation for primary care patients as first contact physiotherapists (FCPs). AIM: To explore patient perceived acceptability of the FCP role using realist methods to understand what works for whom, how, why and in what circumstances. METHODS: A realist evaluation was undertaken, which involved three stages: forming the theory area framework; testing the theory framework and refining the programme theory. The theory framework was formed through realist synthesis. Realist interviews tested this framework. Data were collected from two GP practice case study sites and interviews were undertaken at each site. N = 20 participants were interviewed in total. In each practice, this constituted patients (n = 5), GPs (n = 1), FCPs (n = 2), receptionists (n = 1) and practice managers (n = 1). Interview data were analysed against preliminary hypotheses and, where appropriate, new theory areas were created. RESULTS: The evaluation highlighted that acceptability of the FCP role was influenced by 'expectations', 'accessibility' and 'promoting the role'. Whilst some findings were shared by both practices, different contexts resulted in unique practice findings. CONCLUSION: Patients were predominantly accepting of FCPs, nevertheless, there was a scope to increase acceptability through an implementation strategy that considered the contexts of the individual patient, as well as wider practice contexts.

Patient view of the advanced practitioner (AP) role in primary care: A realist-informed synthesis.

BACKGROUND: Approximately 30% of general practitioner consultations are due to musculoskeletal disorders (MSKDs). Physiotherapists are trained to assess, diagnose and treat a range of MSKDs, and could provide the first point of contact for primary care patients. There is limited evidence on whether this role is acceptable to patients; however, previous research has explored advanced practitioner (AP) roles in primary care, which could inform this new initiative. AIMS: This study used realist synthesis to explore factors that influence patient acceptability of AP roles in primary care. MATERIALS & METHODS: A realist synthesis was undertaken to identify initial programme theories regarding acceptability. Databases were searched to identify relevant literature. Identified studies were subject to inclusion and exclusion criteria, resulting in 38 studies included for synthesis. Theory-specific data extraction sheets were created and utilised. Data were analysed through identifying contexts, mechanisms and outcomes to formulate hypotheses. Hypotheses were validated through consultation with expert stakeholders. RESULTS: Eight theory areas were identified that potentially impacted on patient acceptability of the role: patient's prior experience of condition management; patient's expectations of condition management; communication; continuity of the individual practitioner; practitioner's scope of practice; accessibility; professional hierarchy and promoting the role. Nineteen hypotheses on the AP role were developed around these theory areas. DISCUSSION: Role acceptabiliy was influenced significantly by context and may change as the role develops, for instance, as waiting times change. CONCLUSION: Hypotheses will inform a subsequent realist evaluation exploring the physiotherapy AP role in primary care. Future research is needed to understand the acceptability of first contact physiotherapists delivering certain skills.

Development and performance of a comprehensive targeted sequencing assay for pan-ethnic screening of carrier status.

Identifying individuals as carriers of severe disease traits enables informed decision making about reproductive options. Although carrier screening has traditionally been based on ethnicity, the increasing ethnic admixture in the general population argues for the need for pan-ethnic carrier screening assays. Highly multiplexed mutation panels allow for rapid and efficient testing of hundreds of mutations concurrently. We report the development of the Pan-Ethnic Carrier Screening assay, a targeted sequencing assay for routine screening that simultaneously detects 461 common mutations in 91 different genes underlying severe, early-onset monogenic disorders. Mutation selection was aided by the use of an extensive mutation database from a clinical laboratory with expertise in newborn screening and lysosomal storage disease testing. The assay is based on the Affymetrix GeneChip microarray platform but generates genomic DNA sequence as the output. Analytical sensitivity and specificity, using genomic DNA from archived control cultures and from clinical specimens, was found to be >99% for all mutation types. This targeted sequencing assay has advantages over multiplex PCR and next-generation sequencing assays, including accuracy of mutation detection over a range of mutation types and ease of analysis and reporting of results.

The chloroplast genome of Anomochloa marantoidea (Anomochlooideae; Poaceae) comprises a mixture of grass-like and unique features.

Features in the complete plastome of Anomochloa marantoidea (Poaceae) were investigated. This species is one of four of Anomochlooideae, the crown node of which diverged before those of any other grass subfamily. The plastome was sequenced from overlapping amplicons using previously designed primers. The plastome of A. marantoidea is 138412 bp long with a typical gene content for Poaceae. Five regions were examined in detail because of prior surveys that identified structural alterations among graminoid Poales. Anomochloa marantoidea was found to have an intron in rpoC1, unlike other Poaceae. The insertion region of rpoC2 is unusually short in A. marantoidea compared with those of other grasses, but with atypically long subrepeats. Both ycf1 and ycf2 are nonfunctional as is typical in grasses, but A. marantoidea has a uniquely long ψycf1. Finally, the rbcL-psaI spacer in A. marantoidea is atypically short with no evidence of the ψrpl23 locus found in all other Poaceae. Some of these features are of noteworthy dissimilarity between A. marantoidea and those crown grasses for which entire plastomes have been sequenced. Complete plastome sequences of other Anomochlooideae and outgroups will further advance our understanding of the evolutionary events in the plastome that accompanied graminoid diversification.

Nucleotide variants within the IQGAP1 gene in diffuse-type gastric cancers.

IQGAP1 is recognized as a negative regulator of cell-cell adhesion at adherens junctions in several cell types, including gastric mucosal cells. The histopathologic appearance of diffuse gastric carcinoma is defined by non- or poorly cohesive tumor cells, indicating abnormal intercellular adhesion. Hence, we screened 38 gastric cancers for activating point mutations in IQGAP1. In 2 of the 33 diffuse gastric cancers, there was a missense nucleotide change predicted to alter the amino acid sequence in the GAP-related domain, which includes part of the binding site for the activated small G proteins Cdc42 and Rac1. Many intronic IQGAP1 gene changes were observed, and several occurred more frequently in diffuse-type gastric cancers than in intestinal-type gastric cancers. A highly variable pentanucleotide repeat was identified in the final intron of IQGAP1. The most expanded six-repeat sequence was present exclusively in diffuse-type gastric cancers. Additionally, 19 diffuse cases and two intestinal cases exhibited silent coding region nucleotide alterations. Taken together, our results suggest that IQGAP1 coding sequence mutations are not a frequent event in gastric cancer, but do occur in a subset of diffuse-type gastric carcinomas. Additional studies analyzing other proteins involved in cell adhesion may lead to a better molecular understanding of the histopathologic appearance of diffuse gastric cancers.

Actin filament binding by a monomeric IQGAP1 fragment with a single calponin homology domain.

IQGAP1 is a homodimeric protein that reversibly associates with F-actin, calmodulin, activated Cdc42 and Rac1, CLIP-170, beta-catenin, and E-cadherin. Its F-actin binding site includes a calponin homology domain (CHD) located near the N-terminal of each subunit. Prior studies have implied that medium- to high-affinity F-actin binding (5-50 microM K(d)) requires multiple CHDs located either on an individual polypeptide or on distinct subunits of a multimeric protein. For IQGAP1, a series of six tandem IQGAP coiled-coil repeats (IRs) located past the C-terminal of the CHD of each subunit support protein dimerization and, by extension, the IRs or an undefined subset of them were thought to be essential for F-actin binding mediated by its CHDs. Here we describe efforts to determine the minimal region of IQGAP1 capable of binding F-actin. Several truncation mutants of IQGAP1, which contain progressive deletions of the IRs and CHD, were assayed for F-actin binding in vitro. Fragments that contain both the CHD and at least one IR could bind F-actin and, as expected, removal of all six IRs and the CHD abolished binding. Unexpectedly, a fragment called IQGAP1(2-210), which contains the CHD, but lacks IRs, could bind actin filaments. IQGAP1(2-210) was found to be monomeric, to bind F-actin with a K(d) of approximately 47 microM, to saturate F-actin at a molar ratio of one IQGAP1(2-210) per actin monomer, and to co-localize with cortical actin filaments when expressed by transfection in cultured cells. These collective results identify the first known example of high-affinity actin filament binding mediated by a single CHD.