Visualization-Driven Time-Series Extraction from Wearable Systems Can Facilitate Differentiation of Passive ADL Characteristics among Stroke and Healthy Older Adults.

Wearable technologies allow the measurement of unhindered activities of daily living (ADL) among patients who had a stroke in their natural settings. However, methods to extract meaningful information from large multi-day datasets are limited. This study investigated new visualization-driven time-series extraction methods for distinguishing activities from stroke and healthy adults. Fourteen stroke and fourteen healthy adults wore a wearable sensor at the L5/S1 position for three consecutive days and collected accelerometer data passively in the participant's naturalistic environment. Data from visualization facilitated selecting information-rich time series, which resulted in classification accuracy of 97.3% using recurrent neural networks (RNNs). Individuals with stroke showed a negative correlation between their body mass index (BMI) and higher-acceleration fraction produced during ADL. We also found individuals with stroke made lower activity amplitudes than healthy counterparts in all three activity bands (low, medium, and high). Our findings show that visualization-driven time series can accurately classify movements among stroke and healthy groups using a deep recurrent neural network. This novel visualization-based time-series extraction from naturalistic data provides a physical basis for analyzing passive ADL monitoring data from real-world environments. This time-series extraction method using unit sphere projections of acceleration can be used by a slew of analysis algorithms to remotely track progress among stroke survivors in their rehabilitation program and their ADL abilities.

Decoding the proteomic changes involved in the biofilm formation of Enterococcus faecalis SK460 to elucidate potential biofilm determinants.

BACKGROUND: Enterococcus faecalis is a major clinically relevant nosocomial bacterial pathogen frequently isolated from polymicrobial infections. The biofilm forming ability of E. faecalis attributes a key role in its virulence and drug resistance. Biofilm cells are phenotypically and metabolically different from their planktonic counterparts and many aspects involved in E. faecalis biofilm formation are yet to be elucidated. The strain E. faecalis SK460 used in the present study is esp (Enterococcal surface protein) and fsr (two-component signal transduction system) negative non-gelatinase producing strong biofilm former isolated from a chronic diabetic foot ulcer patient. We executed a label-free quantitative proteomic approach to elucidate the differential protein expression pattern at planktonic and biofilm stages of SK460 to come up with potential determinants associated with Enterococcal biofilm formation. RESULTS: The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of proteomic data revealed that biofilm cells expressed higher levels of proteins which are associated with glycolysis, amino acid biosynthesis, biosynthesis of secondary metabolites, microbial metabolism in diverse environments and stress response factors. Besides these basic survival pathways, LuxS-mediated quorum sensing, arginine metabolism, rhamnose biosynthesis, pheromone and adhesion associated proteins were found to be upregulated during the biofilm transit from planktonic stages. The selected subsets were validated by quantitative real-time PCR. In silico functional interaction analysis revealed that the genes involved in upregulated pathways pose a close molecular interaction thereby coordinating the regulatory network to thrive as a biofilm community. CONCLUSIONS: The present study describes the first report of the quantitative proteome analysis of an esp and fsr negative non gelatinase producing E. faecalis. Proteome analysis evidenced enhanced expression of glycolytic pathways, stress response factors, LuxS quorum signaling system, rhamnopolysaccharide synthesis and pheromone associated proteins in biofilm phenotype. We also pointed out the relevance of LuxS quorum sensing and pheromone associated proteins in the biofilm development of E. faecalis which lacks the Fsr quorum signaling system. These validated biofilm determinants can act as potential inhibiting targets in Enterococcal infections.

Genomic Insights into Biofilm-Forming Enterococcus faecalis SK460 Isolated from a Chronic Diabetic Ulcer Patient.

Enterococcus faecalis is recognized as one of the leading pathogens causing nosocomial infections. Here we report a draft genome sequence of Enterococcus faecalis SK460, isolated from a chronic diabetic foot ulcer patient. This strain exhibits various biofilm-associated genes, virulence genes, and antibiotic-resistance genes related to aminoglycoside, macrolide, and tetracycline resistance.

Metataxonomic approach to decipher the polymicrobial burden in diabetic foot ulcer and its biofilm mode of infection.

Chronic diabetic foot is a global burden affecting millions of people, and the chronicity of an ulcer is directly linked to the diverse bacterial burden and its biofilm mode of infection. The bacterial diversity of 100 chronic diabetic ulcer samples was profiled via traditional culturing method as well as metagenomic approach by sequencing the 16S rRNA V3 hyper-variable region on Illumina Miseq Platform (Illumina, Inc., San Diego, CA). All the relevant clinical metadata, including duration of diabetes, grade of ulcer, presence of neuropathy, and glycaemic level, were noted and correlated with the microbiota. The occurrence and establishment of bacterial biofilm over chronic wound tissues was revealed by Fluorescent in situ Hybridization and Scanning Electron Microscopy. The biofilm-forming ability of predominant bacterial isolates was studied via crystal violet assay and Confocal Laser Scanning Microscopy. The dominant phyla obtained from bacterial diversity analysis were Firmicutes, Proteobacteria, and Actinobacteria. The dominant aerobic pathogens identified by culture method are Pseudomonas, Proteus, Enterococcus, and Staphylococcus, whereas high-throughput sequencing revealed heightened levels of Streptococcus and Corynebacterium along with 22 different obligate anaerobes. The biofilm occurrence in chronic diabetic ulcer infection is well analysed. Herein, we illustrate the comprehensive pattern of bacterial infection and identify the community composition of chronic wound pathogenic biofilm.

Biomechanical analysis of tension band wiring (TBW) of transverse fractures of patella.

PURPOSE: Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires (K-wires) and a stainless steel wire loop placed in a vertically oriented figure-of-8. METHODS: We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners. Interfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. RESULTS: Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p < 0.05, Tukey post hoc test). On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed (p=0.01; Fisher's exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure- of-eight constructs (p < 0.05; t test). CONCLUSION: Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.

Error Correction and the Structure of Inter-Trial Fluctuations in a Redundant Movement Task.

We study inter-trial movement fluctuations exhibited by human participants during the repeated execution of a virtual shuffleboard task. Focusing on skilled performance, theoretical analysis of a previously-developed general model of inter-trial error correction is used to predict the temporal and geometric structure of variability near a goal equivalent manifold (GEM). The theory also predicts that the goal-level error scales linearly with intrinsic body-level noise via the total body-goal sensitivity, a new derived quantity that illustrates how task performance arises from the interaction of active error correction and passive sensitivity properties along the GEM. Linear models estimated from observed fluctuations, together with a novel application of bootstrapping to the estimation of dynamical and correlation properties of the inter-trial dynamics, are used to experimentally confirm all predictions, thus validating our model. In addition, we show that, unlike "static" variability analyses, our dynamical approach yields results that are independent of the coordinates used to measure task execution and, in so doing, provides a new set of task coordinates that are intrinsic to the error-regulation process itself.

Wohlfahrtiimonas chitiniclastica-associated osteomyelitis: a rare case report.

Wohlfahrtiimonas chitiniclastica is a rare pathogen that was first isolated from a parasitic fly, Wohlfahrtia magnifica. It is a very rare but an emerging human pathogen reported only in Europe and South America. Recently, it is reported to be an egressing zoonotic pathogen from different geographical locations. The present case represents the first report of this pathogen from a patient suffering from osteomyelitis from India and so far no reports are available regarding the W. chitiniclastica associated infections in Asian countries. Clinical awareness of such emerging human pathogens is crucial for the infectious disease containment.

Predictors of change in 'discharge destination' following treatment for fracture neck of femur.

OBJECTIVES: The purpose of our study was to analyse the incidence and factors predicting the 'change in discharge destination' in patients with fractured neck of femur who were treated surgically. MATERIALS AND METHODS: Fifteen hundred and seventy-three consecutive patients admitted with a fractured neck of femur, residing in their own home prior to admission were studied. Patients who did not have an operation (n=70) for their hip fracture were excluded from the study. Residential location in the UK is broadly categorised as: RESULTS: A downward drift in "discharge destination" of 20% was noted after analysis. Univariate analysis revealed that age, gender, AMT score, place of fall, type of fracture, walking ability outdoor and indoor, ASA grade, medical co-morbidity requiring physician review and delay beyond 36h to surgery had a significant effect. Multiple logistic regression analysis revealed that increasing age, male gender (OR=1.67), accompaniment for outdoor mobilisation (OR=1.96), increasing ASA grade, AMT score <6 (OR=4.86), pre-operative medical condition requiring physician review (OR=2.27), delay greater than 36h for medical reasons (OR=4.38) were predictors of the change in discharge destination. CONCLUSION: The most important predictors of the change in the discharge destination were the medical condition, cognitive and physical function of the patient at admission. Male gender and increasing age were contributory. The only clinician dependent factor that seemed to affect this change of residential status was delay to surgery secondary to medical problems. Awareness of key predictors that affect the "discharge destination" can be useful for the multidisciplinary team and patients' families to evaluate and plan for an early, satisfactory and appropriate referral to either community services or institutional care, which in turn could have a significant socioeconomic impact.

Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine.

INTRODUCTION: Vertebroplasty and balloon kyphoplasty have shown to improve pain and functional outcome in cases with symptomatic vertebral fractures. Although restoration of the vertebral body height and kyphosis seemed to be easier with balloon kyphoplasty, it became clear that some of the correction achieved by the balloon is lost once it was deflated. Vertebral body stent was developed to eliminate this phenomenon. To our knowledge this is the first study in describing this technique in clinical settings. MATERIALS AND METHODS: Seventeen patients with 20 fractured vertebral bodies were included. All fractures were Type A1.3 or A3.1 (incomplete burst). Information about pain (visual analogue scale-VAS) and function (Oswestry disability index-ODI) and vertebral body deformity (vertebral angle-VA) was recorded in a prospective way at regular intervals. Patients were classified into osteoporotic group (7 patients) and traumatic groups (10 patients, younger than 60 years). RESULTS: There were 6 male and 11 female patients with mean age of 58.1 years (31-88 years). Mean follow up was 12 months. The preoperative pain level showed a mean VAS score of 8.9 in osteoporotic group and 9.7 in traumatic group. Postoperatively, in osteoporotic group, mean VAS was 4.8 at 6 weeks, 4.0 at 6 months and 2.5 at 12 months compared with traumatic fracture group where it was 2.7 at 6 weeks, 2.2 at 6 months and 1.6 at 12 months. Mean ODI in osteoporotic group was 41.7% (14-58%) and in traumatic group it was 20.4% (6-33%). Mean vertebral body angle prior to surgery in osteoporotic group was 9.7 whilst postoperatively it was 5.2°; so the mean correction achieved was 4.5°. In traumatic group preoperative VA was 13° whilst postoperatively it was 5.7°; therefore the mean correction achieved was 7.3°. None of the patients lost reduction at their last follow up. CONCLUSION: Vertebral body stenting leads to satisfactory improvement in pain, function and kyphosis correction in the treatment of osteoporotic and traumatic fractures. Anterior spinal column, especially the fragmented superior endplate is nicely reconstructed by the stent provided it is inserted accurately. With addition of posterior transpedicular instrumentation, indications for this technique may be wider covering some Type B and C fractures with similar vertebral body damage.

Unicompartmental knee replacements with Miller-Galante prosthesis: two to 16-year follow-up of a single surgeon series.

We report the outcome of 94 Miller-Galante unicompartmental knee replacements done by a single surgeon over 16 years in a district general hospital in the UK. Patellofemoral arthritis was considered a contraindication only if symptomatic and confirmed on radiography and surgery. Deformity when present was correctable. The mean age at surgery was 66.54 years. The mean follow-up was 10.8 years (2-16 years). The mean Bristol knee score was 43.1 (28-50); 86% of the patients had good or excellent scores. The average range of flexion was 110.6° (80-130°); 89% of the knees had an appropriate alignment. Using revision as the endpoint, outcome for every knee was established. The survival rate for medial unicompartmental knee replacements was 94% at ten years and 87% at 15 years. Although the survival rate for the lateral unicompartmental knee replacement was 97% at five years, it dropped to 41% at eight years. Lateral unicompartmental knee replacements formed only 9.6% of all the replacements in this series. The results for medial unicompartmental knee replacements are similar to reports by other authors for similar and mobile bearing designs. Unicompartmental knee replacement results in a more kinematic knee and produces good functional results.

Do humans optimally exploit redundancy to control step variability in walking?

It is widely accepted that humans and animals minimize energetic cost while walking. While such principles predict average behavior, they do not explain the variability observed in walking. For robust performance, walking movements must adapt at each step, not just on average. Here, we propose an analytical framework that reconciles issues of optimality, redundancy, and stochasticity. For human treadmill walking, we defined a goal function to formulate a precise mathematical definition of one possible control strategy: maintain constant speed at each stride. We recorded stride times and stride lengths from healthy subjects walking at five speeds. The specified goal function yielded a decomposition of stride-to-stride variations into new gait variables explicitly related to achieving the hypothesized strategy. Subjects exhibited greatly decreased variability for goal-relevant gait fluctuations directly related to achieving this strategy, but far greater variability for goal-irrelevant fluctuations. More importantly, humans immediately corrected goal-relevant deviations at each successive stride, while allowing goal-irrelevant deviations to persist across multiple strides. To demonstrate that this was not the only strategy people could have used to successfully accomplish the task, we created three surrogate data sets. Each tested a specific alternative hypothesis that subjects used a different strategy that made no reference to the hypothesized goal function. Humans did not adopt any of these viable alternative strategies. Finally, we developed a sequence of stochastic control models of stride-to-stride variability for walking, based on the Minimum Intervention Principle. We demonstrate that healthy humans are not precisely "optimal," but instead consistently slightly over-correct small deviations in walking speed at each stride. Our results reveal a new governing principle for regulating stride-to-stride fluctuations in human walking that acts independently of, but in parallel with, minimizing energetic cost. Thus, humans exploit task redundancies to achieve robust control while minimizing effort and allowing potentially beneficial motor variability.

Age at follow-up and mechanical axis are good predictors of function after unicompartmental knee arthroplasty. An analysis of patients over 17 years follow-up.

Alteration of knee alignment after unicompartmental knee arthroplasty (UKA) influences wear of the prosthesis and progression of arthrosis. Recent reports have questioned the traditional view that under-correction of the deformity is advisable in UKA. The aim of this study was to analyse whether the location of the mechanical axis at the knee influences the function of the knee after UKA. We analysed the data from 40 patients (54 knees) who underwent UKA over 17 years. The Bristol knee score was maximal when the mechanical axis passed through zones 0 (area of tibial spines) or 1 (inner half of medial or lateral plateau). The average Bristol knee score of those patients was 18% higher than in patients in whom the mechanical axis passed through the other zones (p < 0.01, t-test). Using multiple regression analysis to correct for the effect of age on score, a significant relationship was found between the location of mechanical axis and function (p < 0.001). Based on these findings, surgeons should attempt to restore the mechanical axis to the centre of the knee during UKA, to help achieve better function.