Osteogenic Capacity of the Prefabricated Periosteofascial Flap using Vascular Induction with Skeletonized Pedicle Transfer in Rabbit Calvarium.

The study investigated the osteogenic capacity of a prefabricated periosteal flap created using only skeletonized pedicle transfer without fascia or muscle for vascular induction in rabbit calvarium. A critical-sized bone defect was made in the parietal bone centered on the sagittal suture, and the demineralized bone matrix was implanted. The periosteofascia over the defect was used as a form of prefabricated periosteofascial flap (PPF group, N=10), conventional periosteofascial flap (CPF group, N=10), and nonvascularized free periosteofascial graft (FPG group, N=6). The prefabricated flap was designed via vascular induction by transferring the central artery and vein of the right auricle onto the periosteofascia for 4 weeks prior to flap elevation. A quantitative comparison of volume restoration and radiodensity in the bone defect and a histological study were performed after 6 weeks of covering the bone defect with periosteofascia. The volume restoration of the bone defect covered with the PPF (43.4%) was not different from that of the CPF (46.2%), but significantly increased compared with that of the FPG (24.6%). The radiodensity of the bone defect covered with the PPF (-186.3 HU) was not different from that of the CPF (-153.6 HU), but significantly increased compared with that of the FPG (-329.8 HU). The results were based on adequate vascular development of the periosteum and were closely related to the osteogenic changes in the implanted demineralized bone matrix (DBM). In conclusion, even in the PPF created by transferring only skeletonized vascular pedicles, the osteogenic capacity of the periosteofascial flap is well maintained.

App-based supplemental exercise during inpatient orthopaedic rehabilitation increases activity levels: a pilot randomised control trial.

BACKGROUND: There is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes. METHODS: Participants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor. RESULTS: Twenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, p = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9-312.3 min, p = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group. CONCLUSION: An app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017).

Doppler Color Scoring System in Women With an Incomplete Miscarriage: Interobserver and Intraobserver Reproducibility Study.

OBJECTIVES: Doppler Color Scoring (DCS) has been used to predict successful expectant management of incomplete miscarriage. The aim of this study was to assess inter- and intraobserver reproducibility of the DCS system in women with incomplete miscarriage noted on transvaginal sonography. METHODS: This was a prospective reproducibility study involving offline analysis of 32 prerecorded video sets on transvaginal sonography in real time of women with incomplete miscarriage. Vascularization of retained products of conception was recorded using the DCS system adopted from the International Ovarian Tumor Analysis group. Five gynecologic sonologists of varying experience assigned a DCS classification to each video in the analysis. The same videos were reanalyzed, in a different order, at least 7 days later, to assess intraobserver agreement. Inter- and intraobserver correlations were performed to determine agreement. Interobserver agreement was also measured between each observer and the reference standard (G.C.). A Cohen's κ coefficient value less than 0 suggests poor agreement, 0.01 to 0.20 slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 and 0.99 almost perfect. RESULTS: Interobserver agreement for all observers for DCS allocation ranged from 0.480 to 0.751. Overall interobserver agreement for 5 observers was substantial (κ, 0.626). Overall interobserver agreements for the 2 inexperienced and 3 experienced observers compared to G.C. were 0.521 and 0.618, respectively. Experienced observers achieved overall almost perfect intraobserver agreement, compared to substantial agreement for inexperienced sonologists. CONCLUSIONS: DCS interobserver reproducibility between all observers and GC ranged from moderate to substantial. DCS intraobserver reproducibility was substantial to almost perfect. The DCS system appears to be a reproducible tool in evaluating women with incomplete miscarriage.

For Fit's Sake: A Norms-Based Approach to Healthy Behaviors Through Influence of Presumed Media Influence.

Based on the influence of presumed media influence (IPMI) model as the theoretical framework, this study examines how injunctive norms and personal norms mediate the influence of healthy lifestyle media messages on public intentions to engage in two types of healthy lifestyle behaviors-physical activity and healthy diet. Nationally representative data collected from 1,055 adults in Singapore demonstrate partial support for the key hypotheses that make up the extended IPMI model, highlighting the importance of a norms-based approach in health communication. Our results indicate that perceived media influence on others indirectly shaped public intentions to engage in healthy lifestyle behaviors through personal norms and attitude, providing partial theoretical support for the extended IPMI model. Practical implications for health communicators in designing health campaigns media messages to motivate the public to engage in healthy lifestyle are discussed.

Organization of the neuroepithelial actin cytoskeleton is regulated by heparan sulfation during neurulation.

Heparan sulfate and cytoskeletal actin microfilaments have both been shown to be important regulators of neural tube closure during embryonic development. To determine the functional relationship of these two molecules in formation of the spinal neural tube, we cultured ARC mouse embryos at embryonic day E8.5 in the presence of chlorate, a competitive inhibitor of glycosaminoglycan sulfation, and examined the effects on organization of actin microfilaments in the neuroepithelium. Compared against embryos cultured under control conditions, chlorate-treated embryos had shortened posterior neuropore, a loss of median hinge point formation and increased bending at the paired dorsolateral hinge points. Furthermore, apical organization of actin microfilaments in the neuroepithelial cells was absent, and this was associated with convex bending of the neuroepithelium. The results suggest that heparan sulfate is an important determinant of cytoskeletal actin organization during spinal neurulation, and that its biological action is dependent on sulfation of the heparan molecule.

Changes in electrical perceptual threshold in the first 6 months following spinal cord injury.

OBJECTIVES: To investigate the use of electrical perceptual threshold (EPT) testing to follow the natural history of sensory progression after complete and incomplete acute spinal cord injury (SCI) and to compare EPT changes with the American Spinal Injuries Association (ASIA) Impairment Scale (AIS). STUDY DESIGN: Prospective descriptive study. METHODS: ASIA examination and EPT testing was performed on 17 patients (7 AIS A, 10 AIS B-D), within 1, 3, and 6 months after acute SCI. EPT assessment was carried out bilaterally at ASIA sensory points from 2 levels above the neurological level to all levels below, including the sacral segments. Comparisons of EPT values above, at, and below the SCI were made at the three time points as well as comparisons of EPT data to ASIA assessment. RESULTS: There was poor agreement between lowest normal level on EPT and ASIA assessment. Over time, EPTs tended to deteriorate above and at the ASIA level in AIS A patients with modest changes below the neurological level of injury (NLI), mainly where EPTs correlated with the zone of partial preservation. Sacral sparing was detected in one patient with EPT testing, but not with ASIA assessment. AIS B-D patients showed improvement at the ASIA level and extensive changes, both improvement and deterioration, below the NLI. CONCLUSION: EPT testing has sufficient sensitivity to detect subclinical changes in sensory function as early as the first month post-SCI, which is not apparent in ASIA examination. In particular, the testing is able to show abnormalities at and around the injury site for both complete and incomplete SCI. In addition, EPT allows for the detection and monitoring of alterations, both improvements and deterioration, in the abnormal range of sensation.

Age, gender, and side differences of cutaneous electrical perceptual threshold testing in an able-bodied population.

OBJECTIVE: To investigate age, gender, and left-right differences in cutaneous electrical perceptual threshold (EPT) testing in an able-bodied, Australian sample. STUDY DESIGN: Prospective experimental. SETTING: Hospital-based spinal cord injuries unit. METHODS: Cutaneous electrical stimulation of the 28 dermatomes at ASIA sensory key points (C2-S4/S5) was performed on 29 female and 16 male healthy volunteers aged 21 to 76 years. Mean EPTs for each dermatome were compared (repeated measures ANOVA) for left-right, gender-related, and age-related (50 years of age) differences. RESULTS: There was no group difference between sides (repeated measures ANOVA, P = 0.934). Women across all ages had lower group mean EPTs than men (P < 0.0001). Women younger than age 50 years had lower mean EPTs than those older than age 50 years (P = 0.008). There was no group difference between younger and older men (P = 0.371). Analysis of individual dermatomes revealed no significant differences in thoracic dermatomes between genders or age groups, contrary to the limb dermatomes. CONCLUSION: There were gender differences in EPT values across all ages. Women had higher EPTs as they advanced in age, but this was less clear in men. There was considerable somatotopic variability in EPTs, especially in the lower limbs. If EPT testing is to be applied to detect subclinical changes within a dermatome, establishment of age- and gender-specific somatotopic normograms is a prerequisite.

Electrical perceptual threshold testing: a validation study.

BACKGROUND/OBJECTIVE: To investigate inter-rater and intra-rater reliability of electrical perceptual threshold (EPT) testing in assessing somatosensory function in healthy volunteers. STUDY DESIGN: Prospective experimental. SETTING: Hospital-based spinal cord injuries unit. METHODS: Cutaneous electrical stimulation of 4 dermatomes at ASIA sensory key points (C3, T1, L3, and S2) was performed on 40 control subjects. The lowest ascending stimulus intensity at which sensation was perceived was recorded as the EPT. Mean EPT values for each dermatome, as determined by 2 testers at 2 time points, were examined and plotted against a normative template. Differences and associations between intra- and inter-rater measurements and left-right measurements were studied. EPT results for 2 people with spinal cord injuries were also examined. RESULTS: EPT measurements from left and right sides, obtained from the 2 time points and 2 testers, were found to be strongly associated, with the exception of left and right side measurements at the S2 dermatome. No significant differences in the mean EPT for tester or time period were found. The intra- and inter-rater reliability was good for all dermatomes tested. Mean EPT measurements fell within the range of a normative template at each of the 4 dermatomes tested. CONCLUSION: EPT is an objective, reproducible, and quantifiable method of assessing sensation in a control group. However, caution should be applied in certain dermatomes such as S2, where there was large variation between left and right side measurements.

Management of spinal cord injury in general practice - part 2.

BACKGROUND: People with spinal cord injury (SCI) are at risk of developing complications specific to the condition. As the incidence of SCI is low, general practitioners may not be familiar with these complications. OBJECTIVE: This article completes the overview of common problems associated with SCI, highlighting specific points to be aware of when managing pressure areas, pain, spasticity, musculoskeletal disorders, neurological complications, sexual dysfunction, fertility, and psychological wellbeing. It aims to give readers a broad understanding of SCI issues, thereby increasing their confidence and ability to provide first line assessment and management. DISCUSSION: General practitioners are well placed to recognise and manage some conditions associated with SCI. Systematically addressing the issues can also serve as the springboard for health promotion, thus pre-empting and potentially avoiding morbidity for the patient with SCI.

Management of spinal cord injury in general practice - part 1.

BACKGROUND: Spinal cord injury (SCI) is a complex disability, often requiring specialised knowledge and expertise to manage multisystem impairments. This topic is often not included in undergraduate medical education and the general practitioner may understandably feel underprepared for managing a patient with SCI. OBJECTIVE: This two part article provides an overview of common complications associated with SCI. DISCUSSION: Common management issues in SCI include neurogenic bladder and bowel dysfunction, autonomic dysreflexia, sexuality, fertility, pressure areas, pain, spasticity, musculoskeletal disorders, neurological complications, general health and psychological wellbeing. Armed with key information, management of the patient with SCI can be systematically addressed in the general practice setting.

Fitting disability into practice--focus on spinal cord injury.

BACKGROUND: People with specialised needs such as spinal cord injury (SCI) may not feature prominently in the caseload of the general practitioner. However, when people with chronic disabilities are aggregated, they constitute a reasonable percentage of consultations. It may be difficult to deliver high quality health care for such complex patients. OBJECTIVE: We propose a method for integration of health care and prevention activities for patients with SCI in general practice, using tools such as a structured questionnaire, general practice management plans and team care arrangements. DISCUSSION: Practice structures can efficiently and effectively accommodate people with disabilities. Tools can serve as clinical prompts, help with planning, save time, and be financially rewarding. Importantly, they can anchor a 12 month cycle of preventive health care, allowing systematic monitoring and increasing intensity/coordination of professional input for those identified with greatest needs.