Three probiotic strains exert different effects on plasma bile acid profiles in healthy obese adults: randomised, double-blind placebo-controlled crossover study.

Microbial metabolism in the gut may alter human bile acid metabolism in a way that beneficially affects lipid homeostasis and therefore cardiovascular disease risk. Deconjugation of bile acids by microbes is thought to be key to this mechanism but has yet to be characterised in blood and stool while observing lipid markers. The aim of this study was to determine the effect of 3 different probiotic strains on plasma and stool bile acids in the context of lipid and glucose metabolism. In this 18-week, randomised, double-blind crossover study, healthy adults (53±8 years) with a high waist circumference underwent a 1-week pre-baseline period and were then randomised to receive 1 capsule/day of Bacillus subtilis R0179 (2.5×109 cfu/capsule; n=39), Lactobacillus plantarum HA-119 (5×109 cfu/capsule; n=38), Bifidobacterium animalis subsp. lactis B94 (5×109 cfu/capsule; n=37) or placebo for 6 weeks. Following a 3-week washout and second pre-baseline week, participants were crossed to the other intervention for 6 weeks followed by a 1-week post-intervention period. Blood and stool samples were collected at the beginning and end of each intervention to measure bile acids, serum lipid profiles, and glucose and insulin levels. Data from the placebo intervention were combined for all participants for analyses. In obese participants, the difference (final-baseline) in the sum of deconjugated plasma bile acids was greater with consumption of B. subtilis (691±378 nmol/l, P=0.01) and B. lactis (380±165 nmol/l, P=0.04) than with placebo (98±176 nmol/l, n=57). No significant differences were observed for any probiotics for stool bile acids, serum lipids, blood glucose or insulin. These data suggest that B. subtilis and B. lactis had no effect on glucose metabolism or serum cholesterol but increased deconjugated plasma bile acids in obese individuals. Additional studies should be conducted to confirm these findings and explore potential mechanisms. This trial was registered at clinicaltrials.gov as NCT01879098.

Consequences of endoscopic inguinal hernioplasty with mesh on subsequent open radical prostatectomy.

AIM: To determine the effect of prior endoscopic hernia repair with prosthetic mesh on subsequent open radical prostatectomy. METHODS: A retrospective study from 1990 to 2004 identified nine patients with preperitoneal mesh placement followed by open radical prostatectomy. Case controls (n = 26) were matched for age, type of operation, year of surgery and pathologic stage of prostatic adenocarcinoma. Outcome variables of operating time, number of pelvic lymph nodes excised, duration of hospital stay, duration of urinary catheterization, recurrence rates, and incidence of complications were compared. Data analysis was performed using Wilcoxon's rank sums test. RESULTS: Intraoperatively, subjective difficulty in dissection was documented in all cases by the performing urologist. Duration of hospital stay was significantly increased by 1.3 days (p < 0.05), as compared to the control group. However, no statistically significant increase in mean operating time (173 vs. 172 min, p = 0.925), number of lymph nodes sampled (4.4 vs. 6.6, p = 0.147), duration of urinary catheterization (22 vs. 19 days, p = 0.925), oncologic recurrence (11 vs. 11% at 6.1 and 4.8 years follow-up), or complications was found. CONCLUSIONS: Prior TEP/TAPP did not increase the morbidity or mortality of subsequent prostate surgery. Despite some subjective operative difficulty, open prostatectomy was safe and feasible in all cases with a comparable oncologic outcome. Mesh-associated inflammation may preclude adequate nodal sampling. While endoscopic hernia repair remains an excellent option to fix unilateral, bilateral, and recurrent herniae, consideration of future prostate surgery is important. Inserting less "inflammatory" mesh or using an open, anterior approach may be prudent in some men at high risk for needing subsequent prostate surgery.

The Timed Get-up-and-Go test revisited: measurement of the component tasks.

The "Timed Get-up-and-Go" (TGUG) test measures the overall time to complete a series of functionally important tasks. In the "Expanded Timed Get-up-and-Go" (ETGUG) test, times for the component tasks are measured using a multimemory stopwatch. Results from the ETGUG test were compared to those from the TGUG test on three groups of subjects: nonimpaired young, nonimpaired elderly, and elderly subjects at risk of falling. Significant differences were found between the two control groups and the at-risk group for all components of the test. Walking speed was the only measurement found to be significantly different between the young and elderly controls. The ETGUG test is a sensitive and objective assessment of function that requires minimal equipment, training, or expense. It better isolates functional deficits, thereby aiding the clinician in devising prevention strategies and guiding both treatment and further testing.

Use of a multimemory stopwatch to measure the temporal gait parameters.

Before a measurement technique is used clinically, it must be shown to be both valid and reliable. The purpose of this paper was to investigate a novel technique for measuring the temporal phases of the gait cycle using a stopwatch and slow motion video. Two healthy, young adult subjects walked at a range of self-selected walking speeds on a resistive grid walkway. The subjects were videotaped while traversing the walkway. Using video played back at slow motion and a multimemory stopwatch, two student physical therapists independently analyzed the videotapes on five separate occasions. Regression analysis was used to compare the data obtained by each of the raters with those obtained from the walkway. Measurements by both raters correlated highly with those obtained from the walkway. The results indicated a slight bias between the walkway data and the stopwatch technique, but the confidence intervals suggest that the relative timing of key events differed by less than 1%. This study shows that it is possible to get valid and reliable measures of the relative durations of the temporal gait parameters using slow motion video and a multimemory stopwatch.

Deficiencies in standing weight shifts by ambulant hemiplegic subjects.

OBJECTIVE: To compare weight shifts of hemiplegic subjects with controls in parallel and diagonal stance. DESIGN: Case-control study. SETTING: All subjects were functionally independent in the general community. Hemiplegic subjects had qualified for and had received rehabilitation. PARTICIPANTS: Independently ambulant hemiplegic subjects, who exhibited an asymmetrical gait pattern, were compared with age-and sex-matched controls recruited from the same community. INTERVENTIONS: Subjects maintained a series of weight shift postures, each for a duration of 10sec, while standing on a transduced platform with feet both parallel and placed diagonally, the latter position designed to mimic the double support phases of the gait cycle. MAIN OUTCOME MEASURES: Locations of center of pressure (CP) were measured in relation to each subject's center of base of support and, ranges of weight shift in each direction were calculated. RESULTS: With feet parallel, the hemiplegic sample was deficient in shifting weight towards the hemiplegic leg and posteriorly (p<.05). The diagonal tests revealed deficiencies in shifting weight posterolaterally over both lower limbs (p<.05) but particularly over the affected leg. The ranges over which weight could be significantly below the values for the normal sample in both cardinal plane and diagonal directions (P<.05). CONCLUSIONS: Even functionally ambulant hemiplegic subjects demonstrate marked limitations in the capacity to shift weight and possess a reduced range of weight shift. The diagonal tests emphasized deficiencies in shifting weight posteriorly over both limbs and toward the affected side, specific rehabilitation of which may improve gait.

A comparison of the range of walking speeds between normal and hemiplegic subjects.

It is known that people who have suffered stroke walk slower than normal. However, their ability to deviate from a preferred speed of walking has not been reported. This study investigated the range of walking speeds of 20 hemiplegic subjects and compared the results with those of 20 normal age- and gender-matched controls. All subjects traversed a computerized grid walkway which measured selected temporal and spatial gait parameters. Subjects walked at five self-selected speeds: "normal"; "slower than normal"; "slowest"; "faster than normal"; and "fastest". Comparisons were made between velocity, range of velocity, stride time and stride length. The hemiplegic group walked significantly slower at all speeds, were less capable of adapting the speed of their gait, possessed a markedly reduced range of walking speed, and walked more cautiously than the controls. These deficiencies are likely to limit the stroke person's ability to respond to environmental demands.

Combining new technologies for effective collection development: a bibliometric study using CD-ROM and a database management program.

Librarians have used bibliometrics for many years to assess collections and to provide data for making selection and deselection decisions. With the advent of new technology--specifically, CD-ROM databases and reprint file database management programs--new cost-effective procedures can be developed. This paper describes a recent multidisciplinary study conducted by two library faculty members and one allied health faculty member to test a bibliometric method that used the MEDLINE and CINAHL databases on CD-ROM and the Papyrus database management program to produce a new collection development methodology.

Predicting step time from step length and velocity.

This study was designed to investigate the relationship between step time and step length in a healthy population of young adults. The sample was composed of 10 females and 10 males with ages ranging from 19 to 25 years. The subjects walked along a resistive grid walkway at an audio-controlled cadence of 80 steps per minute. These trials consisted of two walks with asymmetrical step lengths (2/4 time), two walks with asymmetrical step times (3/4 time) and two in which the only constraint was the cadence. The results indicate that the values of average velocity and average step length can be used to calculate step time with reasonable accuracy in a symmetrical walking pattern, but not under conditions of induced step length or step time asymmetries. It is suggested that stride frequency rather than cadence be used, particularly when measurements are made from patients with asymmetrical walking patterns.

The kinematics of idiopathic gait disorder. A comparison with healthy young and elderly females.

In this study the kinematic gait parameters of healthy young and elderly subjects were compared with those of a group of patients with idiopathic gait disorder of the elderly (IGDE), a condition characterized by dysfunctional walking for which no underlying cause can be determined. The velocity and the temporal/distance gait kinematics were measured for self-selected fast, medium and slow speeds of walking. The elderly walk with a more cautious gait pattern than younger adults. This pattern is characterized by a slow walking speed and a reduced single support phase, with shorter but more frequent strides, and is even more marked in persons with IGDE. The slower the walking speed the more cautious this pattern becomes. The patients with IGDE not only walk far slower than a group of healthy age matched individuals but the range of speeds, from self-selected slow to fast, is much reduced and does not overlap that of the healthy elderly. With objective gait measurements this group might be better identified.

Measurement of the temporal and spatial parameters of gait using a microcomputer based system.

This paper describes a system for measuring the temporal and spatial parameters of gait. The basis of the system is a resistive grid walkway which is controlled by a microcomputer which also collects, processes and stores the data from the walkway. The data obtained from the system, including the temporal and spatial parameters of gait such as step and stride lengths, the durations of swing and support phases of the gait cycle and walking speed, are presented in both numerical and graphical forms. Accuracy to within 1 cm has been verified by analysing videotapes of foot placement during a walk. Special emphasis has been placed on making the system software user-friendly. The presentation of date uses several types of display, from a simple graphical summary of the walk statistics to a more complete report showing all the data from each stride. In the year during which the walkway system has been operational, it has been found easy to use by both subjects and operators, and it produces very useful data.

Two steps equals one stride equals what?: the applicability of normal gait nomenclature to abnormal walking patterns.

This paper considers the basic definitions of 'step' and 'stride' and the temporal phases of the gait cycle, derived from consideration of normal walking patterns. The paper also examines a number of pathological gait patterns to test the universal clinical applicability of these definitions. The objective is not to reject established conventions for naming steps and strides, or the phases naturally occurring within them, but rather to word these conventions a little less rigidly, so that without loss of descriptive precision. some of the more common oatholoaical gaits can also be accommodated.

Gait asymmetries in residual hemiplegia.

Temporal gait asymmetries in 25 patients with residual stroke were measured from a walkway which allowed data collection on-line with a microcomputer. An asymmetry ratio has been introduced to reflect the degree of asymmetry in each of the support phases of the gait cycle. Subjects in this study demonstrated residual deficits in walking, and although there was a general pattern of asymmetry, walking patterns varied even though the group had been selected according to criteria which tended to make for relative functional homogeneity. Both the extent and patterns of temporal gait asymmetries with respect to phases of the gait cycle were found to vary. The basic rehabilitative implication of these findings is that it is not possible to design a single gait reeducation program for all residual stroke patients; the exercises prescribed must address the unique deficiencies of each patient.

Two-dimensional isoelectric focussing/sodium dodecyl sulphate polyacrylamide gel electrophoretic mapping and some molecular characteristics of the proteins of the adult guinea-pig small intestinal microvillus membrane.

The adult guinea-pig small intestinal microvillus membrane was purified approximately 25-fold by both cation-precipitation and differential centrifugation methods. Comparison by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) revealed no substantial differences in polypeptide composition between the two preparations. One-dimensional SDS-PAGE and two-dimensional isoelectric focussing (IEF)/SDS-PAGE, together with Coomassie-blue, silver and lectin-staining, showed three major high molecular weight polypeptides, Mr 108 000, 116 000 and 127 000, as well as a 47 kDa protein (actin), as major constituents of the membrane. The proteins of Mr 108 000 and 116 000 were strongly concanavalin A reactive. A detailed two-dimensional IEF/SDS-PAGE map of the membrane was constructed. Sodium carbonate treatment showed the two concanavalin A-reactive glycoproteins, Mr 108 000 and 116 000, comprising the sucrase-isomaltase complex, to be loosely-associated 'extrinsic' microvillus membrane proteins. Two proteins, Mr 127 000 and 135 000, were tightly-associated 'intrinsic' microvillus proteins. Despite regional differences in specific activity of some small intestinal microvillar enzymes, most noticeably enterokinase (EC 3.4.21.9) and dipeptidyl peptidase IV (EC 3.4.14.x), no substantial regional differences were seen in microvillus membrane polypeptide composition. In contrast, a substantial increase in the major high molecular weight proteins of Mr 108 000 and 116 000 accompanied a 10-fold rise in sucrase-isomaltase activity, and loss of a major protein of Mr 131 000 accompanied the complete loss of lactase activity from the membrane during postnatal development.

A microcomputer-based system for measuring temporal asymmetry in amputee gait.

This paper reports the development of a microcomputer-based system for measuring the temporal factors of amputee gait. The system has been designed for possible use in a standard clinical environment. It consists of a simple walkway, two photoelectric beam relays, a control unit and an APPLE II Plus microcomputer. Preliminary clinical assessment of the system has been conducted. The gait characteristics of eight amputees during their ambulation training were investigated with the use of the new system. A comparison of the results from different groups of subjects, selected primarily on level of amputation, is presented.

Pliocene hominid gait: new interpretations based on available footprint data from Laetoli.

Normative trends in the gait patterns of modern man can be used to reconstruct crucial characteristics of the bipedal behaviour of Pliocene hominids from their fossilized footprints. In this reconstruction the interrelated parameters of velocity, stride-length, and cadence are determined from imprints made in damp volcanic ash some 3.7 million years ago. When early hominid footprint data is fitted to regression equations of high predictability for the interrelationship of these locomotor parameters in modern man, a pattern of gait emerges that contradicts previous reconstructions.