The effect of insoles on symptomatic flatfoot in preschool-aged children: A prospective 1-year follow-up study.

Flatfoot is a common reason for parents to seek help from health care professionals, and limited evidence is available regarding the effects of insoles on preschool-aged children. This study mainly investigated the effect of insoles on symptomatic flatfoot in preschool-aged children and followed up the changes in footprints after 1 year.This study was a prospective, observational cohort study. Children aged 3 to 5 years old who exhibit the signs of flatfoot feet were recruited from the kindergartens in the central Taiwan between March 2010 and December 2013. The Chippaux-Smirak index (CSI) was used to determine whether the footprints of children were associated with flatfoot. The children were divided into an insole group and a no-insole group according to diagnoses by doctors. This study used the modified shoe insole as the intervention, and the CSI measured and followed up the changes in footprints after 1 year.A total of 466 preschool-aged children aged 3 to 5 years old with flatfoot completed the 1-year follow-up study. Of these, 123 children (men 77; women 46) were in the insole group and 343 children (men 187; women 156) were in the no-insole group. After the insoles were worn for 1 year, the CSI values of the children with symptomatic flatfoot decreased by 9.7%, and the 5-year-old children had the biggest change (effect size = 1.25). In the insole group, 34.1% of the footprints were determined as normal at 1-year follow-up, and CSI values decreased by 17.5%. High prevalence of joint laxity was found in both groups (insole group: 34.5%; no-insole group: 35.1%). Of the children in the insole group, the proportion of joint laxity was significantly higher in the flatfoot group (43.1%) than in the normal group (17.7%).This study showed that wearing insoles indeed can reduce the signs of flatfoot in preschool-aged children, and the effect is better in 5-year-old children. It is suggested that insoles can be provided as a conservative treatment for preschool-aged children with symptomatic flatfoot.

Different weight shift trainings can improve the balance performance of patients with a chronic stroke: A randomized controlled trial.

BACKGROUND: Improving balance ability, increasing walking ability, and reducing the occurrence of falls are important objectives in the rehabilitation of stroke patients. Do the posture balance training and the intervention of lateral wedge insoles to improve of balance function and increase walking ability in patients with a chronic stroke? METHODS: A randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. Participants who had a chronic stroke (onset >6 months) were recruited from the rehabilitation and neurology departments of a hospital in central Taiwan. Subjects were divided into 3 groups: a visual biofeedback balance training group, a lateral wedge group, and a control group; apart from their usual rehabilitation program, and both experimental groups received a 6-week training session program. The primary outcome was the balance computerized adaptive test (balance CAT), and secondary outcome was timed up and go (TUG) test. All subjects were evaluated at the baseline, posttraining (6-week), 1st follow-up (10-week), and 2nd follow-up (18-week). RESULTS: A total of 56 subjects were participated in this study, including 38 males and 18 females. The mean age of the subjects was 59.1 years old, and the mean time was 43.7 months after the onset of the stroke. This study found the interaction in groups and measurement time points reached statistical significance of the balance CAT and TUG test (F = 5.740, P < .001; F = 2.926, P = .011; respectively). In addition, the performance of both the visual biofeedback training and lateral wedge group was superior to that of the control group. CONCLUSION: Six-week visual biofeedback training and intervention of 5° lateral wedge insoles can improve the balance ability of patients with a chronic stroke. TRIAL REGISTRY: http://www.chictr.org.cn, ChiCTR-IPR-15007092.

Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery: A prospective cohort study.

The 6-minute walk test (6MWT) has been applied to assess postsurgical recovery in cardiac populations. This study mainly investigated whether the 6MWT could serve as an indicator for physical functioning in patients undergoing cardiac surgery.Participants completed the 6MWT and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline, discharge, and 3 months postoperatively, in order to analyze the construct validity and responsiveness of the 6MWT. The participants in this study were 125 patients (92 males and 33 females) with an average age of 65.1 ±â€Š11.1 years. The mean 6MWT was 308.9 ±â€Š77.3 m in the preoperative phase, decreased to 277.3 ±â€Š85.7 m at discharge, and returned to 378.1 ±â€Š95.2 m at 3-month follow-up. The results showed that the 6-minute walk distances at baseline and at 3-month follow-up were moderately to highly correlated with the physical functioning subscale of the SF-36 (rs = .44 and .54, respectively) and had weak correlation with the nonphysical functioning subscales. The recovery level of physical functioning is meaningfully associated with the 6MWT change from baseline to discharge and from baseline to 3-month follow-up. Patients with higher New York Heart Association (NYHA) Functional Classification levels had lower 6MWT. Additionally, the 6MWT was sensitive to change during the perioperative period (effect sizes from -0.51 to 1.72).The supporting evidence includes the construct validity and responsiveness of the 6MWT. This study supports the feasibility of the 6MWT as an evaluation tool of physical functioning for assessment of postcardiac surgical recovery.

Inhibition of pentraxin 3 in glioma cells impairs proliferation and invasion in vitro and in vivo.

Pentraxin 3 (PTX3) is an inflammatory molecule that is involved in immune responses, inflammation, and cancer. Recent evidence suggests that PTX3 plays a critical role in tumor progression; however, its impact on the biological function of gliomas remains unknown. In the present study, immunohistochemical staining showed that patients with high-grade gliomas exhibited increased expression levels of PTX3 compared to those with low-grade gliomas (P < 0.001). Furthermore, knockdown of PTX3 in GBM8401 cells inhibits proliferation, increases p21 protein levels, and decreases cyclin D1 protein levels, resulting in cell cycle arrest at the G0/G1 phase. In addition, knockdown of PTX3 significantly decreases GBM8401 cell migration and invasion through the downregulation of matrix metalloproteinase-1 and -2 (MMP-1 and MMP-2) expression. In a GBM8401 xenograft animal model, PTX3 knockdown decreases tumor growth in vivo. In conclusion, PTX3 plays an important role in glioma cell proliferation and invasion, and may thus serve as a novel potential therapeutic target in the treatment of gliomas.

Metastasis tumor-associated protein-2 knockdown suppresses the proliferation and invasion of human glioma cells in vitro and in vivo.

Metastasis tumor-associated protein 2 (MTA2) is a member of the MTA family that is closely associated with tumor progression and metastasis. However, the role of MTA2 in glioma cells remains unclear. The expression of MTA2 was measured using immunohistochemistry and western blotting in the human brain tumor tissue array and human glioma cell lines. The impact of MTA2 knockdown on GBM8401 and Hs683 cell growth was evaluated by MTT assay and flow cytometry. Cell migration and invasion were analyzed by cell-migration assay and Matrigel invasion assay. In addition, we used subcutaneous tumor models to study the effect of MTA2 on the growth of glioma cells in vivo. We found that MTA2 protein and mRNA expression are higher in GBM8401 and Hs683 cells than in other glioma cells (M059 J, M059 K and U-87 MG), and glioma tumor tissue correlated significantly with tumor grade (P < 0.001). Knockdown of MTA2 expression significantly inhibited cell growth, cell migration and invasion, and induced G0/G1 phase arrest in human GBM8401 and Hs683 cells in vitro. Moreover, in vivo studies using subcutaneous xenografts in mice models indicate that MTA2 knockdown significantly inhibited tumorigenicity. These results indicate that MTA2 plays an important oncogenic role in the development and progression of gliomas.

An investigation of the factors affecting flatfoot in children with delayed motor development.

This study investigated the prevalence of flatfoot in children with delayed motor development and the relevant factors affecting it. In total, 121 preschool-aged children aged 3-6 with delayed motor development (male: 81; female: 40) were enrolled in the motor-developmentally delayed children group, and 4 times that number, a total of 484 children (male: 324; female: 160), of gender- and age-matched normal developmental children were used as a control group for further analyses. The age was from 3.0 to 6.9 years old for the participants. The judgment criterion of flatfoot was the Chippaux-Smirak index >62.70%, in footprint measurement. The results showed that the prevalence of flatfoot in children with motor developmental delay was higher than that in normal developmental children, approximately 58.7%, and that it decreased with age from 62.8% of 3-year-olds to 50.0% of 6-year-olds. The results also showed that motor-developmentally delayed children with flatfoot are at about 1.5 times the risk of normal developmental children (odds ratio=1.511, p=0.005). In addition, the prevalence of flatfoot is relatively higher in overweight children with delayed motor development, and that in obese children is even as high as 95.8% (23/24). Children with both excessive joint laxity and delayed development are more likely to suffer from flatfoot. The findings of this study can serve as a reference for clinical workers to deal with foot issues in children with delayed motor development.

Change in flatfoot of preschool-aged children: a 1-year follow-up study.

UNLABELLED: The main purpose of this study is to investigate the changes in the signs of flatfoot of preschool-aged children in a 1-year follow-up study. This study performed follow-up on a total of 580 preschool-aged children (boys, 297 children; girls, 283 children) with a median age of 54 (range 36-71 months), and the average follow-up period was 11.8 months. This study used the Chippaux-Smirak index (CSI) of footprint as the assessment tool, and CSI > 62.70 % was used as the standard for determining whether preschool-aged children suffered from flatfoot. The results showed that the signs of flatfoot of preschool-aged children improved with increasing age. At the 1-year follow-up, the average CSI was 5.1 % lower, and the proportion of children with flatfoot was 14 % lower. The follow-up on the change in the signs of flatfoot showed that 37.6 % of the children originally with flatfoot had improved to normal, verifying that flatfoot indeed improves with increasing age. However, the results also showed that 9.9 % of the children who originally had normal feet had developed flatfoot with increasing age, which deserves subsequent investigation. The results of the follow-up also showed that children who were relatively younger, male, obese, and experiencing excessive joint laxity were more likely to experience the signs of flatfoot. CONCLUSION: The 1-year follow-up found that some preschool-aged children with flatfoot may develop normal feet, while children with normal feet may begin to experience the signs. Relevant factors affecting flatfoot in preschool-aged children continue to require further clarification.

Footprint analysis of flatfoot in preschool-aged children.

Our aim in this study was to analyze the footprint measurements of flatfoot in a population of preschool-aged children. Three footprint measurements, the Clarke's angle (CA), Chippaux-Smirak index (CSI), and Staheli arch index (AI), were used for comparison with clinical diagnosis. A total of 2,638 static footprints of children aged from 3 to 6 years were recorded. The clinical diagnosis as a gold standard compared with the results of the CA, CSI, and AI and displayed in a receiver operating characteristic (ROC) curve. In order to illustrate the diagnostic accuracy in clinical settings, their likelihood ratios were calculated given their cutoff points, and their pretest/posttest probabilities were plotted as the Fagan nomogram. The optimal cutoff points for CA, CSI, and AI were 14.04°, 62.70%, and 107.42%, respectively, and all of them showed high sensitivity. The areas under curves were 0.91, 0.95, and 0.92, respectively. The positive predictive values were 0.84, 0.91, and 0.85, and the negative predictive values were 0.82, 0.85, and 0.85, respectively. The positive likelihood ratio values for CA, CSI, and AI were 4.09, 7.52, and 4.61, and the negative likelihood ratio values were 0.18, 0.14, and 0.13, respectively. In conclusion, this study demonstrated that footprint analysis methods are suitable for diagnosing flatfoot in preschool-aged children, and that the most appropriate cutoffs are as follows: CA ≤ 14.04°, CSI > 62.70%, and AI > 107.42%. The CSI had a predictive probability of more than 90% and is recommended in screening for flatfoot in preschool-aged children.

Relevant factors influencing flatfoot in preschool-aged children.

The aim of this study was to discuss the influence of age, gender, obesity status, joint laxity, and the W-sitting habit on flatfoot in preschool-aged children. A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. The children were divided into a normal group (n = 733), a unilateral flatfoot group (n = 266), and a bilateral flatfoot group (n = 599), and a multinomial logistic regression model was used to analyze the data. The prevalence of flatfoot decreased significantly with increasing age: 54.5% of 3-year-old but only 21% for 6-year-old children had bilateral flatfoot. In the bilateral flatfoot group, the risk decreased with increased age, increased with increasing weight beyond the normal range, and was higher for boys than girls. Age and obesity status were not significantly influential in the unilateral flatfoot group. Children with higher joint laxity and a habit of W-sitting also experienced higher risk in both flatfoot groups. In conclusion, this study demonstrates a significant association of age, gender, obesity status, joint laxity, and the W-sitting habit with the bilateral flatfoot in preschool-aged children. Children with unilateral flatfoot differ from those with normal feet and bilateral flatfoot. It is suggested that the unilateral flatfoot deserves special attention in future studies.