Direct Synthesis of Benzoselenophene and Benzothiophene Derivatives from 1,1-Diarylethenes and Biaryls by Chalcogen Cation-Mediated Successive Bond Formation.

A Tf2O-mediated sequential C-Se bond-forming reaction of 1,1-diarylethenes and biaryls with methaneselenic acid has been developed. Upon demethylation workup with ethanolamine, the corresponding benzoselenophene derivatives are obtained directly. The related synthesis of benzothiophene derivatives with sodium methanesulfinate is also possible with the unique assistance of the ball milling technique. The active species is considered to be a highly electrophilic chalcogen cation, which enables successive bond formation even at room temperature.

Clinical prediction rules for multi surfaces walking independence using the Berg Balance Scale or Mini-Balance Evaluation Systems Test in persons with stroke.

BACKGROUND: A Clinical prediction rule (CPR) for determining multi surfaces walking independence in persons with stroke has not been established. OBJECTIVES: To develop a CPR for determining multi surfaces walking independence in persons with stroke. METHODS: This was a multicenter retrospective analysis of 419 persons with stroke. We developed a Berg Balance Scale (BBS)-model CPR combining the BBS, comfortable walking speed (CWS) and cognitive impairment, and a Mini-Balance Evaluation Systems Test (Mini-BESTest)-model CPR combining the Mini-BESTest, CWS, and cognitive impairment. A logistic regression analysis was conducted with multi surfaces walking independence as the dependent variable and each factor as an independent variable. The identified factors were scored (0, 1) based on reported cutoff values. The CPR's accuracy was verified by the area under the curve (AUC). We used a bootstrap method internal validation and calculated the CPR's posttest probability. RESULTS: The logistic regression analysis showed that the BBS, CWS, and cognitive impairment were factors in the BBS model, and the Mini-BESTest was a factor in the Mini-BESTest model. The CPRs were 0-3 points for the BBS model and 0-1 points for the Mini-BESTest model. The AUCs (bootstrap mean AUC) of the CPR score were 0.89 (0.90) for the BBS model and 0.72 (0.72) for the Mini-BESTest model. The negative predictive value (negative likelihood ratio) was 97% (0.054) for CPR scores < 2 for the BBS model and 94% (0.060) for CPR scores < 1 for the Mini-BESTest model. CONCLUSIONS: The CPR developed herein is useful for determining multi surfaces walking independence.

Minimal important change in the Berg Balance Scale in older women with vertebral compression fractures: A retrospective multicenter study.

BACKGROUND: Vertebral compression fractures, which are commonly associated with older age and osteoporotic fractures, have an increased risk of re-fracture. Therefore, improving balance is important to prevent falls. The minimal important change (MIC) has been recommended for interpreting clinically meaningful changes in rating scales. The MIC of the Berg Balance Scale (BBS) for use in older women with vertebral compression fractures has not been established. OBJECTIVE: To identify the MIC of the BBS that can be used in older women with vertebral compression fractures using predictive modeling methods and the receiver-operating characteristic (ROC)-based method. DESIGN: A retrospective longitudinal multicenter study. PATIENTS: Sixty older women (mean age ± standard deviation: 84.1 ± 7.0 years) with vertebral compression fractures who were unable to ambulate independently on a level surface. METHODS: A change of one point in the Functional Ambulation Category (FAC) was used as an anchor to calculate the MIC of the BBS based on the change between admission and discharge. We calculated the MIC for the women whose FAC score improved by ≥1 point. We used three anchor-based methods to examine the MIC: the ROC-based method (MICROC ), the predictive modeling method (MICpred ), and the MICpred -based method adjusted by the rate of improvement and reliability of transition (MICadj ). RESULTS: Thirty-nine women comprised the "important change" group based on their FAC score improvement. In this group, the MICROC (95% confidence interval [CI]) value of the BBS was 10.0 points (5.5-15.5), with an area under the curve of 0.71. The MICpred (95% CI) value was 9.7 (8.1-11.0), and the MICadj (95% CI) was 7.0 (5.5-8.5) points. CONCLUSION: For women with vertebral compression fractures who are unable to ambulate independently, a 7.0-point improvement in the BBS score may be a useful indicator for reducing the amount of assistance required for walking.

Clinical Prediction Models for Nonmortality Outcomes in Older Adults With Hip Fractures: A Systematic Review.

BACKGROUND: Several hip fracture clinical prediction models have been developed. We conducted this study to (i) map outcomes used in clinical prediction models for hip fracture, (ii) identify the domains and instruments of predictors, and (iii) assess the risk of bias. METHODS: We performed systematic searches of studies published from June 2002 to June 2023 in the PubMed, Cochrane Library, CINAHL, CiNii, and Ichushi databases. After the relevant articles were identified, we performed the data extraction and bias risk assessment. We used the Prediction Study Risk Of Bias Assessment Tool (PROBAST) to assess each study's risk of bias. Outcome mapping was performed for the core outcome set of hip fractures. Qualitative synthesis and the PROBAST evaluation were performed on other-than-mortality core outcomes, which are difficult to target in rehabilitation. RESULTS: We screened 3 206 studies for eligibility; 45 studies were included in the outcome mapping, and 10 studies were included in the qualitative synthesis. Outcomes included mortality (n = 35), mobility (n = 8), and activities of daily living (n = 2). No clinical prediction models had pain or health-related quality of life as an outcome. Predictors were reported in 8 domains and 38 measures. The PROBAST evaluation showed a high risk of bias in all 10 studies that were eligible for a qualitative synthesis. CONCLUSIONS: The clinical prediction models had only mortality, mobility, and activities of daily living as outcomes. The development of clinical prediction models with pain and health-related quality of life as outcomes is necessary. Clinical prediction models overcoming the risk of bias identified in this study are also needed.

Cut-off values and sub-items of the Berg Balance Scale for walking-aid use in hospitalized older adults with a hip fracture: a retrospective analysis.

OBJECTIVE: To identify the Berg Balance Scale (BBS) values that can be used to discriminate the use of a walking aid and the BBS sub-items that reveal the differences in the use of walking aids among hospitalized older adults with a hip fracture. METHODS: The cases of 77 older adults (age 80.8 ± 7.5 years) with a hip fracture who were able to walk independently in the hospital were retrospectively analyzed. A receiver operating characteristic curve (AUC) analysis was used to identify BBS scores that optimized the identification of subjects with different levels of aids. The BBS sub-items identifying differing among the walking aids were identified by a classification and regression tree analysis. RESULTS: The BBS scores were highest for no aid, a cane, and a walker, in that order. The ability to walk without an aid and the ability to walk without a walker showed moderate AUCs (0.824 and 0.865) with cutoff values of 51.5 and 45.5 points, respectively. The sub-items identified were Turning 360° (4 vs. < 4 points) as the best discriminator for using/not using a cane and Stool Stepping (≥ 2 vs. < 2 points) for using a cane or walker. CONCLUSION: The BBS is useful for determining whether to discontinue the use of a walker in individuals with a hip fracture.

Berg Balance Scale is a Valid Measure for Plan Interventions and for Assessing Changes in Postural Balance in Patients with Stroke.

OBJECTIVES: After confirming the measurement properties of the Berg Balance Scale (BBS) in patients with stroke by conducting a Rasch analysis, this study sought: (i) to generate a keyform as a tool for goal-setting and intervention-planning; and (ii) to determine the appropriate strata for separating patients' postural balance ability. DESIGN: Methodological analyses of cross-sectional study data. PATIENTS: A pooled sample of 156 patients with stroke: mean (standard deviation) age 74.4 (12.9) years. METHODS: This study evaluated the BBS's rating scale structure, unidimensionality, and measurement accuracy (0: unable to perform or requiring help, to 4: normal performance) and then generated a keyform and strata. RESULTS: The BBS rating scale fulfilled the category functioning criteria. Principal component analysis of standardized residuals confirmed the unidimensionality of the test. All items fit the Rasch analysis. Person ability-item difficulty matching was good. Person reliability was 0.96, and the patients were divided into 9 strata. The keyform for the BBS will enable clinicians and investigators to estimate patients' postural balance ability and monitor their progress. CONCLUSION: The BBS has strong measurement properties. This study generated both a keyform that can contribute to clinicians' decision-making in goalsetting and intervention-planning and strata that can facilitate understanding of patients' abilities.

Development of Cut-off Values on the Berg Balance Scale for Predicting Walking Independence in Older Adults with Hip Fracture.

Objectives: The aim of the current study was to identify a cut-off value for predicting walking independence at discharge in older adults with hip fracture based on their Berg Balance Scale (BBS) score at admission to a convalescent rehabilitation ward. Methods: This was a retrospective, multicenter, observational study of 187 older adults with hip fractures (mean age 83.7, range 66-97 years). Data was collected on the patients' age, sex, treatment, and physical function evaluation. An ordinal logistic regression analysis was used to identify predictors associated with the degree of independence in walking at discharge. Receiver operating characteristic curves were used to estimate cut-off values to predict independent and supervised walking at discharge based on the BBS score at admission. The accuracy of the classification was assessed using the area under the curve (AUC). Results: The BBS score at admission was a significant factor predicting the degree of walking independence at discharge (odds ratio = 1.09, 95%CI: 1.06-1.11). The cut-off values of the BBS score at admission for predicting independent walking and supervised walking at discharge were 28 points (AUC = 0.76, 95%CI: 0.69-0.83) and 21 points (AUC = 0.84, 95%CI: 0.77-0.91), respectively. Conclusions: The BBS scores of older adults with hip fracture on admission to a rehabilitation ward are useful for predicting the degree of independence in walking at discharge and can help to structure therapy according to the predicted degree of independence.

Item distribution of the Berg Balance Scale in older adults with Hip fracture: a Rasch analysis.

INTRODUCTION: Balance impairment occurs after a hip fracture, but the characteristics of the impairment are not clear. OBJECTIVE: To investigate the uni-dimensionality, fit statistics, and item difficulty of the Berg Balance Scale (BBS) in older adults with hip fracture by conducting a Rasch analysis. METHODS: This was an observational cross-sectional study. The 254 participants were all ≥ 65 years old and had been hospitalized for rehabilitation after a unilateral hip fracture incurred during a fall. We collected their BBS scores at the time of hospital discharge and conducted a Rasch analysis to examine the uni-dimensionality, fit statistics, and item difficulty. RESULTS: The principal component analysis (PCA) of the Rasch model demonstrated that the BBS is uni-dimensional. The information-weighted mean square (MnSq) fit statistic was within the range of fit criteria for all items. The underfit item of the outlier-sensitive MnSq fit statistics was "Standing unsupported eyes closed" with the MnSq of 2.06. The difficult items were in order of logits: "Standing on one leg" (logits = 4.01); "Step tool" (logits = 2.74); and "Turn 360°" (logits = 2.61). CONCLUSION: The BBS is uni-dimensional and conforms with the Rasch model. The BBS most difficult items for older adults with a hip fracture required one-legged support and dynamic balance.

Rasch Validation and Comparison of the Mini-BESTest and S-BESTest in Individuals With Stroke.

OBJECTIVE: The purpose of this study was to compare the psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) and S-BESTest and to evaluate which is more suitable for use in clinical settings for individuals with stroke. METHODS: This multicenter retrospective cross-sectional study investigated 115 individuals with stroke (mean age, 70.8 y [SD = 11.2 y]) who were able to stand without physical assistance. All individuals were examined with the BESTest and with the Mini-BESTest and S-BESTest scored based on the BESTest results. The data were analyzed using a Rasch analysis (partial credit model). RESULTS: The Mini-BESTest results revealed a correctly functioning rating scale, good fit of the data to the model (apart from 1 overfit item), good reliability for both persons and items (6 statistically detectable levels of balance ability), local dependence between 1 item pair, and essential unidimensionality. The S-BESTest results demonstrated disordered rating scale thresholds (1 response option required collapsing), good fit of the data to the model (apart from 1 underfit item), good reliability for both persons and items (5 statistically detectable levels of balance ability), local dependence between 2 item pairs, and essential unidimensionality. CONCLUSION: The analyses confirmed that the reliability of the S-BESTest was good and unidimensional and that the test provides several improved points, such as item redundancy and local independence of items. Nevertheless, the Mini-BESTest results supported previous findings as a whole and were better than those from the S-BESTest. IMPACT: Rasch analysis demonstrated that the Mini-BESTest was a better balance assessment scale than the S-BESTest for individuals with stroke based on its psychometric properties. The Mini-BESTest may serve as a useful scale for assessing balance in individuals with stroke, and a keyform plot and strata may help clinical decision-making in terms of interpreting scores and goal setting.

Minimal clinically important difference of the Berg Balance Scale score in older adults with hip fractures.

PURPOSE: The minimal clinically important difference (MCID) is the smallest clinically significant difference in treatment identified as crucial to the patient. There is no known MCID for the Berg Balance Scale (BBS), which measures balance function in patients with hip fractures. We aimed to calculate the MCID of the BBS in older adults with hip fractures. MATERIALS AND METHODS: This is a retrospective multicenter clinical study that included 187 older adults with hip fractures. MCID was calculated using functional ambulation categories (FACs), which were used as anchors for the change in BBS scores between admission and discharge. MCID was calculated as an improvement for more than one point and as a substantial change for improvement for more than two points in the FAC. RESULTS: MCID of the BBS was 11.5 points and that of the substantial change was 18.5 points, with an area under the curve of 0.76 and 0.81, respectively. CONCLUSIONS: MCID for the BBS was 11.5 points in older adults with hip fractures. In addition, an improvement of more than 18.5 points in BBS can be considered a substantial change. These values may be useful in determining meaningful balance function improvement.Implications for rehabilitationHip fractures are a common injury for the older adults, and improvement in gait function has a bearing on prognosis.The effectiveness of meaningful rehabilitation is possible to determine by clarifying the minimal clinically important difference in balance function, which is important for the acquisition of gait.An improvement of 11.5 points or more on the Berg Balance Scale in an older adult with a hip fracture is considered a meaningful effect.

Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

OBJECTIVE: To determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores. DESIGN: A retrospective cross-sectional study. SUBJECTS AND METHODS: The BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated. RESULTS: In the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1-78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.8120-0.834, cut-off scores=75.0-83.4%). CONCLUSION: This study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.

Section of the Balance Evaluation Systems Test (BESTest) Cutoff Values for Walking Speed Level in Older Women With Hip Fracture.

BACKGROUND AND PURPOSE: Hip fracture is a common injury in older adults, with a high proportion of hip fractures affecting women. After a hip fracture, the recovery of the patient's walking speed is very important; one of the key determinants of walking speed is balance. The Balance Evaluation Systems Test (BESTest), a clinical balance measure, categorizes balance into 6 postural control systems. However, the relationship between the walking speed level and the sections of the BESTest has not been explored for older women with hip fracture. Our objective was to establish section scores for the BESTest cutoff values for walking speed in older women with hip fracture. METHODS: This was an observational study involving 46 older women 65 years or older with hip fracture. The BESTest was administered to all participants upon their discharge from the hospital. Participants were divided into groups on the basis of their walking speed levels, and receiver operating characteristic curves were determined for each section of the BESTest. We calculated the cutoff value, area under the curve (AUC), sensitivity, and specificity of each. RESULTS: Section IV-Stability in Gait showed the highest AUC (0.92) compared with the other sections, and the cutoff value determined for the fast and slow walker groups was 64.3% (sensitivity = 0.82, specificity = 0.83). The sections with moderate AUC (0.7-0.9) were I-Biomechanical Constraints (cutoff = 70.0%), III-Anticipatory Postural Adjustments (cutoff = 66.5%), IV-Postural Responses (cutoff = 69.4%), and V-Sensory Orientation (cutoff = 83.4%). The sections with the highest sensitivity (0.82) were I-Biomechanical Constraints and VI-Stability in Gait, and that with the highest specificity (0.88) was II-Stability Limits and Verticality. CONCLUSIONS: Five of the BESTest sections (I-Biomechanical Constraints, III-Anticipatory Postural Adjustments, IV-Postural Responses, V-Sensory Orientation, and IV-Stability in Gait) were able to differentiate between fast and slow walkers among older women with hip fracture. Balance during gait and anticipatory postural adjustments were shown to be important components of balance, and their cutoff values were indicators of the balance required to reach fast walking levels.

Comparing the measurement properties and relationship to gait speed recovery of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale in ambulatory individuals with subacute stroke.

OBJECTIVES: Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed. METHODS: We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital. RESULTS: Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement. CONCLUSIONS: These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.

Comparison of the structural validity of three Balance Evaluation Systems Test in older adults with femoral or vertebral fracture.

OBJECTIVE: To clarify and compare the structural validity of 3 Balance Evaluation Systems Tests (BESTest, Mini-BESTest, and Brief-BESTest) in older adults with femoral or vertebral fractures. DESIGN: Cross-sectional study. SUBJECTS: Ninety-four older adults (age ?65 years) with femoral or vertebral fractures, who could walk without physical assistance. METHODS: Four BESTest models (BESTest, one-factor Mini-BESTest, four-factor Mini-BESTest, and Brief-BESTest) were examined using confirmatory factor analysis, and the models goodness-of-fit was assessed. Unidimensionality of the best-fitting model was confirmed by Rasch principal component analysis on the residuals. RESULTS: Confirmatory factor analysis showed that the four-factor Mini-BESTest model (comparative fit index?=?0.952; Tucker-Lewis index?=?0.937; root-mean square error of approximation?=?0.060; standardized root-mean-square residual?=?0.062) has a better structure than other models. The principal component analysis of standardized residuals showed that the variance attributable to Rasch factor was good, with eigenvalues <2, confirming the factors unidimensionality. CONCLUSION: The four-factor Mini-BESTest model shows good structural validity in older adults with femoral or vertebral fracture. Evaluating dynamic balance by focusing on 4 components (anticipatory postural adjustments, postural responses, sensory orientation, and stability in gait) may help therapists in making clinical decisions.

Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke.

[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment tool, although it is not confined for use in stroke patients. This study aimed to determine the structural validity of the BESTest in self-ambulatory patients with stroke using both factor and Rasch analyses. [Participants and Methods] This retrospective study included 140 self-ambulatory patients with stroke. The structural validity of the BESTest was analyzed according to principal component, exploratory factor, Rasch, confirmatory factor, and correlation analyses. [Results] The analytical results supported a four-factor model comprising 25 items. The four factors included dynamic postural control with gait, static postural control, stepping reaction, and stability limits in sitting. Evidence of high structural validity and reliable internal consistency suggested that the 25-item BESTest is valid and reliable. Each factor was significantly correlated with lower extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest were poorly correlated, and the remaining 25 items were grouped into four factors that demonstrated good structural validity for patients with stroke. Further studies should validate the applicability of the 25-item BESTest four-factor model in a larger sample of patients with stroke in a clinical setting.

Comparative studies of N-glycans and glycosaminoglycans present in SIRC (Statens Seruminstitut rabbit cornea) cells and corneal epithelial cells from rabbit eyes.

PURPOSE: We compared cultured Statens Seruminstitut rabbit cornea (SIRC) cells and corneal epithelial cells from rabbit eyes by analyzing their N-glycans and glycosaminoglycans (GAGs). This work is a fundamental study on the efficacy of using cultured cells instead of animals for drug development. MATERIALS AND METHODS: N-Glycans and GAGs from SIRC cell monolayers and corneal epithelial cells of rabbit eyes were analyzed by capillary electrophoresis (CE) and a combination of high-performance liquid chromatography (HPLC) and mass spectrometry. RESULTS: High mannose-type glycans and a hybrid-type glycan were the common N-glycans in SIRC cells and corneal epithelial cells of rabbit eyes. Mono-fucosylated biantennary glycans with or without one N-acetylneuraminic acid residue were observed only in SIRC cells. Hyaluronic acid was the only measurable GAG in the corneal epithelial cells of rabbit eyes. In contrast, hyaluronic acid and chondroitin sulfates were abundantly present in SIRC cells. CONCLUSIONS: Profiles of both N-glycans and GAGs were conspicuously different between SIRC cells and corneal epithelial cells of rabbit eyes. This report will be useful for the evaluation of pharmaceutical candidates when animals or cultured cells are employed in drug development studies.

Comparative studies of HPLC-fluorometry and LC/MS method for the determination of N-acetylneuraminic acid as a marker of deteriorated ophthalmic solutions.

Methods for determining the deterioration of ophthalmic solutions using both high-performance liquid chromatography (HPLC) with fluorescence detection and liquid chromatography coupled with selected ion monitoring mass spectrometry (LC/MS) are described. The methods are based on the determination of N-acetylneuraminic acid (NeuAc) released by the hydrolysis of foreign bodies that contaminate eye drops during use. The released NeuAc was either labeled with 1,2-diamino-4,5-methylenedioxybenzene (DMB) for fluorometric detection or detected without derivatization by mass spectrometry. The calibration curves for NeuAc showed good linearity between 1.2 ng/mL and 39 ng/mL for fluorometric HPLC and 5.0 ng/mL and 100 ng/mL for LC/MS, respectively. Detection limits for fluorometric HPLC and LC/MS were 0.20 ng/mL and 0.88 ng/mL, respectively. The NeuAc content of some model glycoproteins determined by LC/MS method were 62-78% of those determined by fluorometry. The differences are attributed to matrix effects but the LC/MS method afforded sufficiently high sensitivity that NeuAc in the foreign bodies could be determined in eight of nine test samples.