Static Baropodometry for Assessing Short-Term Functional Outcome after Unilateral Total Knee Arthroplasty: Exploring Correlation between Static Plantar Pressure Measurements and Self-Reported Outcomes.

This study aimed to investigate the association between objective baropodometric and radiological measurements and patient self-reported functional outcomes, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, it sought to evaluate the effectiveness of static baropodometry in predicting short-term KOOS results following unilateral total knee arthroplasty (TKA). We conducted a prospective single-center study involving 32 patients who underwent unilateral TKA for knee osteoarthritis (KOA). Patients were evaluated both preoperatively and six months postoperatively, utilizing objective measurements derived from static baropodometric analysis in a normal, relaxed, bipedal standing position using a multi-platform Plantar Pressure Analysis System (PPAS) and radiographic measurements of the femorotibial angle (FTA) and subjective assessments through the national validated version of the KOOS. The study found an insignificant average correction of -0.69° ± 4.12° in the preoperative FTA at the sixth month after TKA. Moreover, there were no significant differences in the KOOS based on different types of knee alignment (KA) both pre- and postoperatively (p > 0.05). No significant correlations were observed between the KOOS, and total average affected and unaffected plantar pressures (TAAPP and TAUPP) pre- and postoperatively, as well as KA pre- and postoperatively. However, significant changes were observed in TAAPP and TAUPP measurements after unilateral TKA. TAAPP demonstrated a significant increase postoperatively (mean change (SD) = 18.60 (47.71); p = 0.035). In conclusion, this study found no significant correlation between KA, static baropodometric measurements, including pre- and postoperative differences, and KOOS outcomes. Therefore, static plantar pressure measurements alone might not serve as a reliable predictor of short-term clinical outcomes after unilateral TKA, as reported by patients.

Association of vitamins B12 and D3 with Balance and Falls in a sample of Greek older people.

OBJECTIVES: Balance disorders and falls are common in the elderly and have a multifactorial etiology. The purpose of the present cross-sectional study is to evaluate a possible association between vitamins D3 and B12 and impaired balance and falls. METHODS: Ninety patients, females and males, were evaluated, from December 2019 to December 2020 during their first ambulatory visit at the Prevention of Falls Clinic of the General University Hospital of Patras. Vitamins B12 and D3 levels were measured. The number of falls during the last 12 months was recorded and patients were assessed using Mini-Balance Evaluation Systems Test (Mini-BESTest), Fried Phenotype, Walking Speed, Hand Grip Strength, Short Physical Performance Battery. RESULTS: A multiple linear regression analysis showed that Mini-BESTest are statistically significantly predicted, F(10,79)=18.734, p<0.001, adj. R2=0.70 from Vit-B12 and FRIED Phenotype (pre-frail vs non-frail). Similarly, in the multiple binary logistic regression analysis, falls were statistically significantly predicted from FRIED Phenotype (pre-frail vs non-frail) χ2(5)=63.918, p<0.001, Nagelkerke R Squared=0.68. CONCLUSIONS: Higher levels of vitamins B12 but not of D3 are associated with better balance but not with less falls in a sample of community-dwelling older people.

Muscle Cross-Sectional Area Segmentation in Transverse Ultrasound Images Using Vision Transformers.

Automatically measuring a muscle's cross-sectional area is an important application in clinical practice that has been studied extensively in recent years for its ability to assess muscle architecture. Additionally, an adequately segmented cross-sectional area can be used to estimate the echogenicity of the muscle, another valuable parameter correlated with muscle quality. This study assesses state-of-the-art convolutional neural networks and vision transformers for automating this task in a new, large, and diverse database. This database consists of 2005 transverse ultrasound images from four informative muscles for neuromuscular disorders, recorded from 210 subjects of different ages, pathological conditions, and sexes. Regarding the reported results, all of the evaluated deep learning models have achieved near-to-human-level performance. In particular, the manual vs. the automatic measurements of the cross-sectional area exhibit an average discrepancy of less than 38.15 mm2, a significant result demonstrating the feasibility of automating this task. Moreover, the difference in muscle echogenicity estimated from these two readings is only 0.88, another indicator of the proposed method's success. Furthermore, Bland−Altman analysis of the measurements exhibits no systematic errors since most differences fall between the 95% limits of agreements and the two readings have a 0.97 Pearson's correlation coefficient (p < 0.001, validation set) with ICC (2, 1) surpassing 0.97, showing the reliability of this approach. Finally, as a supplementary analysis, the texture of the muscle's visible cross-sectional area was examined using deep learning to investigate whether a classification between healthy subjects and patients with pathological conditions solely from the muscle texture is possible. Our preliminary results indicate that such a task is feasible, but further and more extensive studies are required for more conclusive results.

The Omnitrap Platform: A Versatile Segmented Linear Ion Trap for Multidimensional Multiple-Stage Tandem Mass Spectrometry.

Multidimensional multiple-stage tandem processing of ions is demonstrated successfully in a novel segmented linear ion trap. The enhanced performance is enabled by incorporating the entire range of ion activation methods into a single platform in a highly dynamic fashion. The ion activation network comprises external injection of reagent ions, radical neutral species, photons, electrons, and collisions with neutrals. Axial segmentation of the two-dimensional trapping field provides access to a unique functionality landscape through a system of purpose-designed regions for processing ions with maximum flexibility. Design aspects of the segmented linear ion trap, termed the Omnitrap platform, are highlighted, and motion of ions trapped by rectangular waveforms is investigated experimentally by mapping the stability diagram, tracing secular frequencies, and exploring different isolation techniques. All fragmentation methods incorporated in the Omnitrap platform involving radical chemistry are shown to provide complete sequence coverage for partially unfolded ubiquitin. Three-stage (MS3) tandem mass spectrometry experiments combining collision-induced dissociation of radical ions produced by electron meta-ionization and further involving two intermediate steps of ion isolation and accumulation are performed with high efficiency, producing information rich spectra with signal-to-noise levels comparable to those obtained in a two-stage (MS2) experiment. The advanced capabilities of the Omnitrap platform to provide in-depth top-down MSn characterization of proteins are portrayed. Performance is further enhanced by connecting the Omnitrap platform to an Orbitrap mass analyzer, while successful integration with time-of-flight analyzers has already been demonstrated.

Automatic Extraction of Muscle Parameters with Attention UNet in Ultrasonography.

Automatically delineating the deep and superficial aponeurosis of the skeletal muscles from ultrasound images is important in many aspects of the clinical routine. In particular, finding muscle parameters, such as thickness, fascicle length or pennation angle, is a time-consuming clinical task requiring both human labour and specialised knowledge. In this study, a multi-step solution for automating these tasks is presented. A process to effortlessly extract the aponeurosis for automatically measuring the muscle thickness has been introduced as a first step. This process consists mainly of three parts. In the first part, the Attention UNet has been incorporated to automatically delineate the boundaries of the studied muscles. Afterwards, a specialised post-processing algorithm was utilised to improve (and correct) the segmentation results. Lastly, the calculation of the muscle thickness was performed. The proposed method has achieved similar to a human-level performance. In particular, the overall discrepancy between the automatic and the manual muscle thickness measurements was equal to 0.4 mm, a significant result that demonstrates the feasibility of automating this task. In the second step of the proposed methodology, the fascicle's length and pennation angle are extracted through an unsupervised pipeline. Initially, filtering is applied to the ultrasound images to further distinguish the tissues from the other muscle structures. Later, the well-known K-Means algorithm is used to isolate them successfully. As the last step, the dominant angle of the segmented muscle tissues is reported and compared with manual measurements. The proposed pipeline is showing very promising results in the evaluated dataset. Specifically, in the calculation of the pennation angle, the overall discrepancy between the automatic and the manual measurements was less than 2.22° (degrees), once more comparable with the human-level performance. Finally, regarding the fascicle length measurements, the results were divided based on the muscle properties. In the muscles where a large portion (or all) of the fascicles are located between the upper and lower aponeuroses, the proposed pipeline exhibits superb performance; otherwise, overall accuracy deteriorates due to errors caused by the trigonometric approximations needed for the length calculation.

Therapeutic Efficacy and Safety of Osteoinductive Factors and Cellular Therapies for Long Bone Fractures and Non-Unions: A Meta-Analysis and Systematic Review.

BACKGROUND: Long bone fractures display significant non-union rates, but the exact biological mechanisms implicated in this devastating complication remain unclear. The combination of osteogenetic and angiogenetic factors at the fracture site is an essential prerequisite for successful bone regeneration. The aim of this study is to investigate the results of the clinical implantation of growth factors for intraoperative enhancement of osteogenesis for the treatment of long bone fractures and non-unions. METHODS: A systematic literature review search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the PubMed and Web of Science databases from the date of inception of each database through to 10 January 2022. Specific inclusion and exclusion criteria were applied in order to identify relevant studies reporting on the treatment of upper and lower limb long bone non-unions treated with osteoinductive or cellular factors. RESULTS: Overall, 18 studies met the inclusion criteria and examined the effectiveness of the application of Bone Morphogenetic Proteins-2 and -7 (BMPs), platelet rich plasma (PRP) and mesenchymal stem cells (MSCs). Despite the existence of limitations in the studies analysed (containing mixed groups of open and close fractures, different types of fractures, variability of treatment protocols, different selection criteria and follow-up periods amongst others), their overall effectiveness was found significantly increased in patients who received them compared with the controls (I2 = 60%, 95% CI = 1.59 [0.99-2.54], Z =1.93, p = 0.05). CONCLUSION: Administration of BMP-2 and -7, PRP and MSCs were considered effective and safe methods in fracture treatment, increasing bone consolidation, reducing time to repair and being linked to satisfactory postoperative functional scores.

DKK-1 Is Underexpressed in Mesenchymal Stem Cells from Patients with Ankylosing Spondylitis and Further Downregulated by IL-17.

Dickkopf-1 (Dkk-1) is a key regulator of bone remodeling in spondyloarthropathies. Nevertheless, data regarding its expression in cells of pathophysiologic relevance, such as mesenchymal stem cells (MSCs), are lacking. Herein, we aimed to address DKK1 gene expression and Wnt pathway activation in MSCs from patients with ankylosing spondylitis (AS) and explore the effect of IL-17 on MSCs with respect to DKK-1 expression and Wnt pathway activation. Primary MSCs were isolated from the bone marrow of the femoral head of two patients with AS and two healthy controls undergoing orthopedic surgery. MSCs were cultured for 7 days in expansion medium and for 21 days in osteogenic medium in the presence or absence of IL-17A. Gene expression of DKK-1 and osteoblastic markers was determined by RT-PCR. Alkaline phosphatase activity, alizarin red and Van Kossa staining were used to assess osteoblastic function and mineralization capacity. DKK-1 was significantly downregulated in MSCs and osteoblasts from patients with AS compared to controls. Moreover, MSCs and osteoblasts from AS patients displayed increased Wnt pathway activation and enhanced osteoblastic activity, as indicated by increased expression of osteoblast marker genes and alkaline phosphatase activity. IL-17 downregulated DKK-1 expression and increased osteoblastic activity and mineralization capacity. DKK-1 is underexpressed in MSCs from AS patients compared to controls, whereas IL-17 has an inhibitory effect on DKK-1 expression and stimulates osteoblastic function. These data may have pathogenetic and clinical implications in AS.

Electrospun and 3D printed polymeric materials for one-stage critical-size long bone defect regeneration inspired by the Masquelet technique: Recent Advances.

Critical-size long bone defects represent one of the major causes of fracture non-union and remain a significant challenge in orthopaedic surgery. Two-stage procedures such as a Masquelet technique demonstrate high level of success however their main disadvantage is the need for a second surgery, which is required to remove the non-resorbable cement spacer and to place the bone graft into the biological chamber formed by the 'induced membrane'. Recent research efforts have therefore been dedicated towards the design, fabrication and testing of resorbable implants that could mimic the biological functions of the cement spacer and the induced membrane. Amongst the various manufacturing techniques used to fabricate these implants, three-dimensional (3D) printing and electrospinning methods have gained a significant momentum due their high-level controllability, scalable processing and relatively low cost. This review aims to present recent advances in the evaluation of electrospun and 3D printed polymeric materials for critical-size, long bone defect reconstruction, emphasizing both their beneficial properties and current limitations. Furthermore, we present and discuss current state-of-the art techniques required for characterisation of the materials' physical, mechanical and biological characteristics. These represent the essential first steps towards the development of personalised implants for single-surgery, large defect reconstruction in weight-bearing bones.

Comparison of the Weil and Triple Weil Osteotomies: A Clinical Retrospective Study.

INTRODUCTION: The Weil and triple Weil osteotomies are two widely used procedures in the surgical treatment of metatarsalgia. The aim of this comparative retrospective study was to evaluate the functional results and determine the complications of the two types of osteotomies in a series of patients who underwent surgery due to third rocker metatarsalgia. MATERIAL AND METHODS: In this paper, 71 patients were included between September 2015 and October 2020. The average age was 58 years old (age range: 28-72). Of all the patients, 27 suffered from metatarsalgia due to systemic (extra-regional) or regional diseases were excluded. The remaining 44 patients, after six months of unsuccessful conservative treatment, underwent surgery. Based on the preoperative planning to restore the peripheral parabolic curve of the metatarsals, when a shortening of less than or equal to 3 mm was required, a Weil osteotomy was performed. However, when a shortening of more than 3 mm was required, a triple Weil osteotomy was performed. Therefore, two groups of patients were formed, and a total of 90 osteotomies were performed. During the postoperative period, all the patients were clinically and radiographically assessed. The American Orthopedic Foot and Ankle Society (AOFAS) score was used for the assessment of the functional result, while the pain was assessed using the Visual Analogue Scale (VAS). RESULTS:  The mean follow-up was 24 months. The average operative time for the Weil and the triple Weil osteotomies was 22.8 minutes and 31.5 minutes, respectively. In group A, preoperatively, the average AOFAS score was 31/100, and postoperatively, it was 89/100. In group B, the corresponding values were 30/100 and 93/100, respectively. In group A, the preoperative VAS score was 7.8/10, while the postoperative VAS score was 1.3/10. In group B, the corresponding values were 8.2/10 and 1.7/10, respectively. In group A, stiffness had a percentage equal to 60.9%, and a floating toe was noticed in 16 osteotomies. In group B, superficial infection represented the commonest complication, with an incidence of 25.6%. CONCLUSION: Both Weil and triple Weil osteotomies are effective procedures in the surgical treatment of patients who suffer from third-rocker metatarsalgia. In both cases, correct preoperative planning is of paramount importance for the outcome. However, in terms of the appearance of the floating toe, it seems that in cases where a ray's shortening of more than 3 mm is required, the triple osteotomy is superior to the Weil osteotomy.

Biomechanical Analysis of the Change of the Metatarsophalangeal Joint's Center of Rotation After Weil and Triple Weil Osteotomies: A Comparative Cadaveric Study.

Background The aim of the present biomechanical study on cadavers was to determine both the center of rotation of the metatarsophalangeal joints and the position of the tendons of the interosseous muscles after the Weil and triple Weil osteotomies, and to compare these parameters in order to clarify the pathogenesis of dorsal stiffness and floating toe. Materials and methods Seven fresh-frozen cadaveric feet were utilized. After completing the preparation of both the plantar and the dorsal surface, we performed the dissection of the entire second, third and fourth rays, and each ray was fixed to a wooden wall mounted on a movable frame. The biomechanical analysis was based on an equilibrium system made of pulleys, threads, and variable weights. Geometrical analysis of both osteotomies and fluoroscopy was used to determine the initial and final metatarsophalangeal joint's center of rotation, as well as the change of interosseous muscles position. Results On comparing the results of the findings, we noticed that after Weil osteotomy, the metatarsophalangeal joint's center of rotation was proximally and plantarly displaced by 3.5 mm compared to the control group, and by 3.7 mm in comparison to the triple Weil osteotomy group. In the latter, the center of rotation was displaced by 0.817 mm compared to the control group. Furthermore, after the Weil osteotomy, the position of the interossei tendon was above the metatarsal longitudinal axis. Conclusion In cases where a metatarsal shortening of 5 mm or greater is desired, the Weil osteotomy causes a statistically significant plantar displacement of the metatarsophalangeal joint's center of rotation, compared to cases where triple Weil osteotomy is performed.

Use of the Modified Constraint Induced Movement Therapy Protocol to Improve Function of the Predominant Arm on a Patient With Incomplete Spinal Cord Injury.

ABSTRACT: In this case study, an off label modified constraint induced movement therapy protocol was applied in a 28-year male patient with incomplete tetraplegia C5 American Spinal Cord Injury Association D as a facilitator to enhance predominant upper arm function and regain important activities of daily living. The patient was ambulatory for short distances with arm crutches but could not perform important activities of daily living because of the involvement of his right arm, autonomy, and function were impaired. A 10-wk protocol of modified constraint induced movement therapy was performed, with two daily sessions for 30 mins each, a sling was used to constrain the less affected arm, and exercises of the predominant hand were performed. Spasticity was managed with botulinum toxin injections. After 5 wks, the patient was able to use a spoon, perform intermittent catheterization, dress upper body, and use the right arm to feed himself. The protocol was concluded without further amelioration. The modified constraint induced movement therapy is also a valuable facilitator for incomplete tetraplegia.

Insights into the Cellular and Molecular Mechanisms That Govern the Fracture-Healing Process: A Narrative Review.

Fracture-healing is a complex multi-stage process that usually progresses flawlessly, resulting in restoration of bone architecture and function. Regrettably, however, a considerable number of fractures fail to heal, resulting in delayed unions or non-unions. This may significantly impact several aspects of a patient's life. Not surprisingly, in the past few years, a substantial amount of research and number of clinical studies have been designed, aiming at shedding light into the cellular and molecular mechanisms that regulate fracture-healing. Herein, we present the current knowledge on the pathobiology of the fracture-healing process. In addition, the role of skeletal cells and the impact of marrow adipose tissue on bone repair is discussed. Unveiling the pathogenetic mechanisms that govern the fracture-healing process may lead to the development of novel, smarter, and more effective therapeutic strategies for the treatment of fractures, especially of those with large bone defects.

Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques.

OBJECTIVES: To evaluate three different analgesic techniques, continuous epidural analgesia (EA), continuous intra-articular (IA) infusion analgesia and continuous femoral nerve block (FNB) in postoperative pain management, length of hospital stay (LOS), and time of patient mobilization after total knee arthroplasty (TKA). METHODS: Seventy-two patients undergoing TKA were randomly allocated into three groups according to the analgesic technique used for postoperative pain management. Group EA patients received epidural analgesia (control group), group IA received intra-articular infusion and group FNB received femoral nerve block. RESULTS: Upon analyzing the Numerical Rating Scale (NRS) scores at rest, at passive and active movement, up to 3 days postoperatively, we observed no statistically significant differences at any time point among the three groups. Similarly, no association among these analgesic techniques (EA, IA, FNB) was revealed regarding LOS. However, significant differences emerged concerning the time of mobilization. Patients who received IA achieved earlier mobilization compared to FNB and EA. CONCLUSIONS: Both IA and FNB generate similar analgesic effect with EA for postoperative pain management after TKA. However, IA appears to be significantly more effective in early mobilization compared to EA and FNB. Finally, no clinically important differences could be detected regarding LOS among the techniques studied.

Correlation of quality of life with instrumented analysis of a total knee arthroplasty series at the long-term follow-up.

PURPOSE: The relationship between instrumented knee measurements and patient-reported outcome measures is a newer field that continues to evolve. The aim of this study was to evaluate long-term quality of life (QoL) post-total knee arthroplasty (TKA) surgery correlating validated self-reported questionnaires, clinical examination and instrumented analysis, using baropodometry and accelerometry. METHODS: Thirty-six patients who underwent primary unilateral TKA between 1999 and 2006 were evaluated at 11.3 ± 2.3 years following surgery. Clinical examination included range of motion (ROM) and instrumented knee laxity measurements with the Rolimeter device. The visual analogue scale (VAS) for pain was also recorded. The utilised subjective outcome scores were the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the short form of World Health Organisation Quality of Life (WHOQOL-BREF). Instrumented analysis was performed with baropodometry and accelerometry. QoL was assessed correlating clinical, subjective and instrumented results. Univariate analysis included the Spearman's Rho correlation coefficient and Mann-Whitney tests. RESULTS: At the long-term follow-up all patients had relatively high quality of life measurements, as well as functional scores, except for the Sport/Rec dimension of the KOOS score. Only cadence (p = 0.008) and velocity (p = 0.026) affected the WHOQOL psychology domain no matter the age, follow-up and gender of the patients. The domain was unaffected by VAS and Rolimeter measurements. WHOQOL Social domain was unaffected by all instrumentation measurements except for stance phase (p = 0.025), VAS (p = 0.005) and ROM (p = 0.028). KOOS physical domain was not affected by any parameter. KOOS pain was reversely affected by VAS (p = 0.004), KOOS symptom by ROM (p = 0.000 and median maximum pressure (p = 0.033). CONCLUSION: Quality of life for the TKA patient can be correlated and assessed reliably with instrumented analysis using pedobarography and accelerometry, at the long-term follow-up. LEVEL OF EVIDENCE: III.

Reliability and validity of the mCTSIB dynamic platform test to assess balance in a population of older women living in the community.

OBJECTIVES: Test the reliability and validity of the modified Clinical test of Sensory Interaction in Balance (mCTSIB) of the Balance Platform Biodex Balance System (BBS) in a female community dwelling population. METHOD: 100 women over 65 years community dwellers mean age 71.8 (SD±6, ranging from 65 to 91) years, were examined using the posturography modified Clinical test of Sensory Interaction on Balance (mCTSIB) protocol of the Biodex Balance system SD and the Greek Mini-Best Test (miniBESTest-GR) to assess concurrent validity, with 24 undergoing a second measurement after one week to test the reliability of the method. RESULTS: The m-CTSIB-"Composite Score" test was significantly and positively correlated with the mini-BESTest-GR (r= -0.652, p<0.001) indicating good validity properties. The test-retest reliability was measured using the intra-class correlation coefficient (ICC) using a two-way mixed-effects absolute-agreement single-measurement model, among the two measurements of mCTSIB test (test-retest). No statistical difference was found between the two samples (N1=100, N2=24, t= -1.755, df=122, p=0.08). ICC estimates as 0.628 with 95% confident interval=0.31-0.82. CONCLUSION: The mCTSIB test from the BBS has a moderate validity and reliability to evaluate balance in elderly women living in the community and can be used as a screening tool.

Need for comprehensive management of frailty at an individual level: European perspective from the advantage joint action on frailty.

OBJECTIVES: ADVANTAGE Joint Action is a large collaborative project co-founded by the European Commission and its Member States to build a common understanding of frailty for Member States on which to base a common management approach for older people who are frail or at risk of developing frailty. One of the key objectives of the project is presented in this paper; how to manage frailty at the individual level. METHODS: A systematic review of the literature was conducted, including grey literature and good practices when possible. RESULTS: The management of frailty should be directed towards comprehensive and holistic treatment in multiple and related fields. Prevention requires a multifaceted approach addressing factors that have resonance across the individual's life course. Comprehensive geriatric assessment to diagnose the condition and plan a personalized multidomain treatment increases better outcomes. Multicomponent exercise programmes, adequate protein and vitamin D intake, when insufficient, and reduction in polypharmacy and inadequate prescription, are the most effective strategies found in the literature to manage frailty effectively. CONCLUSION: Frailty can be effectively prevented and managed with a multidomain intervention strategy based on comprehensive geriatric assessment.

Do Secondary Progressive Multiple Sclerosis patients benefit from Computer- based cognitive neurorehabilitation? A randomized sham controlled trial.

BACKGROUND: Cognitive impairment is common in multiple sclerosis (MS), but deficits tend to be more pronounced in progressive MS, negatively impacting daily functional capacity. Despite this, most cognitive rehabilitation (CR) interventions to date have focused on relapsing-remitting MS (RRMS). Moreover, information on the efficacy of CR in progressive MS is limited and controversial. The present study investigated the efficacy of a home based, computer assisted cognitive rehabilitation (HBCACR) intervention (RehaComTM software) exclusively in a Secondary Progressive Multiple Sclerosis (SPMS) sample. METHODS: This was a randomized, multi site, sham controlled trial. Thirty six (36) individuals with SPMS, naïve to the RehaCom software, with cognitive deficits were randomized to the treatment (IG; n= 19) or control group condition (CG; n=17). Treatment with the RehaCom modules consisted of 24 domain and task specific, 45 minute session's over an 8-week period, three sessions per week, applied by each patient at home. The CG completed non specific computer based activities at home with the same frequency and duration. Primary cognitive outcome measures included the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, and secondary outcome measures for depression (BDI-FS), fatigue (MFIS), and quality of life (EuroQol EQ-5D) visual analogue scale (VAS). RESULTS: The two groups were well matched on demographic and clinical characteristics, cognitive reserve and severity of cognitive deficits at baseline assessment. At post treatment assessment the IG group showed significant improvements with large effect sizes; in verbal learning [z = -4.759, p <.0005, g = 2.898], visuospatial memory [z = -3.940, p <.0005, g = 1.699] and information processing speed [z= -4.792, p <.0005, g = 2.980], compared with the sham control group. We also found significant between group differences on physical [z=-3.308, p = .001, g= -.604], cognitive [z = -4.011, p <.0005, g = -1.654], psychosocial [z= 3.308, p = .010, g = -.940], and general fatigue impact [z= -2.623, p = .008, g = -.519], depression severity [z = -2.730, p = .006, g = -.519], and quality of life [z= -4.239, p <.0005, g = -1.885] in favor of the treated group. CONCLUSION: These data provide the first evidence supporting the efficacy of computer based restorative cognitive rehabilitation applied at home exclusively in SPMS patients, suggesting that adaptive neuroplasticity may occur after functional cognitive training in progressive MS. Improved cognitive functioning in combination with mood augmentation appear to have ameliorated fatigue, which impacted daily functioning activity and culminated in improved health related quality of life.

Reliability of muscle thickness measurements in ultrasonography.

This study aims to clarify some of the issues associated with the reliable measurement of muscle thickness on ultrasonographic images of the musculoskeletal system, namely the repeatability of measurements in different time frames, the effect of body side selection, and the effect of scan orientation. Ultrasound scans were performed on muscles associated with essential daily activities: geniohyoid, masseter, anterior arm muscles, rectus femoris, vastus intermedius, tibialis anterior, and gastrocnemius. Measurements of the muscle thickness were performed and repeated after 1, 6, and 24 h, on both dominant and nondominant side, using both transverse and longitudinal scans. Thirteen healthy volunteers (eight males and five females, mean age = 24 years, SD = 2.86, range = 19-29) were included. The intraclass correlation coefficient (ICC) was calculated between the baseline and the 1-, 6-, and 24-h interval, using a two-way mixed model of absolute agreement. The ICC ranged from 0.295 for the longitudinal scan of the left masseter muscle in the 6-h interval to 0.991 for the longitudinal scan of the nondominant anterior arm muscles in the 24-h interval. The results indicate that there is variable reliability of the measurements depending on the muscle, time frame, body side, and scan orientation. Consequently, the choice of these parameters can affect the validity of the measurements. Further investigation on a larger scale is required to establish the preferred parameters for each anatomical site.