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Introduction: Our objective was to conduct an individual patient data meta‐analysis (IPDMA) of the two published randomized placebo‐controlled trials of mirabegron in people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or multiple sclerosis (MS). Methods: We identified two randomized, placebo‐controlled trials. We extracted individual patient data from the trials and evaluated two primary outcomes: change in maximum cystometric capacity and change in the patient perception of bladder condition (PPBC). We also evaluated several secondary outcomes related to urodynamic function and quality of life. We conducted three exploratory analyses to test hypotheses based on our clinical experiences with mirabegron in NLUTD. Analysis of covariance with adjustment for baseline values was used for the statistical analysis. Results: Our IPDMA included 98 patients from the two trials. The results showed that mirabegron was associated with a significant improvement in maximum cystometric capacity (+41 mL, p = 0.04) and in the PPBC (−0.8, p < 0.01) compared to placebo. Secondary outcomes including peak neurogenic detrusor overactivity pressure (−20 cm H2O, p < 0.01), incontinence‐QOL score (+12, p < 0.01), and 24 h pad weights (−79 g, p = 0.04) also improved significantly compared to placebo. Exploratory analyses found similar improvements in people with MS and SCI; some outcomes improved to a greater degree among people with incomplete SCI, or SCIs that were below T7. Conclusions: Our IPDMA provides evidence supporting the use of mirabegron in patients with NLUTD due to SCI or MS. Further work evaluating differential responses in people with different SCI lesion characteristics may be warranted. [ABSTRACT FROM AUTHOR]

Currently, there is a lack of effective treatments for spinal cord injury (SCI), a debilitating medical condition associated with enduring paralysis and irreversible neuronal damage. Extradural decompression of osseous as well as soft tissue components has historically been the principal objective of surgical procedures. Nevertheless, this particular surgical procedure fails to tackle the intradural compressive alterations that contribute to secondary SCI. Here, we propose an early intrathecal decompression strategy and evaluate its role on function outcome, tissue sparing, inflammation, and tissue stiffness after SCI. Durotomy surgery significantly promoted recovery of hindlimb locomotor function in an open‐field test. Radiological analysis suggested that lesion size and tissue edema were significantly reduced in animals that received durotomy. Relative to the group with laminectomy alone, the animals treated with a durotomy had decreased cavitation, scar formation, and inflammatory responses at 4 weeks after SCI. An examination of the mechanical properties revealed that durotomy facilitated an expeditious restoration of the injured tissue's elastic rigidity. In general, early decompressive durotomy could serve as a significant strategy to mitigate the impairments caused by secondary injury and establish a more conducive microenvironment for prospective cellular or biomaterial transplantation. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of an injection of botulinum toxin A (BoNT/A) at the epicenter of the spinal cord injury (SCI) site on the recovery of lower urinary tract function in female rats with thoracic SCI. Materials and Methods: Twenty‐four female Wistar rats with Sham (laminectomy at T8/T9 level) or SCI (at T8/T9; 30 g compression for 5 s) were assigned into Sham‐SS (injected with 5 µL of saline solution), Sham‐BoNT/A (injected with 15 pg/rat, equivalent to 7.5 Units/kg of BoNT/A in 5 µL volume), SCI‐SS (injured and injected with saline), SCI‐BoNT/A (injured and injected with BoNT/A), N = 6 per group. Weekly evaluation of stereotyped micturition behavior, hind‐limb nociception, and locomotor activity was performed 1 week before and during 6 weeks after surgery. Subsequently, all groups underwent simultaneous electromyography of the external urethral sphincter (EUS‐EMG) and cystometric (CMG) studies. Results: A compression SCI at the T8/T9 thoracic level significantly impairs sensory and locomotive functions, as well as stereotyped micturition behavior. However, these impairments were improved by BoNT/A injection after SCI. Neither injections of saline solution nor BoNT/A had an appreciable effect on the same parameters evaluated in the Sham groups. The combined EUS‐EMG and CMG evaluations revealed important improvements of lower urinary tract physiology, particularly a reduction in the frequency of non‐voiding contractions and the properties of EUS bursting activity indicated as the amplitude of the EUS‐EMG signal and duration of burst electrical activity during effective voiding. Conclusion: The severe impairments on sensory and locomotive functions as well stereotyped micturition caused by an SCI could be potentially attenuated by an injection of a small amount of BoNT/A directly into the epicenter of the SCI region. A reduction in the release of neurotoxic neurotransmitters requiring the SNARE complex may be the mechanism triggered by BoNT/A to reduce neurotoxicity and hyperexcitability created in the SCI area to improve the survival of spinal cord cells involved in micturition. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of canagliflozin on clinical outcomes and intermediate markers across population‐specific body mass index (BMI) categories in the CANVAS Program and CREDENCE trial. Methods: Individual participant data were pooled and analysed in subgroups according to population‐specific BMI. The main outcomes of interest were: major adverse cardiovascular events (MACE, a composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death); composite renal outcome; and changes in systolic blood pressure (SBP), body weight, albuminuria and estimated glomerular filtration rate (eGFR) slope. Cox proportional hazards models and mixed‐effect models were used. Results: A total of 14 520 participants were included, of whom 9378 (65%) had obesity. Overall, canagliflozin reduced the risk of MACE (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.75 to 0.93) with no heterogeneity of treatment effect across BMI subgroups (Pheterogeneity = 0.76). Similarly, canagliflozin reduced composite renal outcomes (HR 0.75, 95% CI 0.66 to 0.84) with no heterogeneity across subgroups observed (Pheterogeneity = 0.72). The effects of canagliflozin on body weight and SBP differed across BMI subgroups (Pheterogeneity <0.01 and 0.04, respectively) but were consistent for albuminuria (Pheterogeneity = 0.60). Chronic eGFR slope with canagliflozin treatment was consistent across subgroups (Pheterogeneity >0.95). Conclusions: The cardiovascular and renal benefits of canagliflozin and its safety profile were consistent across population‐specific BMI subgroups for adults in the CANVAS Program and CREDENCE trial. [ABSTRACT FROM AUTHOR]

This article discusses the use of robot-assisted gait training (RAGT) in a patient with bilateral transtibial amputation and cerebellar ataxia. The patient initially received conventional gait training with lower-limb prostheses, but after a stroke, his gait function was reduced. After 10 weeks of conventional gait training, the patient received an additional 3 weeks of RAGT using an end-effector-type device. The results showed improvements in walking function, standing balance, and activities of daily living. While this case study suggests the therapeutic effect of RAGT for patients with bilateral transtibial amputations, further research is needed to establish definitive evidence. [Extracted from the article]

Background and Purpose: The purpose of this study was to evaluate advanced MRI findings in the bilateral hippocampus CA1 region of rats with hemorrhagic shock reperfusion (HSR) and their correlation with histopathological results. Additionally, this study aimed to identify effective MRI examination methods and detection indexes for assessing HSR. Methods: Rats were randomized into the HSR and the Sham groups with 24 rats in each group. MRI examination included diffusion kurtosis imaging (DKI) and 3‐dimensional arterial spin labeling (3D‐ASL). Apoptosis and pyroptosis were evaluated directly from tissue. Results: In the HSR group, cerebral blood flow (CBF) was significantly lower than that of the Sham group, while radial kurtosis (Kr), axial kurtosis (Ka), and mean kurtosis (MK) were all higher. In the HSR group, fractional anisotropy (FA) at 12 and 24 hours and radial diffusivity, axial diffusivity (Da), and mean diffusivity (MD) at 3 and 6 hours were lower than in the Sham group. MD and Da at 24 hours in the HSR group were significantly higher. The apoptosis rate and pyroptosis rate were also enhanced in the HSR group. CBF, FA, MK, Ka, and Kr values in the early stage were strongly correlated with apoptosis rate and pyroptosis rate. The metrics were obtained from DKI and 3D‐ASL. Conclusions: Advanced MRI metrics from DKI and 3D‐ASL, including CBF, FA, Ka, Kr, and MK values, are useful to evaluate abnormal blood perfusion and microstructural changes in the hippocampus CA1 area in the setting of incomplete cerebral ischemia‐reperfusion in rats induced by HSR. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to determine whether the testing strategy for clopidogrel and/or aspirin resistance using CYP2C19 genotyping or urinary 11‐dhTxB2 testing has an impact on clinical outcomes. Methods: A multicentre, randomized, controlled trial was conducted at 14 centres in China from 2019 to 2021. For the intervention group, a specific antiplatelet strategy was assigned based on the CYP2C19 genotype and 11‐dhTxB2, a urinary metabolite of aspirin, and the control group received nonguided (ie, standard of care) treatment. 11‐dhTXB2 is a thromboxane A2 metabolite that can help quantify the effects of resistance to aspirin in individuals after ingestion. The primary efficacy outcome was new stroke, the secondary efficacy outcome was a poor functional prognosis (a modified Rankin scale score ≥3), and the primary safety outcome was bleeding, all within the 90‐day follow‐up period. Results: A total of 2815 patients were screened and 2663 patients were enrolled in the trial, with 1344 subjects assigned to the intervention group and 1319 subjects assigned to the control group. A total of 60.1% were carriers of the CYP2C19 loss‐of‐function allele (*2, *3) and 8.71% tested positive for urinary 11‐dhTxB2‐ indicating aspirin resistance in the intervention group. The primary outcome was not different between the intervention and control groups (P =.842). A total of 200 patients (14.88%) in the intervention group and 240 patients (18.20%) in the control group had a poor functional prognosis (hazard ratio 0.77, 95% confidence interval [CI] 0.63 to 0.95, P =.012). Bleeding events occurred in 49 patients (3.65%) in the intervention group and 72 patients (5.46%) in the control group (hazard ratio 0.66, 95% CI 0.45 to 0.95, P =.025). Conclusions: Personalized antiplatelet therapy based on the CYP2C19 genotype and 11‐dhTxB2 levels was associated with favourable neurological function and reduced bleeding risk in acute ischaemic stroke and transient ischaemic attack patients. The results may help support the role of CYP2C19 genotyping and urinary 11‐dhTxB2 testing in the provision of precise clinical treatment. [ABSTRACT FROM AUTHOR]

Gait analysis provides a convenient strategy for the diagnosis and rehabilitation assessment of diseases of skeletal, muscular, and neurological systems. However, challenges remain in current gait recognition methods due to the drawbacks of complex systems, high cost, affecting natural gait, and one‐size‐fits‐all model. Here, a highly integrated gait recognition system composed of a self‐powered multi‐point body motion sensing network (SMN) based on full textile structure is demonstrated. By combining of newly developed energy harvesting technology of triboelectric nanogenerator (TENG) and traditional textile manufacturing process, SMN not only ensures high pressure response sensitivity up to 1.5 V kPa−1, but also is endowed with several good properties, such as full flexibility, excellent breathability (165 mm s−1), and good moisture permeability (318 g m−2 h−1). By using machine learning to analyze periodic signals and dynamic parameters of limbs swing, the gait recognition system exhibits a high accuracy of 96.7% of five pathological gaits. In addition, a customizable auxiliary rehabilitation exercise system that monitors the extent of the patient's rehabilitation exercise is developed to observe the patient's condition and instruct timely recovery training. The machine learning‐assisted SMN can provide a feasible solution for disease diagnosis and personalized rehabilitation of the patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to consolidate the level of evidence for the effects of walking training with poles (pole walking; PW) on walking ability using a systematic review and meta‐analysis. Type: Systematic review and meta‐analysis. Literature Survey: Databases including PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature databases, and Igaku Chuo Zasshi were searched on June 20, 2021. Methodology: Data from randomized controlled trials (RCTs) comparing the effects of PW with walking without poles and/or other exercise interventions in disease‐specific and aging populations were collected. Data on walking speed, functional mobility, and walking endurance were collected for the meta‐analyses. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated from postintervention means and standard deviations. The PEDro scale was used for assessing the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of evidence. Synthesis: This study included 13 RCTs comprising 750 participants; of these, six RCTs were included in the meta‐analysis. The results showed that moderate‐quality evidence supports the positive effects of PW on walking speed in patients with Parkinson disease (walking speed: SMD = 0.42, 95% CI = 0.04–0.80). In contrast, PW did not significantly improve functional mobility in patients with Parkinson disease and walking speed in older adults. Conclusions: There was moderate‐quality evidence that PW improved walking speed in patients with Parkinson disease. [ABSTRACT FROM AUTHOR]

Chronic impairment in the paretic ankle following stroke often requires that individuals use compensatory patterns such as asymmetric propulsion to achieve effective walking speeds needed for community engagement. Ankle exosuit assistance can provide ankle biomechanical benefit in the lab, but such environments inherently limit the amount of practice available. Community walking studies without exosuits can provide massed practice and benefit walking speed but are limited in their ability to assist proper mechanics. In this study, we combined the positive aspects of community training with those of exosuit assistance. We developed and evaluated a community Robotic Exosuit Augmented Locomotion (cREAL) program. Four participants in the chronic stage of stroke independently used our community ankle exosuit for walking in the community 3–5 days/week for 4 weeks. We performed lab evaluations before and after the 4‐week program. Two participants significantly improved their unassisted paretic propulsion by an average of 27% after the program and walked on average 4001 steps/day more in the week following the program. Despite the small number of participants, this study provides preliminary evidence for the potential of exosuits to augment gait training and rehabilitation in the community. [ABSTRACT FROM AUTHOR]

Aims: Little work has considered the effects of salient interpersonal processes on the successful implementation and receipt of community‐based interventions within randomized control trial designs. Method: Using data from the intervention arm (n = 120) of Nuestras Familias: Andando Entre Culturas (Our Families: Walking Between Cultures)—a community‐based parent training intervention among Latino families—we assessed the effects of two common social support processes (group member and group leader support) during intervention delivery on participant satisfaction, use of intervention techniques at program termination, and longer‐term parenting outcomes. Results: Findings indicated that group member and leader social support predicted program satisfaction, and group leader support predicted greater use of intervention techniques at termination. However, social support processes did not predict longer‐term parenting outcomes. Conclusion: Group member and leader support may help to promote higher consumer satisfaction and initial use of intervention techniques in a community intervention for Latinos. [ABSTRACT FROM AUTHOR]

Background: Neurogenic detrusor overactivity incontinence (NDOI) is often inadequately managed with oral therapy. Objective: To assess efficacy and safety of abobotulinumtoxinA (aboBoNT‐A; Dysport®; Ipsen Ltd.) according to etiology of NDOI. Design, Setting, and Participants: Two phase III, randomized, double‐blind studies (CONTENT1 [NCT02660138] conducted in Asia, Europe and North America; CONTENT2 [NCT02660359] conducted in the Americas, Asia, Europe and Oceania) both included patients with spinal cord injury (SCI) or multiple sclerosis (MS), with inadequately managed NDOI, regularly performing clean intermittent catheterization (CIC). Intervention: Patients in CONTENT1 and CONTENT2 received aboBoNT‐A injections 600 U (n = 162)/800 U (n = 161), or placebo (n = 162) into the detrusor muscle. Outcome Measurements and Statistical Analysis: Primary endpoint: mean change from baseline in number of NDOI episodes/week at Week 6. Secondary endpoints: proportion of patients with no NDOI episodes; incontinence‐related quality of life (I‐QoL); urodynamic parameters; and time‐to‐retreatment. Safety was also assessed. Statistical analyses were conducted for pooled populations by etiology (aboBoNT‐A doses vs. placebo). Results and Limitations: Of 485 randomized patients, 341 (70%) and 144 (30%) had SCI and MS etiologies, respectively. A significant reduction was observed in mean NDOI episodes/week at Week 6 with both aboBoNT‐A doses versus placebo in the SCI (all p < 0.001) and MS (all p < 0.01) groups, as well as significant improvements in I‐QoL and urodynamic parameters. Median time‐to‐retreatment was longer in patients with MS (48–62 weeks across doses) than those with SCI (39–44 weeks). Safety data were similar between etiologies. Urinary tract infection was the most frequent adverse event; similar numbers were reported across treatment groups. Conclusions: AboBoNT‐A was well tolerated and significantly improved continence and bladder function, and QoL, in patients with SCI or MS with NDOI performing regular CIC. Patient Summary: AboBoNT‐A injections improved QoL, symptoms, and bladder function in patients with SCI or MS with bladder muscle overactivity that causes incontinence. [ABSTRACT FROM AUTHOR]

Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty‐five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two‐tailed t‐tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase. [ABSTRACT FROM AUTHOR]

The research paper presents the heterogeneous computing model for analysis & restoration of human walking deformity and posture instability. Gait‐related walking activities are very important for the analysis of postural instability, repairment of gait abnormality, diagnosis of cognitive declination, enhance the cognitive ability of human‐centered humanoid robot system, and many clinical diagnoses, for example, Parkinson, pathological gait, freezing of gait, etc. at an early stage. For experiment analysis, 10 different lower limb activities are being considered of healthy and crouch walking subjects. A total of 25 healthy and 10 crouch walk subjects are considered for experiment purposes of different age groups, sex, and mental status. To achieve this objective the pattern of 10 different rehabilitation activities are captured using RGB‐Depth (RGB‐D) camera and classified using heterogeneous deep learning models. Different deep learning models Convolutional Neural Network (CNN) and CNN‐LSTM (CNN‐Long Short Term Memory) are used for the classification of these rehabilitation exercises. The RGB‐D data is obtained using a Microsoft Kinect v2 sensor on a 100 Hz sampling frequency. Experimental results have shown significant activity recognition accuracy with 96% and 98% for CNN and CNN‐LSTM models respectively. [ABSTRACT FROM AUTHOR]

Long noncoding RNAs (lncRNAs) have been demonstrated to play critical regulatory roles in posttranscriptional and transcriptional regulation in eukaryotic cells. However, the characteristics of many lncRNAs, particularly their expression patterns in the lesion epicenter of spinal tissues following subacute spinal cord injury (SCI), remain unclear. In this study, we determined the expression profiles of lncRNAs in the lesion epicenter of spinal tissues after traumatic SCI and predicted latent regulatory networks. Standard Allen's drop surgery was conducted on mice, and hematoxylin and eosin staining was used to observe the damaged area. High‐throughput sequencing was performed to identify the differential expression profiles of lncRNAs. Quantitative real‐time polymerase chain reaction was conducted to evaluate the quality of the sequencing results. Bioinformatics analyses, including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis, coexpression analysis, and protein–protein interaction analysis, were performed. Targeted binding of lncRNA–miRNA–mRNA was predicted by TargetScan and miRanda. A total of 230 differentially expressed lncRNAs were identified and preliminarily verified, and some potential regulatory networks were constructed. These findings improve our understanding of the mechanisms underlying subacute SCI; differentially expressed lncRNAs are closely involved in pathophysiological processes by regulating multiple pathways. Further studies are essential for revealing the exact mechanism underlying competing endogenous RNA pathways in vivo and in vitro. [ABSTRACT FROM AUTHOR]

Introduction: Onabotulinumtoxin A (BTX‐A) is an effective therapy for overactive bladder (OAB), however, adverse events may prevent patients from initiating therapy. The study objective was to report real‐world rates of incomplete emptying and urinary tract infection (UTI) in men and women undergoing BTX‐A for OAB. Methods: Eleven clinical sites performed a retrospective study of adults undergoing first‐time BTX‐A injection (100 units) for idiopathic OAB in 2016. Exclusions included: postvoid residual (PVR) > 150 ml, prior BTX‐A, pelvic radiation, or need for preprocedure catheterization. Primary outcomes at 6 months were incomplete emptying (clean intermittent catheterization [CIC] or PVR ≥ 300 ml without the need for CIC); and UTI (symptoms with either positive culture or urinalysis or empiric treatment). We compared rates of incomplete emptying and UTI within and between sexes, using univariate and multivariable models. Results: 278 patients (48 men and 230 women) met inclusion criteria. Mean age was 65.5 years (range: 24–95). 35% of men and 17% of women had incomplete emptying. Men had 2.4 (95% CI: 1.04–5.49) higher odds of incomplete emptying than women. 17% of men and 23.5% of women had ≥1 UTI, the majority of which occurred within the first month following injection. The strongest predictor of UTI was a history of prior UTI (OR: 4.2 [95% CI: 1.7–10.3]). Conclusions: In this multicenter retrospective study, rates of incomplete emptying and UTI were higher than many previously published studies. Men were at particular risk for incomplete emptying. Prior UTI was the primary risk factor for postprocedure UTI. [ABSTRACT FROM AUTHOR]

Increasing evidence reveals that physical exercise is an efficient therapeutical approach in the treatment of insulin resistance (IR) and related metabolic diseases. However, the potential beneficial effects of exercise on insulin resistance and its underlying mechanisms remain unclear. Recent findings elucidated the negative role of ASK1 in repressing the glucose uptake through JNK1‐IRS1‐Akt signalling in liver. Thus, a detailed investigation of the effect of ASK1‐mediated insulin signalling on exercise‐mediated improvement of insulin sensitivity and its underlying mechanism was implemented in this study. Using a high‐fat diet‐induced IR rat model of chronic or acute swimming exercise training, we here showed that body weight and visceral fat mass were significantly reduced after chronic exercise. Moreover, chronic exercise reduced serum FFAs levels and hepatic triglyceride content. Both chronic and acute exercise promoted glucose tolerance and insulin sensitivity. Meanwhile, both chronic and acute exercise decreased ASK1 phosphorylation and improved JNK1‐IRS1‐Akt signalling. Furthermore, exercise training decreased CFLAR, CREG and TRAF1 protein levels in liver of obese rats, which are positive regulator of ASK1 activity. These results suggested that swimming exercise demonstrated to be an effective ameliorator of IR through the regulation of ASK1‐mediated insulin signalling and therefore, could present a prospective therapeutic mean towards the treatment of IR and several metabolic diseases based on IR, containing NAFLD and type Ⅱ diabetes. [ABSTRACT FROM AUTHOR]

Hemodynamic instability and cardiovascular (CV) dysfunction are hallmarks of patients living with cervical and high thoracic spinal cord injuries (SCI). Individuals experience bouts of autonomic dysreflexia (AD) and persistent hypotension which hamper the activities of daily living. Despite the widespread use of exercise training to improve health and CV function after SCI, little is known about how different training modalities impact hemodynamic stability and severity of AD in a model of incomplete SCI. In this study, we used implantable telemetry devices to assess animals with T2 contusions following 3.5 weeks of exercise training initiated 8 days post‐injury: passive hindlimb cycling (T2‐CYC, n = 5) or active forelimb swimming (T2‐SW, n = 6). Uninjured and non‐exercised SCI control groups were also included (CON, n = 6; T2‐CON, n = 7; T10‐CON, n = 6). Five weeks post‐injury, both T2‐CON and T2‐CYC presented with resting hypotension compared to uninjured CON and T10‐CON groups; no differences were noted in resting blood pressure in T2‐SW versus CON and T10‐CON. Furthermore, pressor responses to colorectal distention (AD) were larger in all T2‐injured groups compared to T10‐CON, and were not attenuated by either form of exercise training. Interestingly, when T2‐injured animals were re‐stratified based on terminal BBB scores (regardless of training group), animals with limited hindlimb recovery (T2‐LOW, n = 7) had more severe AD responses. Our results suggest that the spontaneous recovery of locomotor and autonomic function after severe but incomplete T2 SCI also influences the severity of AD, and that short periods (3.5 weeks) of passive hindlimb cycling or active forelimb swimming are ineffective in this model. [ABSTRACT FROM AUTHOR]

Aim: To systematically review the effects of pharmacological and lifestyle interventions on body weight as a secondary outcome in people with type 1 diabetes. Methods: The Ovid Medline, Embase and Cochrane Library databases were searched for relevant pharmacological (glucagon‐like peptide‐1 [GLP‐1] receptor agonist, sodium‐glucose co‐transporter‐2 [SGLT‐2] inhibitor, dipeptidyl peptidase‐4 [DPP‐4] inhibitor and metformin) and lifestyle intervention studies (diet and exercise) for adults with type 1 diabetes reporting body weight change and HbA1c published from January 2000 to May 2020. Meta‐analyses were performed for 16 randomized controlled trials (RCTs). Results: Thirty‐three RCTs (n = 9344 participants), 26 pharmacological (on average 43.9 years, 83.1 kg, HbA1c 8.1%; 55.8% male) and seven lifestyle‐based interventions (on average 37.0 years, 85.0 kg, HbA1c 8.1%; 84.6% male), were analysed. The GLP‐1 receptor agonist liraglutide 0.6 mg (mean difference [MD]: –2.22 kg [95% CI: –2.55 to –1.90]), 1.2 mg (MD: –3.74 kg [95% CI: –4.16 to –3.33]) and 1.8 mg (MD: –4.85 kg [95% CI: –5.29 to –4.41]), and the SGLT‐2 inhibitors empagliflozin 2.5 mg (MD: –1.47 kg [95% CI: –2.23 to –0.71]), 10 mg (MD: –2.77 kg [95% CI: –3.24 to –2.31]) and 25 mg (MD: –3.06 kg [95% CI: –3.57 to –2.55]) and sotagliflozin 200 mg (MD: –2.40 kg [95% CI: –2.87 to –1.94]) and 400 mg (MD: –3.23 [95% CI: –3.73 to –2.72]) were associated with significant reductions in body weight. No significant effect on body weight was found for DPP‐4 inhibitors, other GLP‐1‐receptor agonists, metformin, or for lifestyle interventions (i.e. exercise and diet). Conclusions: In people with type 1 diabetes, several adjuvant pharmacological interventions showed weight reduction as a secondary outcome. Future studies in overweight people with type 1 diabetes are needed to establish whether the lifestyle and pharmacological interventions reviewed here have potential as components of complex interventions aimed at body weight reduction as a primary outcome. [ABSTRACT FROM AUTHOR]

Aim: The aim was to develop and operationally define 'performance metrics' that characterize a reference approach to robotic‐assisted low anterior resection (RA‐LAR) and to obtain face and content validity through a consensus meeting. Method: Three senior colorectal surgeons with robotic experience and a senior behavioural scientist formed the Metrics Group. We used published guidelines, training materials, manufacturers' instructions and unedited videos of RA‐LAR to deconstruct the operation into defined, measurable components – performance metrics (i.e. procedure phases, steps, errors and critical errors). The performance metrics were then subjected to detailed critique by 18 expert colorectal surgeons in a modified Delphi process. Results: Performance metrics for RA‐LAR had 15 procedure phases, 128 steps, 89 errors and 117 critical errors in women, 88 errors and 118 critical errors in men. After the modified Delphi process the final performance metrics consisted of 14 procedure phases, 129 steps, 88 errors and 115 critical errors in women, 87 errors and 116 critical errors in men. After discussion by the Delphi panel, all procedure phases received unanimous consensus apart from phase I (patient positioning and preparation, 83%) and phase IV (docking, 94%). Conclusion: A robotic rectal operation can be broken down into procedure phases, steps, with errors and critical errors, known as performance metrics. The face and content of these metrics have been validated by a large group of expert robotic colorectal surgeons from Europe. We consider the metrics essential for the development of a structured training curriculum and standardized procedural assessment for RA‐LAR. [ABSTRACT FROM AUTHOR]

Background: Effective and sustainable interventions are needed to counteract the decline in physical function and sarcopenia in the growing aging population. The aim of this study was to determine the 6 and 12 month effectiveness of blended (e‐health + coaching) home‐based exercise and a dietary protein intervention on physical performance in community‐dwelling older adults. Methods: This cluster randomized controlled trial allocated 45 clusters of older adults already engaged in a weekly community‐based exercise programme. The clusters were randomized to three groups with ratio of 16:15:14; (i) no intervention, control (CON); (ii) blended home‐based exercise intervention (HBex); and (iii) HBex with dietary protein counselling (HBex‐Pro). Both interventions used a tablet PC with app and personalized coaching and were targeting on behaviour change. The study comprised coached 6 month interventions with a 6 month follow‐up. The primary outcome physical performance was assessed by modified Physical Performance Test (m‐PPT). Secondary outcomes were gait speed, physical activity level (PAL), handgrip muscle strength, protein intake, skeletal muscle mass, health status, and executive functioning. Linear mixed models of repeated measured were used to assess intervention effects at 6 and 12 months. Results: The population included 245 older adults (mean age 72 ± 6.5 (SD) years), 71% female, and 54% co‐morbidities observed. Dropout of the intervention was 18% at 6 months and 26% at 12 months. Participants were well functioning, based on an m‐PPT score of 33.9 (2.8) out of 36. For the primary outcome m‐PPT, no significant intervention effects (HBex, +0.03, P = 0.933; HBex‐Pro, −0.13, P = 0.730) were found. Gait speed (+0.20 m/s, P = 0.001), PAL (+0.06, P = 0.008), muscle strength (+2.32 kg, P = 0.001), protein intake (+0.32 g/kg/day, P < 0.001), and muscle mass (+0.33 kg, P = 0.017) improved significantly in the HBex‐Pro group compared with control group after 6 month intervention. The protein intake, muscle mass, and strength remained significantly improved after 12 months as compared with those of control. Health change and executive functioning improved significantly in both intervention groups after 6 months. Conclusions: This HBex and dietary protein interventions did not change the physical performance (m‐PPT) in community‐dwelling older adults. Changes were observed in gait speed, PAL, muscle mass, strength, and dietary protein intake, in response to this combined intervention. [ABSTRACT FROM AUTHOR]

Virtual reality (VR)–based interventions are gaining widespread attention for managing neurological disorders such as stroke. A metastatistical consensus regarding the intervention is strongly warranted. In this study, we attempt to address this gap in the literature and provide the current state of evidence for the effects of VR on gait performance. We conducted both between‐ and within‐group meta‐analyses to provide a state of evidence for VR. Moreover, we conducted a search adhering to PRISMA guidelines on nine databases. Out of 1866 records, 32 studies involving a total of 809 individuals were included in this review. Considering all included studies, significant enhancements in gait parameters were observed with VR‐based interventions compared with conventional therapy. A between‐group meta‐analysis reported beneficial significant medium effects of VR training on cadence (Hedge's g = 0.55), stride length ((STrL; Hedge's g = 0.46), and gait speed (Hedge's g = 0.30). Similarly, a within‐group meta‐analysis further revealed positive medium effects of VR on cadence (Hedge's g = 0.76), STrL (Hedge's g = 0.61), and gait speed (Hedge's g = 0.69). Additional subgroup analyses revealed beneficial effects of joint application of VR and robot‐assisted gait training on gait speed (Hedge's g = 0.50). Collectively, findings from this review provide evidence for the effectiveness of VR‐based gait training for stroke survivors. [ABSTRACT FROM AUTHOR]

The intervention was compared to no or sham walking training or the same dose of overground walking training (with or without the help of therapists or walking aids, or both). The aim of this Cochrane Review was to assess the effects of mechanically assisted walking training compared to control for walking, participation, and quality of life (QoL) in children with CP 3 to 18 years of age. What is the effect of mechanically assisted walking training on walking, participation, and quality of life in children with cerebral palsy?. [Extracted from the article]

Aims: Obesity suppresses brain‐derived neurotrophic factor (BDNF) expression and increases the expression of pro‐inflammatory cytokines. Herein, we assessed whether exercise training (ET), melatonin administration (MT), or their combination can affect the expressions of BDNF and cytokines in the cerebellum of high‐fat diet (HFD)‐fed rats. Methods: Wistar rats (4 weeks old) were divided into five groups: normal diet (ND)‐fed control (ND‐SED), HFD‐fed control (HFD‐SED), HFD‐fed ET (HFD‐ET), HFD‐fed MT (HFD‐MT), and HFD‐fed MT plus ET (HFD‐ETMT) group. The rats were fed ND or HFD for 17 weeks. Rats were subjected to ET (running on a treadmill) and/or MT (melatonin 5 mg/kg body weight, i.p.) for 9 weeks, 8 weeks after beginning the diet intervention. Changes in BDNF and cytokine expression levels were determined using immunoblotting and cytokine arrays, respectively, 36 hours following the last bout of ET. Results: Neither HFD‐ET nor HFD‐MT rats exhibited enhanced BDNF expression in the cerebellum, but HFD‐ETMT rats had higher level of BDNF expression compared with the others. The expression of TrkB, a BDNF receptor, was higher in HFD‐ETMT rats than in HFD‐ET and HFD‐MT rats. HFD enhanced the expression of interleukin (IL)‐1, IL‐2, and interferon‐γ but reduced the expression of IL‐4, IL‐6, and IL13. ET and ET plus MT counteracted these HFD‐induced changes in cytokine expressions. Conclusion: Exercise in combination with melatonin confers the potential benefits of increasing BDNF and improving HFD‐induced dysregulations of cytokines in the cerebellum. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the placement and the performance of a new post‐pyloric feeding (PPF) system, and compare it to esophageal (E) feeding in dogs with severe acute kidney injury (AKI). Design: Prospective study. Setting: University teaching hospital. Animals: Twenty client‐owned dogs with severe AKI treated with hemodialysis. Interventions: Dogs were randomly assigned to 2 feeding techniques, PPF or E feeding; for PPF, an 8‐Fr jejunal (J) tube was introduced through a standard 18‐Fr E‐tube and advanced endoscopically through the pylorus. A commercial liquid diet was administered at a continuous rate for at least 5 days. After the removal of the internal J‐tube, feeding was continued through the E‐tube. Control dogs were fed blended food 5 times daily through an E‐tube. Placement technique, nutritional efficiency, and metabolic response to nutritional support were compared between the groups. Measurements and main results: Feeding tubes were placed a medium of 1 day (interquartile range, 0.8 d) after presentation. Median procedure‐time in the group PPF was 26.5 min (11.5 min), including 8.5 min (2.7 min) for the E‐tube and 17.5 min (5.0 min) for the J‐tube. J‐tubes were used for 5 days (1.5 d) with oral displacement observed in 3/10 dogs. The goal to administer 130% resting energy requirement within 3 days was reached in 13/20 dogs (8/10 PPF, 5/10 E). Despite nutritional support, dogs lost 1.2% body weight per day (1.1%), with no difference between the groups. The metabolic improvement was comparable between the groups, despite marked differences in the diet composition. Conclusions: This new feeding technique can be recommended as an efficient method for early nutritional support in dogs with severe AKI. The protein‐energy wasting observed despite active nutritional support suggests, however, the necessity for increased feeding targets or qualitative changes in diet composition for dogs with AKI. [ABSTRACT FROM AUTHOR]

Walking fosters self‐efficacy, empathy, and connection, and large and small democratic actions. Such capacity seems especially the case when walking is attended by certain spatial qualities that engender, for instance, physical accessibility, a capacity to socialise, a sense of safety, or a pleasing aesthetic. Sometimes, adverse spatial alternatives dominate and then – at very least – indifference seems to loom large and spatial injustices prevail. And in the worst conditions, indifference and injustice tip over into fear and danger. This paper's orientation is towards optimism, however. Our conceptual focus is on the relationship of walking to geography and philosophical pragmatism, and on small and effective antidotes to indifference and injustice. Our empirical contributions come from a qualitative research project in Wollongong, Australia, and specifically from conversations with 25 adult residents who shared with us their experiences of regular walks in the city centre. We interpret those experiences in pragmatic terms as transactions – or experiments in what to do and how – in relation to self, others, and environs. We show how participants are affected by walks and the transactional spaces created by them, and consider how they come to care for things that might not directly concern or affect them. In the process, we discern that they experience how their actions shape and can enrich life in the city – findings that have wider salience for those interested in spatial qualities, spatial justice, and democratising impulses. [ABSTRACT FROM AUTHOR]

Due to advances in captive nonhuman primate (NHP) medical care, the number of geriatric chimpanzees (≥35‐years old) is growing. With old age comes a variety of physical conditions, including arthritis, stroke, and mobility impairments. Programs aimed at enhancing the welfare of geriatric chimpanzees are now quite common, but there are few published empirical evaluations of the efficacy of such programs. The current study aimed to create, implement, and evaluate the effects of participation in a physical therapy (PT) program on physical health, mobility, welfare, and behavior. Nine chimpanzees with mobility impairments participated in personalized PT routines (using positive reinforcement training) twice per week for 5 months. Additionally, nine control chimpanzees (non‐mobility‐impaired, matched with PT chimpanzees on age and gender) participated in body exam behavior sessions (also using positive reinforcement training) twice per week. All chimpanzees were rated on 14 health, well‐being, and behavior items, as well as level of mobility throughout the PT program. Chimpanzees that participated in the PT program showed significant increases in ratings of physical health, well‐being, and activity levels across phases of the program. Furthermore, compared to control chimpanzees, PT chimpanzees showed significant increases in ratings of ease of movement. Because raters were not blind to physical therapy treatment, our results represent an initial evaluation of the program that may suggest that participation in the PT program has physical, behavioral, and welfare benefits. Assessments of novel geriatric‐focused care strategies and programs are essential to further enhance the welfare of the captive chimpanzee population, which is currently comprised of many geriatric animals, whose proportion of the captive population will only increase. Research Highlights: Twice per week, nine mobility‐impaired chimpanzees participated in physical therapy sessions, including squats, weight shifts, standing, and stretching exercises, and nine control chimpanzees participated in positive reinforcement training sessions.Among chimpanzees that participated in physical therapy, results showed significant increases in physical health, well‐being, ease of movement, and activity levels across successive phases of the program. [ABSTRACT FROM AUTHOR]

Background and purpose: Muscle‐strengthening, stretching or proprioceptive treatments may slow symptom progression in Charcot—Marie–Tooth (CMT) neuropathy. The aim of the study was to evaluate safety and efficacy of treadmill training in CMT1A. Methods: We planned a multicenter, prospective, randomized, single‐blind, controlled study. We recruited 53 outpatients affected by CMT1A and randomized them into two treatment groups: one underwent stretching and proprioceptive exercise, whereas the other was additionally treated with treadmill training (TreSPE). Primary outcome measures (OMs) were the walking evaluations and secondary OM was the balance assessment. All participants were assessed at baseline and after 3 and 6 months of treatment. Results: Most patients showed an improvement in at least one OM after 3 months [42/47 (89.4%)] and 6 months [38/40 (95%)] of treatment. No adverse events were reported in either group. Conclusions: The most important finding was that both stretching and proprioceptive exercise and treadmill training had an objective benefit on patients affected by CMT disease, without causing overwork weakness. We had a low rate of drop out and did not find deterioration in motor performance. Our results also confirm that applying evidence‐based medicine methods to rehabilitative research is the correct way to test the efficacy of a treatment. [ABSTRACT FROM AUTHOR]

Women after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) are more likely than men to exhibit asymmetric movement patterns, which are associated with post-traumatic osteoarthritis. We developed the ACL specialized postoperative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of strength, agility, plyometric, and secondary prevention (SAPP) training with and without perturbation training (SAPP + PERT) on gait mechanics in women after ACLR. We hypothesized that movement symmetry would improve over time across both groups but more so among the SAPP + PERT group. Thirtynine female athletes 3-9 months after primary ACLR were randomized to SAPP or SAPP + PERT training. Biomechanical testing during overground walking occurred before (Pre-training) and after (Post-training) training and one and 2 years post-operatively. Hip and knee kinematic and kinetic variables were compared using repeated measures analysis of variance with Bonferroni corrections for post hoc comparisons (α = 0.05). There was a time by limb interaction effect (p = 0.028) for peak knee flexion angle (PKFA), the primary outcome which powered the study, characterized by smaller PKFA in the involved compared to uninvolved limbs across treatment groups at Pretraining, Post-training, and 1 year, but not 2 years. Similar findings occurred across sagittal plane knee excursions and kinetics and hip extension excursion at midstance. There were no meaningful interactions involving group. Neither SAPP nor SAPP + PERT training improved walking mechanics, which persisted 1 but not 2 years after ACLR. Statement of clinical significance: Asymmetrical movement patterns persisted long after participants achieved symmetrical strength and functional performance, suggesting more time is needed to recover fully after ACLR. [ABSTRACT FROM AUTHOR]

Key points: The neuromotor system generates flexible motor patterns that can adapt to changes in our bodies or environment and also take advantage of assistance provided by the environment.We ask how energy minimization influences adaptive learning during human locomotion to improve economy when walking on a split‐belt treadmill. We use a model‐based approach to predict how people should adjust their walking pattern to take advantage of the assistance provided by the treadmill, and we validate these predictions empirically.We show that adaptation to a split‐belt treadmill can be explained as a process by which people reduce step length asymmetry to take advantage of the work performed by the treadmill to reduce metabolic cost.Our results also have implications for the evaluation of devices designed to reduce effort during walking, as locomotor adaptation may serve as a model approach to understand how people learn to take advantage of external assistance. In everyday tasks such as walking and running, we often exploit the work performed by external sources to reduce effort. Recent research has focused on designing assistive devices capable of performing mechanical work to reduce the work performed by muscles and improve walking function. The success of these devices relies on the user learning to take advantage of this external assistance. Although adaptation is central to this process, the study of adaptation is often done using approaches that seem to have little in common with the use of external assistance. We show in 16 young, healthy participants that a common approach for studying adaptation, split‐belt treadmill walking, can be understood from a perspective in which people learn to take advantage of mechanical work performed by the treadmill. Initially, during split‐belt walking, people step further forward on the slow belt than the fast belt which we measure as a negative step length asymmetry, but this asymmetry is reduced with practice. We demonstrate that reductions in asymmetry allow people to extract positive work from the treadmill, reduce the positive work performed by the legs, and reduce metabolic cost. We also show that walking with positive step length asymmetries, defined by longer steps on the fast belt, minimizes metabolic cost, and people choose this pattern after guided experience of a wide range of asymmetries. Our results suggest that split‐belt adaptation can be interpreted as a process by which people learn to take advantage of mechanical work performed by an external device to improve economy. Key points: The neuromotor system generates flexible motor patterns that can adapt to changes in our bodies or environment and also take advantage of assistance provided by the environment.We ask how energy minimization influences adaptive learning during human locomotion to improve economy when walking on a split‐belt treadmill. We use a model‐based approach to predict how people should adjust their walking pattern to take advantage of the assistance provided by the treadmill, and we validate these predictions empirically.We show that adaptation to a split‐belt treadmill can be explained as a process by which people reduce step length asymmetry to take advantage of the work performed by the treadmill to reduce metabolic cost.Our results also have implications for the evaluation of devices designed to reduce effort during walking, as locomotor adaptation may serve as a model approach to understand how people learn to take advantage of external assistance. [ABSTRACT FROM AUTHOR]

Background: Gait monitoring is important for rehabilitation but clinic-based measurements provide a brief snapshot of gait patterns. Many consumer-based activity monitors facilitate continuous gait monitoring in daily life but may be subject to measurement errors. This study examines a novel consumer-based activity monitor that is worn on the feet, and therefore not susceptible to inaccurately detecting upper body movements as gait.Objective: To evaluate the clinical validity of Sensoria smart socks, a commercially available wireless gait monitoring technology.Design: A method comparison study between the GAITRite, a criterion standard for clinical gait monitoring, and Sensoria smart socks.Setting: Outpatient rehabilitation clinic.Participants: Thirty individuals capable of supervised ambulation, with or without assistive devices, were recruited through the use of flyers and emails. Data were analyzed for 29 participants. Fifteen participants had no neurologic diagnosis. Fourteen participants had a neurologic diagnosis that could result in gait impairments. Diagnoses included Parkinson disease, stroke, brain injury, developmental delay, and acoustic neuroma.Methods: Participants completed three gait trials with simultaneous measurements by the smart socks and the GAITRite.Main Outcome Measures: Measurements of step count, cadence, and velocity were compared between the two gait monitoring systems.Results: There was no significant difference in step count measurements between the two systems. Although there was a significant difference in cadence measurements for the total sample group, the mean difference fell within the GAITRite Standard Error of Measurement. There was no significant difference in velocity measurements for the total sample group and the mean difference fell within the GAITRite Standard Error of Measurement.Conclusion: These results support the clinical validity of the smart socks for measuring step number and velocity. Further investigation is warranted to determine the efficacy and clinical value of the smart socks system for measuring cadence and for monitoring gait over longer distances outside the clinic.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

RACS do, however, promote JDocs heavily, and the program is freely accessible online, though the more extensive offering of JDocs requires a paid subscription. Prevocational surgical trainees have been described as the ' I lost tribe i ' of surgical training.1 Recently graduated from their medical schools, employed by hospitals for service provision and not yet on college-accredited programs, who is responsible for the education and training of these aspiring surgeons? Enhancing prevocational surgical education and training through trainee-led hospital-supported groups and the RACS JDocs framework. [Extracted from the article]

Poster 486 Body-weight-supported Treadmill Training in Retraining Gait Among Chronic Stroke Survivors: Randomized Controlled Study Objective Chronic stroke survivors trained by body-weight-supported treadmill training would show greater improvement then those trained by conventional physical therapy. Conclusions Treadmill training with or without body-weight support offers subtle additional advantage over conventional physical therapy approaches in improving gait in chronic ambulatory stroke survivors and is worth a trial. [Extracted from the article]