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Background: Postmenopausal women frequently encounter a range of symptoms, including fatigue, diminished physical strength, reduced energy levels, vasomotor symptoms such as hot flushes, and vaginal atrophy, all of which adversely affect their overall quality of life. Engaging in physical activity and structured exercise may effectively alleviate these symptoms and enhance overall well-being. The present study aimed to investigate the relationship between physical activity and quality of life in postmenopausal Greek women., Methods: This cross-sectional clinical study included 219 postmenopausal women. Women with natural menopause for at least 12 consecutive months were enrolled in this descriptive, cross-sectional study. The female participants were asked to fill out the International Physical Activity Questionnaire-short form (IPAQ), the Hospital Anxiety and Depression Scale (HADS), and the EuroQol (EQ-5D-5L) instrument. Anthropometric measurements included weight, height, and waist circumference measurements., Results: A total of 219 postmenopausal women with an age of 61.4 ± 6.1 years and body mass index (BMI) of 25.6 ± 3.7 kg/m 2 were studied. Out of the total postmenopausal women studied, 64.8% were physically active. The mean value of MET-min/week was M = 1383.46 ± 1030.12. Physical activity among postmenopausal Greek women showed a strong correlation of PA with quality of life (r = 0.5; p ≤ 0.001) and age (r = 0.55; p ≤ 0.001) and a medium correlation with the HADS (r = 0.4; p ≤ 0.05)., Conclusions: There was a 64.8% prevalence of physically active postmenopausal Greek women. The findings underscore the significance of fostering physical activity and quality of life among postmenopausal women to formulate efficacious therapeutic interventions. The results demonstrate a correlation between physical activity and the age of female participants, quality of life, and the HADS and can be used to improve postmenopausal women's physical activity levels, which is recommended as a strategy for improving the quality of life in postmenopausal women.

Background Children with cerebral palsy (CP) often experience motor and postural disorders, along with spasticity, muscle weakness, muscle-tendon contractures, and decreased joint range of motion (ROM). Muscle-tendon contractures are typically addressed through orthopaedic surgery to improve joint ROM, which can result in further muscle weakness. This study aimed to investigate the impact of selective percutaneous myofascial lengthening (SPML) combined with functional physiotherapy on joint passive ROM and isometric muscle strength in the lower extremities of children with spastic CP. Methods A single-group pre- and post-test design was utilised in this study. Twenty-six children aged five to seven years with spastic CP and Gross Motor Function Classification System levels II-IV underwent the SPML procedure and received nine months of postoperative functional strength training physiotherapy. Joint passive ROM and isometric muscle strength were measured using a universal goniometer and a digital hand-held dynamometer, respectively. Paired-sample t-tests were conducted to compare baseline and follow-up measurements. Results Significant improvements (p < 0.05) were observed in passive ROM of hip abduction, straight leg raise, popliteal angle, and ankle dorsiflexion, as well as in isometric strength of hip flexors, extensors, abductors and adductors, knee extensors, and ankle dorsiflexors. Conclusions The SPML procedure supported by postoperative functional physiotherapy can effectively address fixed contractures by significantly increasing passive joint ROM and muscle strength. Further research with longer-term follow-up measurements is necessary to confirm and expand upon these findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Scientific and Ethical Council of the ATTIKON University General Hospital issued approval ΕΒΔ 2199/14-03-2017. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Skoutelis et al.)

Background: Walking is the most affected motor function in children with cerebral palsy (CP). Orthopaedic surgery is regularly used to improve ambulation in children with CP. Selective Percutaneous Myofascial Lengthening (SPML) is considered the state-of-the art technique for surgical lengthening of spastic/contracted muscles in CP. The purpose of this study was to investigate the effect of combined SPML surgery and postoperative functional physiotherapy on gait function and characteristics of children with spastic cerebral palsy (CP)., Methods: Twenty-six children with spastic CP, aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II (n = 6), III (n = 12) and IV (n = 8) participated in a quasi-experimental one-group pretest-posttest study with a 9-month follow-up. The Global Motion Graph Deviation Index (MGDI) (including MGDI sub-indices of each joint in each plane of motion) and spatiotemporal parameters of a three-dimensional kinematic gait analysis were used to assess the gait function and characteristics, respectively., Results: Nine months following SPML and functional physiotherapy, statistically significant improvements (p < 0.05) were noted in the Global MGDI, the MGDIs of sagittal plane knee and ankle motion analysis graphs, and the four most common spatiotemporal measures of gait: walking velocity, stride length, step length, and cadence., Conclusion: Children with spastic CP seem to gain better overall gait function following SPML procedure and functional physiotherapy, by achieving higher walking velocity, longer stride length and step length, and faster cadence. Further studies with control group and longer follow-up three-dimensional gait analyses are warranted to validate these positive results., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

The purpose of this study was to investigate psychometric properties of the Greek translation of Pittsburgh Sleep Quality Index (GR-PSQI) in a Greek chronic non-specific low back pain (CNSLBP) sample, thus, providing insight on its clarity and acceptability as a widely used sleep assessment tool in clinical practice. Asymptomatic volunteers (n = 73) and CNSLBP volunteers (n = 47), participated in the study. For the assessment of construct validity, the known-groups method was used. Thus, all the participants (asymptomatic and CNSLBP) completed the GR-PSQI. For the assessment of concurrent validity, the CNSLBP participants additionally completed the following validated questionnaires for depression, insomnia and sleep quality: Beck Depression Inventory Questionnaire (BDI), Insomnia Severity Index (ISI), and Sleep Quality Numeric Rating Scale (SQNRS). For the assessment of test-retest reliability, the CNSLBP participants completed the GR-PSQI a second time, one week after the first time. The results showed excellent test-retest reliability (ICC = 0.969, SEM = 0.90, SDD = 2.49%) and internal consistency (Cronbach α = 0.985), moderate to good concurrent validity (from r = 0.556 to r = 0.860) among PSQI, BDI, SQNRS, and ISI, as well as excellent construct validity ( p = 0.000) between the two groups. The Greek translation of PSQI could be a valuable tool for Greek healthcare professionals in both clinical and research environments.

Purpose: To synthesize the technical factors influencing adherence to nonpharmacological treatment (NPhT) in children with chronic pulmonary diseases (CPDs), using mobile health (mHealth) technology., Methods: Five electronic databases were searched from inception to October 12, 2022, with terms related to pediatrics, CPDs, adherence, NPhT, and mHealth. The methodological quality was assessed using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool checklist., Results: Eleven articles were included. Six major technical themes were supported by the evidence that may influence adherence to NPhT: design and context, technical support/business model, connectivity, free availability, privacy and security, and cultural readiness., Conclusions: The design of mHealth applications (apps) should be done according to the needs of pediatric patients. This may mitigate any barriers and potentially foster adherence to the use of the apps., What This Adds to the Evidence: Six major technical themes may influence adherence to NPhT in children with chronic respiratory diseases.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A487 ., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.)

Objectives: A method of pain assessment is the drawing of pain on a specially designed manikin where the patients color the area representing their pain distribution. In recent years, software applications have been developed for the purpose of digital pain drawing data acquisition and processing. Although such specific software applications have already been released, they have been built with obsolete programming tools. The purpose of the study was to investigate the test - retest reliability of a new pain drawing analysis software, in a sample of patients with shoulder pain., Methods: Data collected from 31 subjects with shoulder pain. Participants were asked twice to color their pain distribution in the painting environment of a tablet software application called 'Pain Distribution.', Results: The reliability of pain extent was found to be good (ICC = 0.80). The Jaccard index for the reliability of pain location was found to be moderate, equal to 42.02 ± 19.13%., Conclusion: The results demonstrated good reliability of pain extent and moderate reliability of pain location using the new pain distribution analysis application 'Pain Distribution.' This pain drawing software application could be a reliable, inexpensive, and clinically usable solution for assessing the distribution of pain in patients with shoulder pain.

Objectives: The right heart is mainly supplied with blood by the right coronary artery (RCA). The impact of RCA chronic total occlusion (CTO) on the function of the right heart [right atrium (RA) and ventricle (RV)] and whether successful recanalization of a RCA CTO improves the function of the right heart is not clearly understood yet. We aimed to evaluate right atrial function after recanalization of the RCA using transthoracic echocardiography with additional strain imaging., Methods and Results: Fifty-five patients undergoing RCA CTO recanalization at the University Medical Center of Mainz were included in the study. Right atrial strain was assessed before and 6 months after successful CTO revascularization. The median age of the total collective was 66 (50-90) years. We did not find difference in our analysis of RA Volume (p 0.086), RA area (p 0.093), RA major dimension (p 0.32) and RA minor dimension (p 0.139) at baseline and follow-up. Mean RA reservoir strain at baseline was 30.9% (21.1-43.0) vs. 33.4% (20.7-47.7) at follow up (p < 0.001). Mean RA conduit strain was - 17.5% (- 10.7-(- 29.7)) at baseline vs. - 18.2% (- 9.6-(- 31.7)) at follow-up (p = 0.346). Mean RA contraction strain was - 12.9% (- 8.0- (- 21.3)) at baseline vs. - 15.5% (- 8.7-(- 26.6)) at follow-up (p < 0.001)., Conclusion: Right atrial function was altered in patients with RCA CTO. Successful revascularisation of an RCA CTO improved RA function assessed by strain imaging at follow-up., (© 2023. The Author(s).)

Background: There is the need for the development of reliable and easy to use in clinical setting gait assessment tools. An open-access video analysis software that administers the calculation of kinematical and spatio-temporal characteristics of human movement is Kinovea® however, its repeatability as a gait analysis tool has not been well addressed. The purpose of the study was to examine the applicability and reliability of an objective, quantitative, low-cost and easy to use in the clinical setting, gait evaluation method, using Kinovea® software., Methods: Data collected from 44 healthy subjects recording gait in sagittal and frontal plane using two smartphones. Time consumption of the procedure was captured. Kinovea® software was used to calculate kinematical and spatial parameters., Results: Intra- and inter-rater reliability of the video processing as well as intra-rater reliability of the measurement procedure represented good to excellent and there were less random measurement errors. There was no measurement error due to random variation for the most of the calculated parameters, except of the pelvis position., Conclusions: The results suggest that excepting low accuracy in calculation of pelvis position, gait evaluation using Kinovea® software is objective, quantitative, low-cost, reliable and easy to use in the clinical setting.

The study was aimed at examining the reliability of the Double Inclinometer (DI) method for the assessment of thoracolumbar Range of Movement (ROM) and Joint Position Sense (JPS) in patients with a recent history of Low Back Pain (LBP). Twenty patients with a history of LBP in the last three months participated. The thoracolumbar ROM and JPS were examined from a standing position by using both the DI and the tape measure method. The DI method was found to have moderate to good intra-rater (ICC = 0.68-0.79, SEM = 2.20-2.77°, SDD = 6.09-7.67°), moderate inter-rater (ICC = 0.59-0.62, SEM = 2.96-3.35°, SDD = 8.19-9.27°) and poor test-retest reliability (ICC = 0.13-0.17, SEM = 3.98-4.32°, SDD = 11.02-11.96°) for the assessment of thoracolumbar JPS. For the assessment of thoracolumbar ROM, the DI method was found to have good to excellent intra-rater (ICC = 0.88-0.94, SEM = 4.25-6.20°, SDD = 11.77-17.17°), excellent inter-rater (ICC = 0.90-0.91, SEM = 7.26-7.74°, SDD = 20.11-21.43°) and excellent test-retest reliability (ICC = 0.91-0.93, SEM = 6.03-6.87°, SDD = 16.70-19.02°). The concurrent validity of the DI method with the tape measure method was found to be very weak for the assessment of thoracolumbar JPS (r = 0.02, p = 0.93) and strong for the assessment of thoracolumbar ROM (r = 0.66, p = 0.001). The DI method seems to be a very reliable method for the assessment of thoracolumbar ROM in individuals with a recent history of LBP.

Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT in consecutive patients referred for elective endovascular treatment due to claudication [Rutherford categories (RC) 2 & 3] between January 2018 and December 2021. Diagnostic work-up by non-invasive imaging and, if required, cardiac catheterization was performed according to clinical data, ECG findings and baseline hsTnT. The occurrence of cardiac death, myocardial infarction or urgent revascularization during follow-up was the primary endpoint. Of 346 patients, 14 (4.0%) exhibited elevated hsTnT ≥ 14 ng/L, including 7 (2.0%) with acute myocardial injury by serial hsTnT sampling. Coronary revascularization by percutaneous coronary intervention was necessary in 6 of 332 (1.5%) patients with normal versus nine of 14 (64.3%) patients with elevated hsTnT (p < 0.001). During 2.4 ± 1.4 years of follow-up, 20 of 286 (7.0%) patients with normal versus four of 13 (30.8%) with elevated hsTnT at baseline reached the composite primary endpoint (p = 0.03 by log-rank test). In conclusion, elevated troponins in cardiac asymptomatic patients with claudication modify subsequent cardiac management and may increase the need for closer surveillance and more aggressive conservative management in polyvascular disease.

Until now, non-specific chronic neck pain has mainly been considered as a musculoskeletal system dysfunction, with associated psychological involvement due to its prolonged or recurrent nature. However, patients with non-specific chronic neck pain frequently additionally exhibit respiratory dysfunction. Emerging evidence suggests that addressing the respiratory dysfunction in these patients will provide additional therapeutic benefits in musculoskeletal and respiratory-related outcomes for several reasons (biomechanical, biochemical, and psychological). Motor control dysfunction of the muscles surrounding the spine (diaphragm included) negatively affects the mechanics and biochemistry of breathing (pH-homeostasis). An impaired and ineffective breathing pattern has been recognized as the primary source of many unexplained symptoms (anxiety, depression, confusion, chest pain, hypocapnia, and breathlessness) in patients with non-specific chronic neck pain. The proposed protocol's purpose is dual: to assess the relative effectiveness of manual therapy in the cervical spine and the diaphragm, in combination with breathing reeducation exercises, along with cervical spine manual therapy or usual physical therapy care on the underlying dysfunctions in patients with non-specific chronic neck pain via a randomized controlled clinical trial, and to validate part of the outcome measures. Several musculoskeletal and respiratory dysfunction outcomes will be employed to delimit the initial extent and level of dysfunction and its resolution with the treatments under study.

Introduction: The Mini-Manual Ability Classification System (Mini-MACS) is an adaptation of the MACS for children with cerebral palsy (CP) aged 1-4 years, which classifies children's performance to handle objects that are relevant to their age and development. The availability of a reliable Mini-MACS in Greek would allow for using it safely and properly in the clinical and research context of Greece. Therefore, the purpose of this study was to translate the original English version into Greek and examine its test-retest and interrater reliability., Material and Methods: The English Mini-MACS was translated into Greek using the "forward-backward" method. Sixty-three children with CP, Gross Motor Function Classification System (GMFCS) levels I-V, aged 12 -50 months were included in the reliability study. Test-retest and interrater reliability were assessed using the interclass correlation coefficient (ICC). The association between Mini-MACS and GMFCS level ratings was also assessed using Spearman's rho correlation coefficient ( ρ )., Results: The translated version was easy to understand and use. The Greek Mini-MACS was found to have excellent test-retest reliability (ICC > 0.96) for both parents and therapists, good interrater reliability (ICC=0.89) between therapists and parents, and moderate-to-strong correlation with the GMFCS ( ρ  = 0.56-0.64, p < 0.0001)., Conclusion: The Greek Mini-MACS constitutes a user-friendly and reliable scale for use in the Greek population., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Skoutelis et al.)

Background: Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months., Methods: Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD., Results: Pressure in the RA increased significantly after removing the introducer sheath ( P = 0.034), whereas no difference was found in oxygen saturation in the RA ( P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath ( P = 0.718). Oxygen saturation in the LA also showed no significant difference ( P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %)., Conclusions: Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months., (© 2022 JGC All rights reserved; www.jgc301.com.)

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.

Aim: The aim of this study is to provide evidence on how use of standardized intravascular ultrasound (IVUS) use impacts stent size choice in the setting of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) compared to visual estimation., Methods and Results: Data of 82 consecutive patients who had successfully undergone IVUS-guided revascularization of CTO at the University Medical Center Mainz were analyzed. Angiography-based stent size prediction for the proximal and distal vessels was compared to the implanted stent diameter after IVUS assessment. Angiography-based stent size prediction for the proximal vessel was 3.09 ± 0.41, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (3.24 ± 0.45, p < 0.001). Proximal vessel stent size prediction was underestimated in the majority of patients by angiographic estimation. Angiography-based stent size prediction for the distal vessel was 2.79 ± 0.38, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (2.92 ± 0.39, p < 0.001)., Conclusion: Pre-stent IVUS assessment in CTO PCI provides important information on vessel morphology and size. Angiography-based stent size prediction for the proximal and distal vessels was frequently underestimated, IVUS use demonstrated larger vessel diameter, resulting in significantly larger implanted stent diameter., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Blessing, Buono, Ahoopai, Geyer, Knorr, Brandt, Steven, Drosos, Muenzel, Wenzel, Gori and Dimitriadis.)

Background: Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI)., Methods: Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study., Results: Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect., Conclusions: Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation., (© 2022. The Author(s).)

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

Feasibility and efficacy of complex percutaneous coronary intervention (PCI) in the elderly, a more frail population due to more comorbidities is incompletely understood. We therefore set out to compare success and complication rate of PCI for chronic total occlusion (CTO) in octogenarians, in comparison to non-octogenarians. Data from 267 patients (58 patients over 80 years of age and 209 under 80 years of age) who had undergone CTO PCI were analyzed. To compare the results we calculated the propensity score and used inverse probability of treatment weighting. We evaluated demographic, clinical, angiographic, and periprocedural information. The median age of the total collective was 68 (31-90) years (octogenarian collective 82 (80-90) years vs non-octogenarians 65 (31-79) years). We observed a high success rate in both collectives (82.8% vs 90.4%, p = 0.10) and no difference in periprocedural complications or complications in the follow-up period. In our collective restenosis rate at follow-up was comparable to the propensity sore weighted population (11.3% vs 16.3%, p = 0.9). Our results show that CTO PCI in older patients is safe and feasible with comparable in-hospital and follow-up complication rates compared to a younger patient population., (© 2022. The Author(s).)

Background: Right ventricular (RV) dysfunction has been linked to worse outcomes in patients undergoing TAVI. Assessment of RV function is challenging due to its complex morphology. RV longitudinal strain (LS) assessed by speckle-tracking echocardiography (STE) is a novel measure that may overcome most of the limitations of conventional echocardiographic parameters of RV function. The aim of current study was to assess the prognostic value of RV LS in patients undergoing TAVI and to assess echocardiographic predictors of long-term mortality., Methods and Results: A retrospective analysis of all consecutive patients who underwent TAVI at our hospital between 1 January 2015 and 1 June 2016. Indication for TAVI was approved by a local heart-team. Echocardiographic data at baseline and after TAVI were re-analyzed and RV LS was measured in all patients with adequate image quality. A total of 229 patients were included in our study (mean age 83.8 ± 5 years, 62% women, mean EuroSCORE II 5.7 ± 5%). All-cause mortality occurred in 17.3% over a mean follow-up of 929 ± 373 days. In multivariate analysis, only baseline average RV free-wall LS (HR 1.05, 95% CI (1.01 to 1.10), p = 0.049) and more than mild tricuspid valve regurgitation (TR) after TAVI (HR 4.39, 95% CI (2.22 to 8.70), p < 0.001) independently increased the risk of all-cause mortality at long- term follow-up (2.5 years), while conventional echocardiographic parameters of RV function did not predict mortality., Conclusion: Pre-procedural RV LS and post-procedural tricuspid regurgitation significantly predicted long-term all-cause mortality in patients undergoing TAVI while conventional echocardiographic parameters of RV function failed in predicting long-term outcome. RV longitudinal strain by STE should be considered in the routine echocardiographic assessments of patients with severe AS.

Introduction Pain drawings (PDs) are an important component of the assessment of a patient with pain. Although analog pain drawings (APDs), such as pen-on-paper drawings, have been extensively used in clinical assessment and clinical research, there is a lack of digital pain drawing (DPD) software that would be able to quantify and analyze the digital pain distribution obtained by the patients. The aim of this work is to describe a method that can quantify the extent and location of pain through novel custom-built software able to analyze data from the digital pain drawings obtained from the patients. Methods The application analysis and software specifications were based on the information gathered from the literature, and the programmers created the custom-built software according to the published needs of the pain scientific community. Results We developed a custom-built software named "Pain Distribution," which, among others, automatically calculates the number of the pixels the patient has chosen and therefore quantifies the pain extent, provides the frequency distribution from a group of images, and has the option to select the threshold over which the patient is considered with central sensitization (CS). Additionally, it delivers results and statistics for both every image and the frequency distribution, providing mean values, standard deviations, and CS indicators, as well as the ability to export them in *.txt file format for further analysis. Conclusion A novel Pain Distribution application was developed, freely available for use in any setting, clinical, research, or academic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Kanellopoulos et al.)

Purpose: This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP)., Methods: Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS., Results: There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group ( p  < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group ( p  < 0.001), but not for the control group ( p  > 0.05)., Conclusion: SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence., Competing Interests: None.The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Patients with chronic back pain as a result of degenerated disc disease, besides pain, also present with impaired gait. The purpose of the article was to evaluate kinetic and kinematic characteristics during gait analysis in patients with chronic low back pain as a result of degenerated disc disease, before and after the application of physiotherapy, including manual therapy techniques. Seventy-five patients suffering from chronic low back pain were randomly divided into 3 groups of 25 each. Each group received five sessions (one per week) of interventions with the first group receiving manual therapy treatment, the second a sham treatment and the third, classic physiotherapy (stretching exercises, TENS and massage). The effectiveness of each treatment was evaluated using an optoelectronic system for recording and analysis of gait (kinetic and kinematic data). Patients overall showed an impaired gait pattern with a difference in kinetic and kinematic data between the left and the right side. Following the application of the above-named interventions, only the group that received manual therapy showed a tendency towards symmetry between the right and left side. In patients suffering from chronic low back pain as a result of degenerated disc disease, the application of five manual therapy sessions seems to produce a tendency towards symmetry in gait.

Background: Sleep disordered breathing (SDB) is a frequent comorbidity in cardiac disease patients. Nevertheless, the prevalence and relationship between SDB and severe primary mitral regurgitation (PMR) has not been well investigated to date., Methods: A cohort of 121 patients with significant PMR undergoing mitral valve surgery were prospectively enrolled and received a cardiorespiratory single night polygraphy screening using ApneaLink before surgery. Eighty-two of them underwent a follow-up examination including a follow-up single-night sleep study 3 months after surgery., Results: The mean age of patients was 65.3 ± 12.0 years. Sixty patients (49.6%) were female. The mean EuroSCORE II was 2.5 ± 2.4%. Initially, 91 (75.2%) patients presented with SDB, among whom 50.4% (46 patients, 38.0% of total cohort) were classified as moderate to severe. These patients tended to require significantly longer postoperative intensive care and mechanical ventilation. Among the 82 patients who completed follow-up exams, mitral valve surgery led to a significant reduction in relevant SDB (20.7%). The apnea-hypopnea index (from 11/h [4;18] to 4/h [3;14] ( p = 0.04)), the oxygenation-desaturation index (from 8/h [3;18] to 5/h [3;12] ( p = 0.008)) as well as the saturation time below 90% (from 32 min [13;86] to 18 min [5;36] ( p = 0.005)), were all shown to be improved significantly., Conclusion: The prevalence of SDB is very high in patients with severe primary mitral regurgitation and may contribute to postoperative complications and prolonged intensive care. A significantly reduced but still high prevalence of SDB was observed 3 months after mitral valve surgery, highlighting the bidirectional relationship between SDB and heart failure.

We sought to determine the effects of the use of a Bioengineered Combo Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent (Combo ® DTS) in patients with chronic total occlusion (CTO) by evaluating clinical outcomes and by performing an optical coherence tomography (OCT) analysis. We retrospectively analyzed data from 39 patients who had successfully undergone OCT-guided revascularization of a CTO being treated with a Combo ® DTS. Clinical assessment, angiography (with quantitative coronary angiography analysis) and OCT examination were performed at baseline and at follow-up. The median follow-up period was 189 days, ranging from 157 to 615 days. At follow-up, revascularization was required due to angiographic restenosis in 40% (14 of 35) of patients. OCT analysis detected neointima proliferation in 23 (76.6%) patients. Neointima formation was often associated with microvessels in 18 patients (60%). Neoatheroslcerosis was observed in 2 (6.6%) patients. Malapposition was found in 4 patients (13.3%), and stent fractures were found in 11 patients (36.6%). Rate of strut coverage was 96.3% at follow-up. In conclusion, the implantation of a Combo ® DTS after successful CTO recanalization was associated with a restenosis rate of 40% despite good stent implantation at baseline, proven by OCT. Neointima formation was found as a main contributor to restenosis. Nevertheless, we observed a low rate of major cardiovascular events in our follow-up.

The most frequently employed versions of the sit-to-stand test (STST) are the 5 times STSΤ and the 30 seconds STST. However, it is not known whether a variation with different number of repetitions or time could be more appropriate for older adults. The objective of this study was to investigate the reliability of STST at different time points and number of repetitions. The test was performed in 33 older adults (73±6.1 years) for 40 seconds. The participants performed the procedure twice with a day interval between the sessions. The test was video-taped and the data were processed by two examiners. The highest test-retest reliability was found for the 4 th (ICC=0.73, SEM=1.48, SDD=1.68), 5 th (ICC=0.76, SEM=1.73, SDD=1.97) and 6 th repetition (ICC=0.78, SEM=1.78, SDD=2.03). The inter-rater reliability was excellent independently of the number of trials (ICC>0.9). The correlation of the time at the 4 th and 6 th repetition with the time at the traditionally selected 5 th repetition was excellent (r>0.9). The termination of the STST at the 4 th repetition seems to provide equally reliable and valid estimations with the termination at the 5 th repetition. Future studies should examine a 4 times STST since the reduction of the number of repetitions may be less tiring and safer for older adults., Competing Interests: The authors have no conflict of interest., (Copyright: © 2020 Hylonome Publications.)

(1) Background: Knowledge about predictors for the long-time patency of recanalized chronic total coronary occlusions (CTOs) is limited. Evidence from invasive follow-up in the absence of acute coronary syndrome (routine surveillance coronary angiography) is scarce. (2) Methods: In a monocentric-retrospective analysis, we obtained baseline as well as periprocedural data of patients undergoing routine invasive follow-up. We defined target vessel failure (TVF) as a combined primary endpoint, consisting of re-occlusion, restenosis, and target vessel revascularization (TVR). (3) Results: We included 93 consecutive patients (15.1% female) from October 2013 to May 2018. After a follow-up period of 206 ± 129 days (median 185 (IQR 127-237)), re-occlusion had occurred in 7.5%, restenosis in 11.8%, and TVR in 5.4%; the cumulative incidence of TVF was 15.1%. Reduced TIMI-flow immediately after recanalization (OR for TVR: 11.0 (95% CI: 2.7-45.5), p = 0.001) as well as female gender (OR for TVR: 11.0 (95% CI: 2.1-58.5), p = 0.005) were found to be predictive for pathological angiographic findings at follow-up. Furthermore, higher blood values of high-sensitive troponin after successful revascularization were associated with all endpoints. Interestingly, neither the J-CTO score nor the presence of symptoms at the follow-up visit could be correlated to adverse angiographic results. (4) Conclusions: In this medium-sized cohort of patients with surveillance coronary angiography, we were able to identify reduced TIMI flow and female gender as the strongest predictors for future TVF.

The technique used at the time of implantation has a central role in determining the risk of thrombosis in bioresorbable vascular scaffolds (BRS). Different definitions of the "optimal" implantation technique exist, however. The impact of individual procedural characteristics on the risk of scaffold thrombosis (ScT) was evaluated in a single-center observational study that enrolled 657 patients (79% males, mean age 63 ± 12 years) with 763 lesions who received a total of 925 BRS for de novo lesions. During a median 1076 (762⁻1206) days' follow-up there were 28 cases of thrombosis. Independent predictors of ScT included the use of predilatation balloons bigger than the nominal BRS diameter (hazard ratio (HR) = 0.4 (0.16⁻0.98), p = 0.04), sizing (implantation in vessels with reference vessel diameter >3.5 mm or <2.5 mm: HR = 5.71 (2.32⁻14.05), p = 0.0002) and the degree of vessel expansion (ratio of minimum lumen to reference vessel diameter, HR: 0.005 (0.0001⁻0.23), p = 0.007). In addition, a mild BRS oversizing (final BRS diameter to vessel diameter 1.14⁻1.28) was associated with a lower thrombosis risk, whereas undersizing and more severe oversizing (final BRS diameter to vessel diameter <1.04 and >1.35, respectively) were associated with an increased risk of ScT (HR = 0.13 (0.02⁻0.59), p = 0.0007). In conclusion, different components of the "optimal" technique have different impacts on the risk of BRS thrombosis. Besides predilatation with a balloon larger than the BRS diameter, correct vessel size selection and a mild to moderate oversizing appear to be protective.

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group ( n = 18), individualized home-based exercise ( n = 18) and control group ( n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol&#95;GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions ( p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements ( p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance.

Objective: Evaluation of the impact of the sheath diameter on vascular complications and mortality in transfemoral aortic valve implantation., Method: Between 2012 and 2014, 183 patients underwent the procedure using a sheath diameter of 18-24 F. This collective was divided into two groups: group 1, with a sheath diameter of 18F (G1, n = 94), consisted of patients with 18F Medtronic Sentrant and 18 F Direct Flow sheaths, and group 2 with a sheath diameter of 19-24 F (G2, n = 89) consisted of patients with Edwards expandable e-sheath and Solopath sheaths. Perclose-Proglide® was used as a closure device in all patients., Results: G1 had significantly more female patients (64.9% vs. 46.1% in G2, p = 0.01) and the average BMI was lower (26 ± 4.5% vs. 27.4 ± 4.7%, p = 0.03). There was no significant difference in the incidence of major and minor vascular complications (G1: 12.8% vs. G2: 12.4%, p = 0.9). 30-day mortality was similar in both groups (G1: 6.4 ± 2.5% [95% CI: 0.88-0.98], G2: 3.7 ± 1.9% [95% CI: 0.92-0.99]. The Kaplan Meier analysis of survival revealed no significant differences either., Conclusion: The difference in sheath diameter had no effect on either incidence or severity of vascular complications. There was no impact on mortality either.

Objectives: The aim of the study was to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration., Methods: Seventy-five subjects suffering from chronic LBP (>3 months) were randomly allocated into 3 groups of 25 subjects each. Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage). Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions., Results: Paired t -tests showed a significant improvement for all outcome measures in the MT and CP group ( p  < 0.05). Analysis of covariance revealed that the MT group had significant improvement in all outcome measures in comparison with the sham and CP group ( p  < 0.05), whereas no significant difference was observed between the sham and CP group ( p  > 0.05)., Discussion: MT is preferable to CP in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration. The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration., Level of Evidence: 1b.

Background: Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities., Methods: Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated., Results: The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function., Conclusions: Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction.

We present an HOCM patient in whom marked regression of left ventricular hypertrophy occurred within two years following outflow desobliteration by percutaneous septal ablation. Maximum wall thickness (initially documented by both echo and MRI) decreased from 34 mm to 22 mm (followup by echo only due to presence of the ICD), crossing the threshold value of 30 mm which was one of the risk markers that had triggered the primary prophylactic ICD implantation in this case prior to septal ablation.

A 63-year-old female with complex congenital heart disease underwent a classical Blalock-Taussig (B-T) shunt operation at the age of 3 years in 1948. The cardiac morphology was not amenable to further definite surgical repair in that period of time. With this palliative operation, the patient survived to the age of 63 years and now presented with exercise intolerance and significant desaturation. Cardiac catheterization with angiography revealed a severe stenosis of the B-T shunt at the pulmonary end. Balloon dilation and stent implantation could be performed successfully. Follow-up after 5 months showed a patent B-T shunt and an increase of oxygen saturation from 65% to 80% and mild improvement of pulmonary blood flow and exercise tolerance., (© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.)