Background: European data support the use of low high-sensitivity troponin (hs-cTn) measurements or a 0/1-hour (0/1-h) algorithm for myocardial infarction (MI) or to exclude major adverse cardiac events (MACE) among Emergency Department (ED) patients with possible acute coronary syndrome (ACS). However, modest US data exist to validate these strategies. This study evaluated the diagnostic performance of an initial hs-cTnT measure below the limit of quantification (LOQ: 6 ng/L), a 0/1-h algorithm, and their combination with HEART scores for excluding MACE in a multisite US cohort. Methods: A prospective cohort study was conducted at 8 US sites, enrolling adult ED patients with symptoms suggestive of ACS and without ST-elevation on electrocardiogram. Baseline and 1-hour blood samples were collected and hs-cTnT (Roche, Basel Switzerland) measured. Treating providers blinded to hs-cTnT results prospectively calculated HEART scores. MACE (cardiac death, MI, and coronary revascularization) at 30-days was adjudicated. The proportion of patients with initial hs-cTnT measures <LOQ and risk based on a 0/1-h algorithm was determined. The negative predictive value (NPV) was calculated for both strategies when used alone or with a HEART score. Results: Among 1,462 participants with initial hs-cTnT measures, 46.4% (678/1,462) were women and 37.1% (542/1,462) were African American with a mean age of 57.6 (SD±12.9) years. MACE at 30-days occurred in 14.4% (210/1,462). Initial hs-cTnT measures <LOQ occurred in 32.8% (479/1,462), yielding a NPV of 98.3% (95%CI: 96.7-99.3%) for 30-day MACE. A low risk HEART score with an initial hs-cTnT < LOQ occurred in 20.1% (294/1,462) yielding a NPV of 99.0% (95%CI: 97.0-99.8%) for 30-day MACE. A 0/1-h algorithm was complete in 1,430 patients, ruling-out 57.8% (826/1,430) with a NPV of 97.2% (95%CI: 95.9-98.2%) for 30-day MACE. Adding a low HEART score to the 0/1-h algorithm ruled-out 30.8% (441/1430) with a NPV of 98.4% (95%CI: 96.8-99.4%) for 30-day MACE. Conclusions: In a prospective multisite US cohort, an initial hs-cTnT <LOQ combined with a low risk HEART score has 99% NPV for 30-day MACE. The 0/1-h hs-cTnT algorithm did not achieve a NPV > 99% for 30-day MACE when used alone or with a HEART score. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02984436

Introduction This study aimed to compare the efficacy of eccentrically focused resistance exercise (ECC RT) to concentrically focused resistance exercise (CNC RT) on knee osteoarthritis (OA) symptoms and strength. Methods Ninety participants consented. Participants were randomized to CNC RT, ECC RT, or a wait-list, no-exercise control group. Four months of supervised exercise training was completed using traditional weight machines (CNC RT) or modified-matched machines that overloaded the eccentric action (ECC RT). Main outcomes included one-repetition maximal strength (knee extension, leg flexion, and leg press), weekly rate of strength gain, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) total score and subscores. Results Fifty-four participants (60–85 yr, 61% women) completed the study. Both CNC RT and ECC RT groups showed 16%–28% improvement relative to the wait-list, no-exercise control group (P = 0.003–0.005) for all leg strength measures. The rate of weekly strength gain was greater for CNC RT than for ECC RT for leg press and knee flexion (by 2.9%–4.8%; both, P < 0.05) but not knee extension (0.7%; P = 0.38). There were no significant differences in WOMAC total and subscores across groups over time. Leg press strength change was the greatest contributor to change in WOMAC total scores (R 2 = 0.223). The change in knee flexion strength from baseline to month 4 was a significant predictor of the change in WOMAC pain subscore (F ratio = 4.84, df = 45, P = 0.032). Both modes of strength training were well tolerated. Conclusions Both resistance training types effectively increased leg strength. Knee flexion and knee extension muscle strength can modify function and pain symptoms irrespective of muscle contraction type. Which mode to pick could be determined by preference, goals, tolerance to the contraction type, and equipment availability.

Objective This study determined whether kinesiophobia levels were different among older adults with chronic low back pain (LBP) and varying body mass index (BMI) and whether kinesiophobia predicted perceived disability or walking endurance. Design This study was a secondary analysis from a larger interventional study. Obese, older adults with LBP (N=55; 60-85 years) were participants in this study. Data were stratified based on BMI: overweight (25-29.9 kg/m2), obese (30-34.9 kg/m2) and severely obese (35 kg/m2). Participants completed a battery of surveys (modified Tampa Scale of Kinesiophobia [TSK-11], Fear Avoidance Beliefs [FAB], Pain Catastrophizing scale [PCS], and perceived disability measures of the Oswestry Disability Index [ODI], Roland Morris Disability Questionnaire [RMDQ]). Walking endurance time was captured using a symptom limited graded walking treadmill test. Peak LBP ratings were captured during the walk test. Results Walking endurance times did not differ by BMI group, but peak LBP ratings were higher in the moderate and severely obese groups compared to the overweight group (3.0 and 3.1 points vs. 2.1; p<0.05). There were no difference in the kinesiophobia scores (TSK-11, PCS, FAB work and activity subscores) or the perceived disability scores (ODI, RMD). However, adjusted regression analyses revealed that TSK-11 scores contributed 10-21% of the variance of the models pain with walking and perceived disability due to back pain. Kinesiophobia was not a significant contributor to the variance of the regression modeling for walking endurance. Conclusions In the obese older population with LBP, the TSK-11 might be a quick and simple measure to identify patients at risk for poor self-perception of functional ability The TSK and ODI may be quick useful measures to assess initial perceptions before rehabilitation. Kinesiophobia may be a good therapeutic target to address to help affected obese older adults fully engage in therapies for LBP.

Objective:This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) treatment in adults and elderly adults with knee osteoarthritis (OA).Design:This was a prospective, repeated-measures study design in which patients with knee OA were administered 1% sodium hyaluronate. Patients (N=28) were stratified by age (adults, 50-64 years and elderly adults, ≥65 years). Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six.Materials and Methods:Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for pro-inflammatory cytokines (interleukins 1β, 6,8,12, tumor necrosis factor-α, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz.Results:HA improved ambulatory knee pain in adults and elderly groups by month six, but adults reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-α occurred in adults compared to elderly adults (-95.8% ± 7.1% vs 19.2% ± 83.8%, respectively; p=.044). Fluid tended to improve at both shear speeds in adults compared to the elderly adults. The reduction in pain severity correlated with the change in IL-1β levels by month six (r= -.566; p=.044).Conclusion: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.

Objective This study determined whether mobility and functional pain were different among older men and women with chronic low back pain (LBP) and varying body mass index (BMI) levels. Design This was a comparative, descriptive study of obese, older adults with LBP (N=55; 60-85 years). Participants were stratified based on BMI: overweight (25-29.9 kg/m2), obese (30-34.9 kg/m2) and severely obese (35 kg/m2). Participants completed a functional test battery (walking endurance, chair rise, stair climb, 7-day activity monitoring, gait parameters) and pain ratings with activity (‘functional pain’). Results Functional pain scores during walking and stair climb were highest in the severely obese group compared with the overweight group (p<0.05), but functional test scores were not found to be significantly different by BMI. Gait base of support was 36% greater and single/double support times were 3.1-6.1% greater in the severely obese group compared to the overweight group (p<0.05). Women had slower chair rise and stair climb times, and had slower walking velocity than men. Daily step numbers were lowest in the severely obese group compared with the obese and overweight groups (2971 vs 3511 and 4421 steps/day; p<0.05), but were not different by gender. Normalized lumbar extensor, abdominal curl and leg press strength values were lowest in the severely obese group, and women had 18-34% lower strength values than men for all three exercises (p<0.05). Lumbar strength was associated with stair climb, chair rise and walking endurance times. BMI was an independent predictor of walking endurance time, but not steps taken per day. Conclusions In this study, obese persons reported higher functional pain values during walking and stair climb compared to overweight participants, and had lower lumbar strength. Rehabilitation strategies that include lumbar extensor strengthening may help improve functional mobility and walking duration, both of which can help with weight management in the obese, older adult with chronic LBP.

DNA strand breaks and inflammatory biomarkers are a good functional measure of a food's bioavailability.

No abstract

HA is associated with lower functional pain severity, with minimal impact on functional test scores. We interpreted this finding to represent an increase in the quality of the movement and functional activity. The change in functional pain did not correspond to changes in SF-36 quality-of-life scores.