Baylor Research Institute

Dixon-Ibarra, A., S. Driver, K. Vanderbom and K. Humphries (2016). “Understanding physical activity in the group home setting: a qualitative inquiry.” Disabil Rehabil: Mar 23:1-10. [Epub ahead of print].

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PURPOSE: Persons with intellectual disabilities have low physical activity levels and high rates of chronic disease. One predictor limitedly explored is the home environment, which could influence the type and amount of physical activity in this population. The purpose of this study is to qualitatively explore physical activity in the group home setting and determine what key stakeholders want from a physical activity programme. METHOD: This study adopted a qualitative descriptive design, using semistructured focus groups. Twenty stakeholders (i.e., residents with intellectual disability, support staff and programme coordinators) participated in one of three focus groups, separated by stakeholder status. RESULTS: A number of factors emerged that would assist rehabilitation professionals in understanding physical activity within the group home setting. The following six meta-themes were identified: nature of residents’ physical activity, facilitators to physical activity, barriers to physical activity, personal factors, organizational factors and solutions to increase physical activity. CONCLUSIONS: Findings suggest that residents with intellectual disabilities have low physical activity and opportunities for participation. Key attributes of the group home setting were identified between barriers and facilitators to activity. Consideration for the development of physical activity programmes should focus on the unique needs of the group home setting as expressed by stakeholders. Implications for rehabilitation Physical activity can improve physical fitness, function, and community participation yet physical activity remains low among adults with intellectual disabilities. Understanding physical activity within the group home setting is essential to develop targeted interventions to increase activity within that environment. Key barriers for physical activity within the group home setting include; operational priorities, limited staff, staff turnover, busy schedules, and staff attitudes towards physical activity.

Meng, X. L., T. S. Day, N. McNeill, P. Ashcraft, T. Frischmuth, S. H. Cheng, Z. P. Liu, J. S. Shen and R. Schiffmann (2016). “Molecular basis for globotriaosylceramide regulation and enzyme uptake in immortalized aortic endothelial cells from Fabry mice.” J Inherit Metab Dis. Mar 10. [Epub ahead of print]

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Fabry disease is caused by deficient activity of alpha-galactosidase A and subsequent intracellular accumulation of glycosphingolipids, mainly globotriaosylceramide (Gb3). Vascular endothelial cells may play important roles in disease pathogenesis, and are one of the main target cell types in therapeutic interventions. In this study, we generated immortalized aortic endothelial cell lines from a mouse model of Fabry disease. These cells retained endothelial cell-specific markers and functions. Gb3 expression level in one of these clones (referred to as FMEC2) was highly susceptible to culture media, and appeared to be regulated by glucosylceramide synthase. Results also showed that Gb3 could be upregulated by hydrocortisone. FMEC2 express the mannose 6-phosphate receptor and sortilin but not the mannose receptor. Uptake studies suggested that sortilin plays a role in the binding and internalization of mammalian cell-produced alpha-galactosidase A. Moss-aGal (a plant-made enzyme) was endocytosed by FMEC2 via a receptor other than the aforementioned receptors. In conclusion, this study suggests that glucosylceramide synthase and hydrocortisone may play important roles in modulating Gb3 levels in Fabry mouse aortic endothelial cells, and that endocytosis of recombinant alpha-galactosidase A involves a combination of multiple receptors depending on the properties of the enzyme.

Weir, M. R., T. C. Pearson, A. Patel, V. R. Peddi, R. Kalil, J. Scandling, L. Chan, P. Baliga, L. Melton, S. Mulgaonkar, T. Waid, H. Schaefer, N. Youssef, L. Anandagoda, D. McCollum, S. Lawson and R. Gordon (2016). “Long-term Follow-up of Kidney Transplant Recipients in the Spare-the-Nephron-Trial.” Transplantation. Mar 4. [Epub ahead of print]

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In the Spare-the-Nephron (STN) Study, kidney transplant recipients randomized about 115 days posttransplant to convert from CNI (calcineurin inhibitor)/MMF to sirolimus (SRL)/MMF had a significantly greater improvement in measured GFR (mGFR) at 12 months compared with those kept on CNI/MMF. The difference at 24 months was not statistically significant. From 14 top enrolling centers, 128 of 175 patients identified with a functioning graft at 2 years consented to enroll in an observational, noninterventional extension study to collect retrospectively and prospectively annual follow-up data for the interval since baseline (completion of the parent STN study at 24 months posttransplant). Overall, 11 patients died, including 5 (7.6%) in the SRL/MMF group and 6 (9.7%) in the CNI/MMF group. Twenty-two grafts have been lost including 10 (15.2%) in the SRL/MMF arm and 12 (19.4%) in the CNI/MMF arm. Death and chronic rejection were the most common causes of graft loss in both arms. There were modestly more cardiovascular events in the MMF/SRL group. Estimated creatinine clearance (Cockcroft-Gault) from baseline out to 6 additional years (8 years posttransplant, ITT analysis, SRL/MMF, n = 34; CNI/MMF, n = 26) was 63.2 +/- 28.5 mL/min/1.73 m in the SRL/MMF group and 59.2 +/- 27.2 mL/min/1.73 m in the CNI/MMF group and was not statistically significant, but there is a clinically meaningful trend for improved long-term renal function in the SRL/MMF group compared with the CNI/MMF group. The long-term decision for immunosuppression needs to be carefully individualized.

Barker, S. J., A. Shander and M. A. Ramsay (2016). “Continuous Noninvasive Hemoglobin Monitoring: A Measured Response to a Critical Review.” Anesth Analg 122(2): 565-572.

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SpHb accuracy may eventually improve to the point where it can actually replace invasive blood sampling and lab analysis (lab-Hb). In the meantime, SpHb monitoring can and will supplement lab-Hb continuously between individual lab-Hb measurements. SpHb monitoring is a technological breakthrough because it allows real-time, continuous evaluation of changes (or absence of changes) of Hb levels. There are already thousands of SpHb devices in clinical use around the world. Although the technology and its accuracy are still improving, SpHb has repeatedly demonstrated clinically usable accuracy in head-to-head comparisons with lab-Hb and similar trend accuracy (precision) as invasive methods. Most importantly, because of its continuous, noninvasive trending ability, SpHb monitoring has been shown to help clinicians reduce RBC transfusions and initiate more timely RBC transfusions when they are needed. In occult bleeding patients, SpHb has helped save lives and enhance the quality of care. Clinicians should carefully consider the appropriate role for SpHb monitoring in their practice and thereby establish appropriate criteria for performance. Twenty years from now, we will hopefully look back on the advent of SpHb monitoring and marvel at the impact it has had on patient safety, quality, and cost of care, just like we do today with pulse oximetry. (No abstract; excerpt from text.)

Flanagin, B. A., R. Garofalo, E. Y. Lo, L. Feher, A. Castagna, H. Qin and S. G. Krishnan (2016). “Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair.” Int J Shoulder Surg 10(1): 3-9.

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PURPOSE: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. MATERIALS AND METHODS: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student’s t-test to compare the effect of other clinical characteristics on final outcome. RESULTS: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. CONCLUSIONS: Arthroscopic TO rotator cuff repair technique leads to statistically significant midterm improvement in ROM and satisfactory midterm subjective outcome scores with low complication/failure rates in patients with average medium-sized rotator cuff tears with minimal fatty infiltration. Further work is required to evaluate radiographic healing rates with this technique and to compare outcomes following suture anchor repair. Level of evidence: Level IV.