Effects of video game-based therapy in an adolescent with cerebral palsy: A case report

BACKGROUND Herein,we report the case of a 13-year-old boy with spastic quadriplegia cerebral palsy(CP)at Gross Motor Function Classification System(GMFCS)level II,en-gaging in a 6-wk video game-based therapy(VBT)program.This study aimed to offer essential insights regarding VBT’s impact on enhancing the physical function and improving the quality of life(QoL)of adolescents diagnosed with CP.This report provides a distinctive viewpoint that can inform and direct future clinical practices and research endeavors.CASE SUMMARY The boy presented with moderate mobility,balance,and overall well-being.He faced challenges with diminished lower limb strength,which affected his daily living and physical fitness capabilities.Our participant was diagnosed with spas-tic quadriplegic CP at GMFCS level II.He participated in a 6-wk program of VBT using a play station.This innovative approach incorporates warm-up exercises,interactive activities,and cool-down routines,targeting various movements,in-cluding single-leg stance,weight shifting,kicking,jumping,marching,and squatting.After VBT,the strength of the left hip extensor significantly increased from 199.3 N to 541.3 N.Distance covered as part of a 6-min walk test increased by 82 m.His Paediatric QoL Inventory score increased dramatically by 25.9%.CONCLUSION VBT is an innovative,individualized therapy that enhances physical function and QoL in CP,emphasizing its role in ambulatory patients.

Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians

BACKGROUND The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty(TKA)procedure,as well as the associations between the length of waiting time,pain,and physical frailty and function.The study focused on individuals aged 50 years and above,as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation.This study hypothesizes that delayed TKR due to coronavirus disease 2019(COVID-19)will bear negative effect in self-management,pain,and physical frailty and function in older adults.AIM To investigate the effects of COVID-19 pandemic on self-management,pain,and physical function in older adults awaiting TKA in Malaysia.METHODS This cross-sectional study has the data of participants,who matched the criteria and scheduled for TKA for the first time,extracted from the TKA registry in the Department of Orthopaedics and Traumatology,Hospital Canselor Tuanku Mukhriz.Data on pain status,and self-management,physical frailty,and instrumental activities daily living were also collected.Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.RESULTS Out of 180 had deferred TKA,50%of them aged 50 years old and above,80%were women with ethnic distribution Malay(66%),Chinese(22%),Indian(10%),and others(2%)respectively.Ninety-two percent of the participants took medication to manage their pain during the waiting time,while 10%used herbs and traditional supplements,and 68%did exercises as part of their osteoarthritis(OA)self-management.Thirty-six participants were found to have physical frailty(strength,assistance with walking,rising from a chair,climbing stairs,and falls questionnaire score>4)which accounted for 72%.Increased pain was associated with physical frailty with odds ratio,odds ratio(95%confidence interval):1.46(1.04-2.05).This association remained significant even after the adjustment according to age and self-management.CONCLUSION While deferring TKA during a pandemic is unavoidable,patient monitoring for OA treatment during the waiting period is important in reducing physical frailty,ensuring the older patients’independence.

Modeling and simulation of the“IL-36 cytokine”and CAR-T cells interplay in cancer onset

Background:CAR-T cells are chimeric antigen receptor(CAR)-T cells;they are targetspecific engineered cells on tumor cells and produce T cell-mediated antitumor responses.CAR-T cell therapy is the“first-line”therapy in immunotherapy for the treatment of highly clonal neoplasms such as lymphoma and leukemia.This adoptive therapy is currently being studied and tested even in the case of solid tumors such as osteosarcoma since,precisely for this type of tumor,the use of immune checkpoint inhibitors remained disappointing.Although CAR-T is a promising therapeutic technique,there are therapeutic limits linked to the persistence of these cells and to the tumor’s immune escape.CAR-T cell engineering techniques are allowed to express interleukin IL-36,and seem to be much more efficient in antitumoral action.IL-36 is involved in the long-term antitumor action,allowing CAR-T cells to be more efficient in their antitumor action due to a“cross-talk”action between the“IL-36/dendritic cells”axis and the adaptive immunity.Methods:This analysis makes the model useful for evaluating cell dynamics in the case of tumor relapses or specific understanding of the action of CAR-T cells in certain types of tumor.The model proposed here seeks to quantify the action and interaction between the three fundamental elements of this antitumor activity induced by this type of adoptive immunotherapy:IL-36,“armored”CAR-T cells(i.e.,engineered to produce IL-36)and the tumor cell population,focusing exclusively on the action of this interleukin and on the antitumor consequences of the so modified CAR-T cells.Mathematical model was developed and numerical simulations were carried out during this research.The development of the model with stability analysis by conditions of Routh–Hurwitz shows how IL-36 makes CAR-T cells more efficient and persistent over time and more effective in the antitumoral treatment,making therapy more effective against the“solid tumor”.Findings:Primary malignant bone tumors are quite rare(about 3%of all tumors)and the vast majority consist of osteosarcomas and Ewing’s sarcoma and,approximately,the 20%of patients undergo metastasis situations that is the most likely cause of death.Interpretation:In bone tumor like osteosarcoma,there is a variation of the cellular mechanical characteristics that can influence the efficacy of chemotherapy and increase the metastatic capacity;an approach related to adoptive immunotherapy with CAR-T cells may be a possible solution because this type of therapy is not influenced by the biomechanics of cancer cells which show peculiar characteristics.