Benign joint hypermobility syndrome

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Iwona Słowińska

2014-11-01

Full Text Available Benign joint hypermobility syndrome (BJHS, commonly known as loose ligament syndrome, is a non-inflammatory rheumatic condition. It is characterised by a greater than normal range of motion of the joints of the limbs and spine. The prevalence of the syndrome in preschool-age children is estimated to be between 2% and 30%, depending on ethnic background (with higher prevalence in Asian and African populations, occurring most often in families with a history of the condition and more frequently in girls. This paper presents a case report of a 12-year-old girl. A broad differential diagnostic approach to recurrent joint inflammation with joint effusion and pain made it possible to establish a diagnosis of benign joint hypermobility syndrome. The child met the Brighton criteria; her Beighton score was 7 out of 9. Patient education aimed at eliminating abnormal joint movement and an appropriate rehabilitation programme play key roles in the treatment of BJHS.

Generalised joint hypermobility and shoulder joint hypermobility, - risk of upper body musculoskeletal symptoms and reduced quality of life in the general population

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Juul-Kristensen, Birgit; Østengaard, Lasse; Hansen, Sebrina

2017-01-01

BACKGROUND: Generalised Joint Hypermobility (GJH) is a hereditary condition with an ability to exceed the joints beyond the normal range. The prevalence of GJH in the adult population and its impact on upper body musculoskeletal health and quality of life has mostly been studied in selected popul...

Joint hypermobility: incidence and some clinical symptoms

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M P Isaev

2003-01-01

Full Text Available Objective. To study joint mobility range among urban population aged 18 to 30 years and to assess association of joint and other connective tissue structures disorders clinical signs with hypermobility. Material and methods. 769 randomly selected individuals aged 18 to 30 (mean - 25,56 years (419 female and 350 male were examined. Hypermobility was assessed with 9-point Beighton scale. Examination included skin stretchability evaluation at elbow back surface, determination of flat feet, high palate, joint pain and deformities of knee joints, joint luxation and subluxation, hand and feet vasospastic disturbances, cardiac pain, oculist examination. Methods of variational statistics were used (x2, Student's test, Spirmen's correlation. Results. Hypermobility incidence and joint mobility in population aged 18 to 30 years in Orenburg largely comply with data received in Moscow. Joint mobility up to 5 points in women and up to 4 points in men is usual for persons of this age and in absence of additional clinical symptoms cannot be considered as pathological. Knee joint deformities, presence of high palate, cardiac pain accompanied by signs of vegetative dysfunction, hand and feet vasospastic disturbances are significantly connected with degree of joint mobility and in some cases can help in hypermobility syndrome diagnosis.

Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type

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Johannessen, Elise Christine; Reiten, Helle Sundnes; Løvaas, Helene

2016-01-01

Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey...

Features that exacerbate fatigue severity in joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

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Krahe, Anne Maree; Adams, Roger David; Nicholson, Leslie Lorenda

2018-08-01

To assess the prevalence, severity and impact of fatigue on individuals with joint hypermobility syndrome (JHS)/Ehlers-Danlos syndrome - hypermobility type (EDS-HT) and establish potential determinants of fatigue severity in this population. Questionnaires on symptoms and signs related to fatigue, quality of life, mental health, physical activity participation and sleep quality were completed by people with JHS/EDS-HT recruited through two social media sites. Multiple regression analysis was performed to identify predictors of fatigue in this population. Significant fatigue was reported by 79.5% of the 117 participants. Multiple regression analysis identified five predictors of fatigue severity, four being potentially modifiable, accounting for 52.3% of the variance in reported fatigue scores. Predictors of fatigue severity were: the self-perceived extent of joint hypermobility, orthostatic dizziness related to heat and exercise, levels of participation in personal relationships and community, current levels of physical activity and dissatisfaction with the diagnostic process and management options provided for their condition. Fatigue is a significant symptom associated with JHS/EDS-HT. Assessment of individuals with this condition should include measures of fatigue severity to enable targeted management of potentially modifiable factors associated with fatigue severity. Implications for rehabilitation Fatigue is a significant symptom reported by individuals affected by joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type. Potentially modifiable features that contribute to fatigue severity in this population have been identified. Targeted management of these features may decrease the severity and impact of fatigue in joint hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

The neuromuscular differential diagnosis of joint hypermobility

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Donkervoort, S.; Bonnemann, C.G.; Loeys, B.L.; Jungbluth, H.; Voermans, N.C.

2015-01-01

Joint hypermobility is the defining feature of various inherited connective tissue disorders such as Marfan syndrome and various types of Ehlers-Danlos syndrome and these will generally be the first conditions to be considered by geneticists and pediatricians in the differential diagnosis of a

The differential diagnosis of children with joint hypermobility: a review of the literature

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Elliott Elizabeth J

2009-01-01

Full Text Available Abstract Background In this study we aimed to identify and review publications relating to the diagnosis of joint hypermobility and instability and develop an evidence based approach to the diagnosis of children presenting with joint hypermobility and related symptoms. Methods We searched Medline for papers with an emphasis on the diagnosis of joint hypermobility, including Heritable Disorders of Connective Tissue (HDCT. Results 3330 papers were identified: 1534 pertained to instability of a particular joint; 1666 related to the diagnosis of Ehlers Danlos syndromes and 330 related to joint hypermobility. There are inconsistencies in the literature on joint hypermobility and how it relates to and overlaps with milder forms of HDCT. There is no reliable method of differentiating between Joint Hypermobility Syndrome, familial articular hypermobility and Ehlers-Danlos syndrome (hypermobile type, suggesting these three disorders may be different manifestations of the same spectrum of disorders. We describe our approach to children presenting with joint hypermobility and the published evidence and expert opinion on which this is based. Conclusion There is value in identifying both the underlying genetic cause of joint hypermobility in an individual child and those hypermobile children who have symptoms such as pain and fatigue and might benefit from multidisciplinary rehabilitation management. Every effort should be made to diagnose the underlying disorder responsible for joint hypermobility which may only become apparent over time. We recommend that the term "Joint Hypermobility Syndrome" is used for children with symptomatic joint hypermobility resulting from any underlying HDCT and that these children are best described using both the term Joint Hypermobility Syndrome and their HDCT diagnosis.

Subjective health complaints and illness perception amongst adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-HypermobilityType - a cross-sectional study.

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Hope, Lena; Juul-Kristensen, Birgit; Løvaas, Helene; Løvvik, Camilla; Maeland, Silje

2017-10-17

To investigate the prevalence and severity of subjective health complaints and describe illness perception in a population of Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type. This study was a postal survey with a questionnaire battery on demographic data, subjective health complaints inventory, and illness perception. A total of 110 individuals diagnosed with Joint Hypermobility Syndrome or Ehlers-Danlos Syndrome-Hypermobile Type from two specialized hospitals in Norway were offered participation. Further, 140 gender- and age-matched healthy controls from statistics Norway representing the general population were sent the questionnaire for reference. Overall response rate was 30.4% (n = 76), with 44.5% (n = 49) in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type and 19.3% (n = 27) in controls. Subjective health complaints were significantly higher in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type - than in the controls (32.06 vs. 11.08; p Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type had low understanding of their illness and symptoms (understanding, mean: 3.93, SD 2.88), and reported to have moderate personal and treatment control over their illness. Adults with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported higher frequency and severity of subjective health complaints than the matched controls from the general adult population in Norway. Furthermore, Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome-Hypermobile Type reported low understanding of their illness and associated symptoms, and moderate belief that their illness can be kept under control through self-management or treatment. This may indicate one of the reasons why prognosis for these patients is poor. Implications for rehabilitation Awareness of the complexity of the subjective health complaints and inquiry into illness perception could contribute with valuable information about these

Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population.

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Junge, Tina; Henriksen, Peter; Hansen, Sebrina; Østengaard, Lasse; Golightly, Yvonne M; Juul-Kristensen, Birgit

2017-10-27

Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult population. This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. Total response rate was 49% (n = 1006). The prevalence of self-reported GJHk and KJH was 13% and 23%, mostly representing women. More than half of the respondents with GJHk and KJH had knee joint symptoms. The odds for reporting knee joint symptoms, severity of knee joint symptoms and duration of knee joint symptoms were twice as high for respondents with GJHk and KJH. Respondents with GJHk and KJH reported lower HRQoL. GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower HRQoL. The impact of these conditions on HRQoL is comparable with knee osteoarthritis. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

Knowledge, assessment, and management of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type among Flemish physiotherapists.

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Rombaut, Lies; Deane, Janet; Simmonds, Jane; De Wandele, Inge; De Paepe, Anne; Malfait, Fransiska; Calders, Patrick

2015-03-01

Physiotherapy plays a fundamental role in managing adults with the joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). However, it is a challenge for both the patient and the physiotherapist as the condition is poorly understood and treatment for JHS/EDS-HT is currently undefined. Insight into current practice is, therefore, necessary in order to establish baseline knowledge in this area and in the long term to improve the standard of patient care. Therefore, the purpose of this study was to evaluate current physiotherapists' knowledge of JHS/EDS-HT and to gain insight into current physiotherapy practice with emphasis on assessment, management, and treatment efficacy. Three hundred twenty-five Flemish physiotherapists participated in the study by filling out electronically a modified version of the "Hypermobility and Hypermobility Syndrome Questionnaire" (HHQ), which covered theoretical constructs such as general knowledge, assessment, management, and learning in relation to generalized joint hypermobility and JHS/EDS-HT. The results show that physiotherapists report a low level of confidence with regard to assessment and management of JHS/EDS-HT. Knowledge of hypermobility and JHS/EDS-HT is weak, especially regarding the features associated with JHS/EDS-HT. Many treatment approaches are used by physiotherapists with the majority showing preference for education, reassurance, muscle strengthening, proprioceptive and core stability training. Almost all approaches were perceived as being clinically effective by the physiotherapists, highlighting a lack of consensus. In conclusion, this study in Flemish physiotherapists confirms that JHS/EDS-HT is under-recognized, not well known and deemed difficult to treat. Further education is required and sought by the physiotherapists surveyed, and future research is needed. © 2015 Wiley Periodicals, Inc.

Psychopathological manifestations of joint hypermobility and joint hypermobility syndrome/ Ehlers-Danlos syndrome, hypermobility type: The link between connective tissue and psychological distress revised.

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Sinibaldi, Lorenzo; Ursini, Gianluca; Castori, Marco

2015-03-01

Psychological distress is a known feature of generalized joint hypermobility (gJHM), as well as of its most common syndromic presentation, namely Ehlers-Danlos syndrome, hypermobility type (a.k.a. joint hypermobility syndrome - JHS/EDS-HT), and significantly contributes to the quality of life of affected individuals. Most published articles dealt with the link between gJHM (or JHS/EDS-HT) and anxiety-related conditions, and a novel generation of studies is emerging aimed at investigating the psychopathologic background of such an association. In this paper, literature review was carried out with a semi-systematic approach spanning the entire spectrum of psychopathological findings in gJHM and JHS/EDS-HT. Interestingly, in addition to the confirmation of a tight link between anxiety and gJHM, preliminary connections with depression, attention deficit (and hyperactivity) disorder, autism spectrum disorders, and obsessive-compulsive personality disorder were also found. Few papers investigated the relationship with schizophrenia with contrasting results. The mind-body connections hypothesized on the basis of available data were discussed with focus on somatotype, presumed psychopathology, and involvement of the extracellular matrix in the central nervous system. The hypothesis of positive Beighton score and alteration of interoceptive/proprioceptive/body awareness as possible endophenotypes in families with symptomatic gJHM or JHS/EDS-HT is also suggested. Concluding remarks addressed the implications of the psychopathological features of gJHM and JHS/EDS-HT in clinical practice. © 2015 Wiley Periodicals, Inc.

Refining patterns of joint hypermobility, habitus, and orthopedic traits in joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type.

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Morlino, Silvia; Dordoni, Chiara; Sperduti, Isabella; Venturini, Marina; Celletti, Claudia; Camerota, Filippo; Colombi, Marina; Castori, Marco

2017-04-01

Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two overlapping heritable disorders (JHS/EDS-HT) recognized by separated sets of diagnostic criteria and still lack a confirmatory test. This descriptive research was aimed at better characterizing the clinical phenotype of JHS/EDS-HT with focus on available diagnostic criteria, and in order to propose novel features and assessment strategies. One hundred and eighty-nine (163 females, 26 males; age: 2-73 years) patients from two Italian reference centers were investigated for Beighton score, range of motion in 21 additional joints, rate and sites of dislocations and sprains, recurrent soft-tissue injuries, tendon and muscle ruptures, body mass index, arm span/height ratio, wrist and thumb signs, and 12 additional orthopedic features. Rough rates were compared by age, sex, and handedness with a series of parametric and non-parametric tools. Multiple correspondence analysis was carried out for possible co-segregations of features. Beighton score and hypermobility at other joints were influenced by age at diagnosis. Rate and sites of joint instability complications did not vary according to age at diagnosis except for soft-tissue injuries. No major difference was registered by sex and dominant versus non-dominant body side. At multiple correspondence analysis, selected features tend to co-segregate in a dichotomous distribution. Dolichostenomelia and arachnodactyly segregated independently. This study pointed out a more protean musculoskeletal phenotype than previously considered according to available diagnostic criteria for JHS/EDS-HT. Our findings corroborated the need for a re-thinking of JHS/EDS-HT on clinical grounds in order to find better therapeutic and research strategies. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome.

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Sundelin, Heléne E K; Stephansson, Olof; Johansson, Kari; Ludvigsson, Jonas F

2017-01-01

An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected. In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes. Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome. Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome. © 2016 Nordic Federation of

Joint hypermobility leading to osteoarthrosis and chondrocalcinosis.

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Bird, H A; Tribe, C R; Bacon, P A

1978-06-01

We have reviewed 21 adults referred to rheumatology clinic and considered to have generalised joint hypermobility by the criteria of Carter and Wilkinson (1964), modified by Beighton et al. (1973). They fell into two categories. 5 patients had a raised plasma viscosity (PV) and in each case a definite pathology was found to account for this, superimposed on hypermobile joints. The remaining 16 had a normal PV and this group was thought to represent the late natural history of hypermobility. 5 of these (aged 32 to 54 years) had no evidence of osteoarthrosis but the remaining 11 (aged 34 to 80 years) had widespread radiological osteoarthrosis. Synovial histology was obtained at arthroscopy in 6 of these patients and 4 (aged 60 to 75) had chondrocalcinosis. This previously undescribed finding may be the end result of hypermobile joints. Hypermobile patients with joint deformity (lax connective tissue), widespread synovial thickening (traumatic), and hot joint effusions (chondrocalcinosis) may mimic rheumatoid arthritis. They must be distinguished from patients who develop rheumatoid arthritis in hypermobile joints.

Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge

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Scheper, Mark C.; de Vries, Janneke E.; Verbunt, Jeanine; Engelbert, Raoul H. H.

2015-01-01

Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in >= 4 joints over a period >= 3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition,

Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type) : it is a challenge

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Scheper, Mark C; de Vries, Janneke E; Verbunt, Jeanine; Engelbert, Raoul HH

2015-01-01

Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH

Girls with generalized joint hypermobility display changed muscle activity and postural sway during static balance tasks

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Juul-Kristensen, B; Johansen, Kl; Hendriksen, P

2016-01-01

OBJECTIVES: To study knee muscle activity and static postural sway in girls with generalized joint hypermobility (GJH). METHOD: Sixteen girls with GJH and 11 girls with non-GJH (NGJH) aged 14 years, randomly recruited among schoolchildren, participated in this study. GJH inclusion criteria were......: Beighton score minimum 6/9 and one hypermobile knee; for NGJH: Beighton score maximum 5/9 and no knees with hypermobility. The participants performed a static two-legged balance test with eyes open (2EO) and eyes closed (2EC) and a one-legged stance test with eyes open (1EO). Postural sway (centre......) of Q, H, and G muscle activity was calculated. Knee function was self-reported using the Knee Injury and Osteoarthritis Outcome Score for children (KOOS-Child). RESULTS: GJH had a significantly lower lateral HQ CCI and a higher medial/lateral HQ CCI ratio in all balance tasks. Group mean EMG varied...

The extent and risk of knee injuries in children aged 9-14 with Generalised Joint Hypermobility and knee joint hypermobility

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Junge, Tina; Runge, Lisbeth; Juul-Kristensen, Birgit

2015-01-01

BACKGROUND: Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The ...

Evaluation of Kinesiophobia and Its Correlations with Pain and Fatigue in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

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Claudia Celletti

2013-01-01

Full Text Available Ehlers-Danlos syndrome hypermobility type a. k. a. joint hypermobility syndrome (JHS/EDS-HT is a hereditary musculoskeletal disorder associating generalized joint hypermobility with chronic pain. Anecdotal reports suggest a prominent role for kinesiophobia in disease manifestations, but no study has systematically addressed this point. Objective. To investigate the impact of kinesiophobia and its relationship with pain, fatigue, and quality of life in JHS/EDS-HT. Design. Cross-sectional study. Subjects/Patients. 42 patients (40 female and 2 male with JHS/EDS-HT diagnosis following standardized diagnostic criteria were selected. Methods. Disease features were analyzed by means of specific questionnaires and scales evaluating kinesiophobia, pain, fatigue, and quality of life. The relationships among variables were investigated using the Spearman bivariate analysis. Results. Kinesiophobia resulted predominantly in the patients’ sample. The values of kinesiophobia did not correlate with intensity of pain, quality of life, and (or the single component of fatigue. A strong correlation was discovered between kinesiophobia and general severity of fatigue. Conclusions. In JHS/EDS-HT, the onset of pain-avoiding strategies is related to the presence of pain but not to its intensity. The clear-cut correlation between kinesiophobia and severity of fatigue suggests a direct link between musculoskeletal pain and fatigue. In JHS/EDS-HT, the underlying mechanism is likely to be facilitated by primary disease characteristics, including hypotonia.

Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type.

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Simmonds, Jane V; Herbland, Anthony; Hakim, Alan; Ninis, Nelly; Lever, William; Aziz, Qasim; Cairns, Mindy

2017-11-10

To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type and to explore patient experiences of physiotherapy. A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers-Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically. 946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30-2.36, p Ehlers-Danlos syndrome - hypermobility type in this survey. Implications for rehabilitation Exercise is a cornerstone of treatment for Ehlers-Danlos syndrome/Ehlers-Danlos syndrome - hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience.

Gait analysis of adults with generalised joint hypermobility

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Simonsen, Erik B; Tegner, Heidi; Alkjær, Tine

2012-01-01

BACKGROUND: The majority of adults with Generalised Joint Hypermobility experience symptoms such as pain and joint instability, which is likely to influence their gait pattern. Accordingly, the purpose of the present project was to perform a biomechanical gait analysis on a group of patients...

Hypermobility and joint hypermobility syndrome in Brazilian students and teachers of ballet dance.

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Sanches, S B; Oliveira, G M; Osório, F L; Crippa, J A S; Martín-Santos, R

2015-04-01

The current literature has been discussing the risks and benefits of joint hypermobility (JHM) for careers in ballet This study aimed to evaluate the prevalence of JHM and joint hypermobility syndrome (JHS) in a group of ballet teachers and students, looking both at aspects related to the flexibility required to dance, as at the risk of injuries when hypermobility is associated with other symptoms, in the case of JHS. We evaluated ballet teachers and ballet students, with age ranging from 18 to 40 years. All participants completed identification and sociodemographic questionnaires and underwent a physical examination. JHM was assessed using the Beighton score with goniometry. Symptoms of JHS were evaluated according to the Brighton criteria. Final sample consisted of 77 participants, being 44 ballet students and 33 ballet teachers. The prevalence of JHM in the sample as a whole was 58 %. Teachers and students had no significant differences regarding the prevalence of JHM (p = 0.74) (OR 1.21; 95 % CI 0.48-3.07). However, the prevalence of JHS was significantly different (p = 0.04) between students (16 %) and teachers (36 %). Teachers were three times more likely than student to have JHS (OR 3.02; 95 % CI 1.03-8.85). Teachers and students also presented differences in the frequency of specific items of Beighton score and Brighton criteria. These data provide elements to discuss the relationship between hypermobility, ballet technique and selection for dance, suggesting that dancers with JHS could find in ballet teaching an alternative to maintain professional activity with dance, while remaining protected from the higher risk of injury that professional dancers may be exposed to.

Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

Directory of Open Access Journals (Sweden)

Claudia Celletti

2017-01-01

Full Text Available Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT, is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

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Celletti, Claudia; Camerota, Filippo; Castori, Marco; Censi, Federica; Gioffrè, Laura; Calcagnini, Giovanni; Strano, Stefano

2017-01-01

Background . Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests. Methods . The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group. Results . Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls. Conclusions. This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

Transcriptome-Wide Expression Profiling in Skin Fibroblasts of Patients with Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type.

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Chiarelli, Nicola; Carini, Giulia; Zoppi, Nicoletta; Dordoni, Chiara; Ritelli, Marco; Venturini, Marina; Castori, Marco; Colombi, Marina

2016-01-01

Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT), is likely the most common systemic heritable connective tissue disorder, and is mostly recognized by generalized joint hypermobility, joint instability complications, minor skin changes and a wide range of satellite features. JHS/EDS-HT is considered an autosomal dominant trait but is still without a defined molecular basis. The absence of (a) causative gene(s) for JHS/EDS-HT is likely attributable to marked genetic heterogeneity and/or interaction of multiple loci. In order to help in deciphering such a complex molecular background, we carried out a comprehensive immunofluorescence analysis and gene expression profiling in cultured skin fibroblasts from five women affected with JHS/EDS-HT. Protein study revealed disarray of several matrix structural components such as fibrillins, tenascins, elastin, collagens, fibronectin, and their integrin receptors. Transcriptome analysis indicated perturbation of different signaling cascades that are required for homeostatic regulation either during development or in adult tissues as well as altered expression of several genes involved in maintenance of extracellular matrix architecture and homeostasis (e.g., SPON2, TGM2, MMP16, GPC4, SULF1), cell-cell adhesion (e.g., CDH2, CHD10, PCDH9, CLDN11, FLG, DSP), immune/inflammatory/pain responses (e.g., CFD, AQP9, COLEC12, KCNQ5, PRLR), and essential for redox balance (e.g., ADH1C, AKR1C2, AKR1C3, MAOB, GSTM5). Our findings provide a picture of the gene expression profile and dysregulated pathways in JHS/EDS-HT skin fibroblasts that correlate well with the systemic phenotype of the patients.

Neuromuscular knee joint control in adolescents with and without Generalised Joint Hypermobility during landing in the Single leg Hop for Distance test

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Junge, Tina; Juul-Kristensen, B; Thorlund, J B

2014-01-01

Severe knee injuries can occur due to biomechanical factors such as knee joint laxity. Generalised Joint Hypermobility (GJH) has been proposed as an intrinsic risk factor for knee injuries in adults and adolescents, as individuals with GJH often have knee joint hypermobility. Also, critical knee ...

Neuromuscular knee joint control in adolescents with and without Generalised Joint Hypermobility during landing in the Single leg Hop for Distance test

DEFF Research Database (Denmark)

Junge, Tina; Juul-Kristensen, B; Thorlund, J B

Severe knee injuries can occur due to biomechanical factors such as knee joint laxity. Generalised Joint Hypermobility (GJH) has been proposed as an intrinsic risk factor for knee injuries in adults and adolescents, as individuals with GJH often have knee joint hypermobility. Also, critical knee ...

The Influence of the “Straighten Your Back” Command on the Sagittal Spinal Curvatures in Children with Generalized Joint Hypermobility

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Dariusz Czaprowski

2017-01-01

Full Text Available Objectives. The aim of the study was to assess the change of sagittal spinal curvatures in children with generalized joint hypermobility (GJH instructed with “straighten your back” command (SYB. Methods. The study included 56 children with GJH. The control group consisted of 193 children. Sacral slope (SS, lumbar lordosis (LL, global thoracic kyphosis (TK, lower thoracic kyphosis (LK, and upper thoracic kyphosis (UK were assessed with Saunders inclinometer both in spontaneous positions (standing and sitting and after the SYB. Results. Children with GJH after SYB presented the following: in standing, increase in SS and decrease in TK, LK, and UK (P<0.01, with LL not significantly changed; in sitting: decrease in global thoracic kyphosis (35.5° (SD 20.5 versus 21.0° (SD 15.5, P<0.001 below the standards proposed in the literature (30–40° and flattening of its lower part (P<0.001. The same changes were observed in the control group. Conclusions. In children with generalized joint hypermobility, the “straighten your back” command leads to excessive reduction of the global thoracic kyphosis and flattening of its lower part. Therefore, the “straighten your back” command should not be used to achieve the optimal standing and sitting positions.

Effect of generalized joint hypermobility on knee function and muscle activation in children and adults

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Jensen, Bente Rona; Olesen, Annesofie T.; Pedersen, Mogens Theisen

2013-01-01

Introduction: We investigated muscle activation strategy and performance of knee extensor and flexor muscles in children and adults with generalized joint hypermobility (GJH) and compared them with controls. Methods: Muscle activation, torque steadiness, electromechanical delay, and muscle strength...... were evaluated in 39 children and 36 adults during isometric knee extension and flexion. Subjects performed isometric maximum contractions, submaximal contractions at 25% maximum voluntary contraction (MVC), and explosive contractions. Results: Agonist activation was reduced, and coactivation ratio...... was greater in GJH during knee flexion compared with controls. Torque steadiness was impaired in adults with GJH during knee flexion. No effect of GJH was found on muscle strength or electromechanical delay. Correlation analysis revealed an association between GJH severity and function in adults. Conclusions...

Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type: a revision of the rehabilitative approach

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Claudia Celletti

2016-09-01

Full Text Available Joint hypermobility syndrome (JHS and Ehlers-Danlos syndrome, hypermobility type (EDS-HT are two clinically overlapping heritable connective tissue disorders strongly associating with pain, fatigue and other secondary aspects. No specific treatment exist for this syndrome and rehabilitation play a role in the management of these patients. The aim of this paper is to evaluate what are the evidence in literature about rehabilitation. Research was done using database PUBMED and consist in a revision of the studies published in the last 15 years. All studies agree to the beneficial role of the rehabilitative treatment and physical therapy but it’s necessary to add more further studies to establish a high quality, evidence-based physical therapy for this specific population.

Relationship between Fatigue and Gait Abnormality in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

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Celletti, Claudia; Galli, Manuela; Cimolin, Veronica; Castori, Marco; Albertini, Giorgio; Camerota, Filippo

2012-01-01

Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The…

Benign joint hypermobility syndrome in soldiers; what is the effect of military training courses on associated joint instabilities?

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Kamran Azma

2014-01-01

Full Text Available Background: Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS among soldiers and effect of training courses on related joint instabilities. Materials and Methods: In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. Results: The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS of 4 (4.3%, P = 0.03, 5 (5.5%, P = 0.005 and also 6 out of 9 (6.5%, P = 0.01. The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1% and 6 (2.6% for discrimination of two groups (P = 0.03. There was no significant difference between two groups in case of shoulder dislocation anyway. Conclusion: Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Gastrointestinal disorders in joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type: A review for the gastroenterologist.

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Beckers, A B; Keszthelyi, D; Fikree, A; Vork, L; Masclee, A; Farmer, A D; Aziz, Q

2017-08-01

Joint hypermobility syndrome (JHS)/Ehlers-Danlos syndrome hypermobility type (EDS-HT) is the most common hereditary non-inflammatory disorder of connective tissue, characterized by a wide range of symptoms, mainly joint hyperextensibility and musculoskeletal symptoms. A majority of patients also experiences gastrointestinal (GI) symptoms. Furthermore, JHS/EDS-HT has specifically been shown to be highly prevalent in patients with functional GI disorders, such as functional dyspepsia and irritable bowel syndrome. The aim of this review was to examine the nature of GI symptoms and their underlying pathophysiology in JHS/EDS-HT. In addition, we consider the clinical implications of the diagnosis and treatment of JHS/EDS-HT for practicing clinicians in gastroenterology. Observations summarized in this review may furthermore represent the first step toward the identification of a new pathophysiological basis for a substantial subgroup of patients with functional GI disorders. © 2017 John Wiley & Sons Ltd.

Low tendon stiffness and abnormal ultrastructure distinguish classic Ehlers-Danlos syndrome from benign joint hypermobility syndrome in patients

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Nielsen, Rie Harboe; Couppé, Christian; Jensen, Jacob Kildevang

2014-01-01

There is a clinical overlap between classic Ehlers-Danlos syndrome (cEDS) and benign joint hypermobility syndrome (BJHS), with hypermobility as the main symptom. The purpose of this study was to investigate the role of type V collagen mutations and tendon pathology in these 2 syndromes. In patients...... and abnormal ultrastructure distinguish classic Ehlers-Danlos syndrome from benign joint hypermobility syndrome in patients....

High Prevalence of Hypermobility and Benign Joint Hypermobility Syndrome (BJHS) in Oman

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Clark, Carol J.; Simmonds, Jane V.

2007-01-01

PURPOSE: To ascertain the prevalence of hypermobility and BJHS in a female patient population with musculoskeletal pain and compare the associated features with a pain free control group. RELEVANCE: Hypermobility is linked with increased musculoskeletal signs and symptoms. The existence of hypermobility with pain may indicate the presence of BJHS, which is a heritable connective tissue disorder synonymous with Ehlers-Danlos type III. Hypermobility is known to be race dependant with Asians and...

Ehlers-Danlos Syndrome Hypermobility Type

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EHLERS-DANLOS SYNDROME HYPERMOBILITY TYPE Ehlers-Danlos syndrome hypermobility type is a connective tissue disorder that mostly affects the bones and joints. People with this condition have loose joints ...

Scapular Kinematics: A Comparison between Females with and Without General Hypermobility Syndrome in Arm Elevation

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Salman Nazary-Moghadam

2010-07-01

Full Text Available Objective: Numerous studies showed increasing incidence of acute or recurrent dislocations of the shoulder joint in people with General Hypermobility Syndrome (GHS. Given the critical role of scapular orientation in function of shoulder, the aim of this study is to compare the parameters indicating position and orientation of scapula between females with and without General Hypermobility Syndrome in frontal and sagital plane in arm elevation. Materials & Methods: In this cross sectional and case-control study, 16 females with General Hypermobility Syndrome were selected simply and conveniently and 16 healthy females were selected and matched by age, body mass index and menstrual status. A three dimensional motion analysis system (vicon 460 was used to measure scapular position (upper-lower and medial-lateral translations and orientation (upward rotation, posterior tilt and internal rotation angle. Measurement were taken with the arm placed in different angles of arm elevation. Date analysis was performed with Independent T test. Results: Upward rotation angles in sagital plane in 90º (P=0.03, 120º (P=0.01 and full range of arm elevation (P=0.04 were lower in case group as compared to control group. Also patients with General Hypermobility Syndrome showed a lesser amount of lateral scapular translation in 90º (P=0.02 and full range of sagital plane arm elevation (P=0.02. In addition, lateral scapular translation in 120º (P=0.02 and full range of frontal plane arm elevation (P=0.01 was lower in case group compared with control group. Conclusion: Altered kinematics in General Hypermobility Syndrome has a greater role in shoulder injuries and neuromuscular defect  seems to be an underlying cause of scapular kinematics' changes in people with hypermobility syndrome.

Physiotherapy Intervention for Joint Hypermobility in Three Cases with Heritable Connective Tissue Disorders

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Kaux, Jean-François; Foidart-Dessalle, Marguerite; Croisier, Jean-Louis; Toussaint, Geoffrey; Forthomme, Bénédicte; Crielaard, Jean-Michel

2010-01-01

Introduction: In Joint Hypermobility Syndromes, chronic pain is the most disabling symptom. Its origin can be multiple (i.e. subluxations, sprains, pathologies of tendons, ligaments, peripheral nerves, multiple operations). The goal of this article was intended to discuss appropriate physiotherapy in hyperlax patients. Patients and Method: The recovery process was analyzed in three cases (Marfan Syndrome, Ehlers-Danlos Syndrome and Osteogenesis Imperfecta). Hypermobility was assessed using...

Generalized joint hypermobility in childhood is a possible risk for the development of joint pain in adolescence

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Sohrbeck-Nøhr, Oline; Kristensen, Jens; Boyle, Eleanor

2014-01-01

. The aims for this study were to investigate the association between GJH and development of joint pain and to investigate the current GJH status and physical function in Danish adolescents.MethodsThis was a longitudinal cohort study nested within the Copenhagen Hypermobility Cohort. All children (n¿=¿301......) were examined for the exposure, GJH, using the Beighton test at baseline at either 8 or 10 years of age and then re-examined when they reached 14 years of age. The children were categorized into two groups based on their number of positive Beighton tests using different cut points (i.e. GJH4 defined...... as either¿Children...

Proprioceptive acuity into knee hypermobile range in children with Joint Hypermobility Syndrome

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Pacey, Verity; Adams, Roger D; Tofts, Louise; Munns, Craig F; Nicholson, Leslie L

2014-01-01

Background Children with Joint Hypermobility Syndrome (JHS) have reduced knee joint proprioceptive acuity compared to peers. Altered proprioception at end of range in individuals with JHS is hypothesised to contribute to recurrent joint injuries and instability. This study aims to provide the first objective comparison of functional knee joint proprioceptive acuity in hyperextension range compared to early flexion range in children with JHS. Methods Active, weight-bearing knee joint proprioce...

Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders.

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Colombi, Marina; Dordoni, Chiara; Chiarelli, Nicola; Ritelli, Marco

2015-03-01

Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is an evolving and protean disorder mostly recognized by generalized joint hypermobility and without a defined molecular basis. JHS/EDS-HT also presents with other connective tissue features affecting a variety of structures and organs, such as skin, eye, bone, and internal organs. However, most of these signs are present in variable combinations and severity in many other heritable connective tissue disorders. Accordingly, JHS/EDS-HT is an "exclusion" diagnosis which needs the absence of any consistent feature indicative of other partially overlapping connective tissue disorders. While both Villefranche and Brighton criteria include such an exclusion as a mandatory item, a systematic approach for reaching a stringent clinical diagnosis of JHS/EDS-HT is still lacking. The absence of a consensus on the diagnostic approach to JHS/EDS-HT concerning its clinical boundaries with similar conditions contribute to limit our actual understanding of the pathologic and molecular bases of this disorder. In this review, we revise the differential diagnosis of JHS/EDS-HT with those heritable connective tissue disorders which show a significant overlap with the former and mostly include EDS classic, vascular and kyphoscoliotic types, osteogenesis imperfecta, Marfan syndrome, Loeys-Dietz syndrome, arterial tortuosity syndrome, and lateral meningocele syndrome. A diagnostic flow chart is also offered with the attempt to support the less experienced clinician in stringently recognizing JHS/EDS-HT and stimulate the debate in the scientific community for both management and research purposes. © 2015 Wiley Periodicals, Inc.

Hypermobility in Adolescent Athletes

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Schmidt, Heidi; Pedersen, Trine Lykke; Junge, Tina

2017-01-01

Study Design Cross-sectional. Background Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. Objective To assess the prevalence of GJH in elite-level adolescent...

Hypermobility syndromes in paediatrics: progressions in assessment and management

OpenAIRE

Mooney, Alice Margaret

2016-01-01

Joint Hypermobility Syndrome (JHS) and Ehlers Danlos Syndrome-Hypermobility Type (EDS-HM) referred to collectively as Hypermobility Syndromes (HMS), are heritable disorders of connective tissue comprising symptomatic joint hypermobility predisposing to arthralgia, soft-tissue injury and joint instability which if not managed effectively result in ongoing cycles of disability. How HMS affects paediatric patients and how physiotherapists approach the condition in this population ...

Phenotypic variability in developmental coordination disorder: Clustering of generalized joint hypermobility with attention deficit/hyperactivity disorder, atypical swallowing and narrative difficulties.

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Celletti, Claudia; Mari, Giorgia; Ghibellini, Giulia; Celli, Mauro; Castori, Marco; Camerota, Filippo

2015-03-01

Developmental coordination disorder (DCD) is a recognized childhood disorder mostly characterized by motor coordination difficulties. Joint hypermobility syndrome, alternatively termed Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly featuring generalized joint hypermobility (gJHM), musculoskeletal pain, and minor skin features. Although these two conditions seem apparently unrelated, recent evidence highlights a high rate of motor and coordination findings in children with gJHM or JHS/EDS-HT. Here, we investigated the prevalence of gJHM in 41 Italian children with DCD in order to check for the existence of recognizable phenotypic subgroups of DCD in relation to the presence/absence of gJHM. All patients were screened for Beighton score and a set of neuropsychological tests for motor competences (Movement Assessment Battery for Children and Visual-Motor Integration tests), and language and learning difficulties (Linguistic Comprehension Test, Peabody Picture Vocabulary Test, Boston Naming Test, Bus Story Test, and Memoria-Training tests). All patients were also screening for selected JHS/EDS-HT-associated features and swallowing problems. Nineteen (46%) children showed gJHM and 22 (54%) did not. Children with DCD and gJHM showed a significant excess of frequent falls (95 vs. 18%), easy bruising (74 vs. 0%), motor impersistence (89 vs. 23%), sore hands for writing (53 vs. 9%), attention deficit/hyperactivity disorder (89 vs. 36%), constipation (53 vs. 0%), arthralgias/myalgias (58 vs. 4%), narrative difficulties (74 vs. 32%), and atypical swallowing (74 vs. 18%). This study confirms the non-causal association between DCD and gJHM, which, in turn, seems to increase the risk for non-random additional features. The excess of language, learning, and swallowing difficulties in patients with DCD and gJHM suggests a wider effect of lax tissues in the development of the nervous system. © 2015 Wiley Periodicals, Inc.

Effects of Neoprene Wrist/Hand Splints on Handwriting for Students with Joint Hypermobility Syndrome: A Single System Design Study

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Frohlich, Lauren; Wesley, Alison; Wallen, Margaret; Bundy, Anita

2012-01-01

Purpose: Pain associated with hypermobility of wrist and hand joints can contribute to decreased handwriting output. This study examined the effectiveness of a neoprene wrist/hand splint in reducing pain and increasing handwriting speed and endurance for students with joint hypermobility syndrome. Methods: Multiple baseline, single system design…

Chronic pain in hypermobility syndrome and Ehlers–Danlos syndrome (hypermobility type: it is a challenge

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Scheper MC

2015-08-01

Full Text Available Mark C Scheper,1,2 Janneke E de Vries,1–3 Jeanine Verbunt,3,4 Raoul HH Engelbert1,2 1School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, 2Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, 3Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht; 4Adelante, Center of expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands Abstract: Generalized joint hypermobility (GJH is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers–Danlos syndrome. However, within the Ehlers–Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers–Danlos syndrome hypermobility type (EDS-HT. Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1 and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2. In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3. Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the

Eyes-Closed Single-Limb Balance is Not Related to Hypermobility Status in Dancers.

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Marulli, Tiffany A; Harmon-Matthews, Lindsay E; Davis-Coen, J Hope; Willigenburg, Nienke W; Hewett, Timothy E

2017-06-15

Hypermobility may be associated with decreased lower extremity proprioception, which in turn may increase injury risk. The prevalence of hypermobility in dancers varies across studies, but joint hypermobility appears to be more common in dancers than in the general population. The purpose of this study was to determine how hypermobility affects eyes-closed single-limb balance as an indirect measure of proprioception in dancers. The secondary aim was to compare hypermobility and balance across dancer affiliation groups. Data were collected from 45 professional dancers, 11 collegiate modern dancers, 227 student dancers, and 15 pre-professional dancers during routine dance screens. Dancer hypermobility status was assessed via an eight-point Beighton-Horan Laxity test. Single-limb balance time, in seconds, was assessed in parallel position with the eyes closed. Hypermobile (HM) and non-hypermobile (NHM) dancers showed very similar balance times (HM median: 36.5 seconds; NHM median: 33.0 seconds; p = 0.982). Hypermobility was not significantly different between dancer affiliation groups (p = 0.154): 47% in ballet academy students, 27% in collegiate modern dancers, 62% in pre-professional dancers, and 36% in professional dancers. The student, pre-professional, and professional ballet dancers all demonstrated longer balance times than the collegiate modern dancers; however, this difference was only significant between the professional ballet dancers and collegiate modern dancers (p = 0.026). Dancers demonstrated a higher prevalence of hypermobility than what has been reported for the general population. Joint hypermobility did not affect eyes-closed single-limb balance time. Future studies are needed to determine if joint hypermobility affects more sensitive measures of proprioception and risk of injury.

Echocardiographic findings and joint hypermobility: patients with mitral valve prolapse vs. healthy controls

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Moradmand S

2008-11-01

Full Text Available "nBackground: Mitral valve prolapse is a relatively common valvular abnormality in most communities and joint hypermobility (JHM is also seen in many healthy people as well as in certain clinical disorders, such as Marfan syndrome. The present study was designed to investigate the association between joint hypermobility and mitral valve prolapse (MVP in an Iranian population sample. "nMethods: Fifty-seven patients with nonrheumatic and isolated mitral anterior leaflet prolapse (24 men and 33 women, mean age 23.5 +/-2.3 and 51 healthy subjects (20 men and 31 women, mean age 22.9+/-2.3 were studied. The presence of JHM was evaluated according to the Carter-Wilkinson & Beighton criteria. Echocardiographic examination was performed in all subjects and the correlation between the echocardiographic features of the mitral valve and the hypermobility score were investigated. "nResults: The frequency of JHM in patients with MVP was found to be significantly higher than that of controls (26.3% vs. 7.8%, with mean JHM scores of 3.1+/-2.2 and 1.9+/-1.7, respectively. The patients in the MVP group had significantly increased the anterior mitral leaflet thickness (AMLT, 3.4+/-0.4 mm vs. 3.0+/-0.3 mm; p<0.0005 and maximal leaflet displacement (MLD, 2.4+/-0.3 mm vs. 1.5+/-0.2 mm; p<0.0005 compared to the controls. "nConclusions: We detect a statistically significant relationship between isolated MVP and joint hypermobility as well as between the severity of JHM and echocardiographic features of the mitral leaflets. These results suggest a common etiology for MVP and JHM, which should be investigated in future well-conducted studies.

Correlation between hypermobility score and injury rate in artistic gymnastics.

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Bukva, Bojan; Vrgoč, Goran; Madić, Dejan; Sporiš, Goran; Trajković, Nebojša

2018-01-10

Generalized Joint Hypermobility (GJH) is suggested as a contributing factor for injuries in young athletes and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of joint and soft tissue injuries during sports activities. The aim of this study was to determine the correlation between the hypermobility rate (using the Beighton`s modification of the Carter-Wilkinson criteria of hypermobility) in gymnasts and injury rate, during the period of one year. This study observed 24 artistic gymnasts (11-26 years old), members of Qatar National Team in artistic gymnastics. We examined the Beighton joint hypermobility screen and a seasonal injury survey. The gymnasts characteristics (age, gender) and gymnastics characteristics (training per day and number of years in training artistic gymnastics) and its' relations to injury rate were also included. The most common injury was the lower back pain injury, followed by knee, shoulder, hip and ankle injuries. We found strong correlation of number of years gymnastics training and injury rate (p0.05). According to this study there is no correlation between GJH rate and injury rate in artistic gymnasts in Qatar. Total training period in gymnastics have greater contribution in injury rate.

Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility Type: A Discriminative Analysis.

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Scheper, M C; Pacey, V; Rombaut, L; Adams, R D; Tofts, L; Calders, P; Nicholson, L L; Engelbert, R H H

2017-03-01

Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia. Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression. Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). When applying a threshold of 30.8 N/cm 2 for males and 29.0 N/cm 2 for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobility, and healthy controls (odds ratio 6.0). Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain. © 2016, American College of Rheumatology.

Joint hypermobility and headache: the glue that binds the two together--part 2.

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Martin, Vincent T; Neilson, Derek

2014-09-01

Past studies have reported that connective tissue disorders (CTDs) are more common in patients with specific types of headache disorders. The objectives of this study are (1) to review and critique the clinical studies reporting an association between joint hypermobility, CTDs and headache and (2) to postulate mechanisms though which CTDs might predispose to headache disorders. PubMed was searched for relevant articles with search terms that included joint hypermobility, Ehlers-Danlos syndrome, Marfan syndrome, and specific headache disorders. A narrative review was performed of these articles as well as those identified from the bibliography of these articles. Case reports and case control studies confirm an association between CTDs and migraine, coat-hanger headaches, carotid arterial dissections, intracranial hypotension, Arnold Chiari malformations-type 1, cervical spine disorders, and temporomandibular joint disorders. Observational cross-sectional studies suggest that the prevalence of CTDs is increased in patients with specific types of headache disorders. It is unknown if the CTDs directly cause these headaches disorders or are associated with them through other mechanisms. © 2014 American Headache Society.

Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility.

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Núria eMallorquí-Bagué

2014-10-01

Full Text Available Objective: Anxiety is associated with increased physiological reactivity and also increased ‘interoceptive’ sensitivity to such changes in internal bodily arousal. Joint hypermobility, an expression of a common variation in the connective tissue protein collagen, is increasingly recognized as a risk factor to anxiety and related disorders. This study explored the link between anxiety, interoceptive sensitivity and hypermobility in a sub-clinical population using neuroimaging and psychophysiological evaluation. Methods: Thirty-six healthy volunteers undertook interoceptive sensitivity tests, a clinical examination for hypermobility and completed validated questionnaire measures of state, anxiety and body awareness tendency. Nineteen participants also performed an emotional processing paradigm during functional neuroimaging. Results: We confirmed a significant relationship between state anxiety score and joint hypermobility. Interoceptive sensitivity mediated the relationship between state anxiety and hypermobility. Hypermobile, compared to non-hypermobile, participants displayed heightened neural reactivity to sad and angry scenes within brain regions implicated in anxious feeling states, notably insular cortex. Conclusions: Our findings highlight the dependence of anxiety state on bodily context, and increase our understanding of the mechanisms through which vulnerability to anxiety disorders arises in people bearing a common variant of collagen.

The effects of neuromuscular taping on gait walking strategy in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type

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Camerota, Filippo; Galli, Manuela; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio

2015-01-01

Objective: In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type (JHS/EDS-HT). Methods: A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). Results: At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Conclusions: Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms. PMID:25649985

The effects of neuromuscular taping on gait walking strategy in a patient with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type.

Science.gov (United States)

Camerota, Filippo; Galli, Manuela; Cimolin, Veronica; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio

2015-02-01

In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms.

Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment.

Science.gov (United States)

Mustafa, Rawand; Güngörmüş, Metin; Mollaoğlu, Nur

2018-03-12

The aim of this study was to compare and evaluate the efficacy of different concentrations of dextrose prolotherapy for the treatment of temporomandibular joint (TMJ) hypermobility. A prospective, randomized clinical trial including patients with subluxation or dislocation was performed. The study comprised 40 patients. Patients were randomly divided into 4 groups: control group, 10% dextrose, 20% dextrose, and 30% dextrose group. Patients in all groups received injections into 4 different areas of each TMJ in 4 sessions at monthly intervals. Visual analog scale of TMJ pain intensity, maximum mouth opening (MMO), joint sounds, and frequency of luxations were recorded preoperatively and postoperatively after 1 month of last injection. The collected data were then statistically analyzed. Each group showed postoperatively significant improvement in TMJ pain, significant decrease in both MMO and joint sound. Besides that, TMJ locking was not observed in any patient during the follow-up period. There were no statistically significant differences throughout the study intervals between the groups. It was concluded that there was no significant difference between control group and dextrose groups and there is no superiority of any concentration of dextrose over the others in TMJ prolotherapy, and all treatment procedures were efficient in improvement of clinical symptoms related to TMJ hypermobility. If dextrose is used as a proliferant, it can be said that 10% dextrose can be sufficient in TMJ hypermobility treatment.

Analysis of body mass index in children with polyarticular hypermobility

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Paulina Lebowska

2018-03-01

Conclusions: Value of BMI on the centile charts are comparable in children with hypermobility and children without occurring features hypermobility of joints. Given the prevalence of frequensy hypermobility among children and young people, prevention in the form of assessment of the hypermobility is very important.

Central sensitization as the mechanism underlying pain in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

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Di Stefano, G; Celletti, C; Baron, R; Castori, M; Di Franco, M; La Cesa, S; Leone, C; Pepe, A; Cruccu, G; Truini, A; Camerota, F

2016-09-01

Patients with joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT) commonly suffer from pain. How this hereditary connective tissue disorder causes pain remains unclear although previous studies suggested it shares similar mechanisms with neuropathic pain and fibromyalgia. In this prospective study seeking information on the mechanisms underlying pain in patients with JHS/EDS-HT, we enrolled 27 consecutive patients with this connective tissue disorder. Patients underwent a detailed clinical examination, including the neuropathic pain questionnaire DN4 and the fibromyalgia rapid screening tool. As quantitative sensory testing methods, we included thermal-pain perceptive thresholds and the wind-up ratio and recorded a standard nerve conduction study to assess non-nociceptive fibres and laser-evoked potentials, assessing nociceptive fibres. Clinical examination and diagnostic tests disclosed no somatosensory nervous system damage. Conversely, most patients suffered from widespread pain, the fibromyalgia rapid screening tool elicited positive findings, and quantitative sensory testing showed lowered cold and heat pain thresholds and an increased wind-up ratio. While the lack of somatosensory nervous system damage is incompatible with neuropathic pain as the mechanism underlying pain in JHS/EDS-HT, the lowered cold and heat pain thresholds and increased wind-up ratio imply that pain in JHS/EDS-HT might arise through central sensitization. Hence, this connective tissue disorder and fibromyalgia share similar pain mechanisms. WHAT DOES THIS STUDY ADD?: In patients with JHS/EDS-HT, the persistent nociceptive input due to joint abnormalities probably triggers central sensitization in the dorsal horn neurons and causes widespread pain. © 2016 European Pain Federation - EFIC®

Skin extensibility and consistency in patients with Ehlers-Danlos syndrome and benign joint hypermobility syndrome

DEFF Research Database (Denmark)

Remvig, L; Duhn, P H; Ullman, S

2009-01-01

OBJECTIVES: The reproducibility of clinical tests for skin extensibility and consistency, essential for differentiating between types of Ehlers-Danlos syndrome (EDS) and benign joint hypermobility syndrome (BJHS), is unknown. Paraclinical methods may provide objective differential diagnostic...

Comparative Clinical Profile of Postural Orthostatic Tachycardia Patients With and Without Joint Hypermobility Syndrome

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Blair P Grubb

2010-04-01

Full Text Available Background: Autonomic dysfunction is common in patients with the joint hypermobility syndrome (JHS. However, there is a paucity of reported data on clinical features of Postural orthostatic tachycardia syndrome (POTS in patients suffering from JHS.Methods: This retrospective study was approved by our local Institutional Review Board (IRB. Over a period of 10 years, 26 patients of POTS were identified for inclusion in this study. All these patients had features of Joint Hypermobility Syndrome (by Brighton criterion. A comparison group of 39 patients with other forms of POTS were also followed in the autonomic clinic during the same time. We present a descriptive report on the comparative clinical profile of the clinical features of Postural Orthostatic Tachycardia patients with and without Joint Hypermobility syndrome. The data is presented as a mean±SD and percentages wherever applicable.Results: Out of 65 patients, 26 patients (all females, 20 Caucasians had POTS and JHS. The mean age at presentation of POTS was 24±13 (range 10-53 years vs 41±12 (range 19-65 years, P=0.0001, Migraine was a common co morbidity 73 vs 29% p=0,001. In two patients POTS was precipitated by pregnancy, and in three by surgery, urinary tract infection and a viral syndrome respectively. The common clinical features were fatigue (58%, orthostatic palpitations (54%, presyncope (58%, and syncope (62%.Conclusion: Patients with POTS and JHS appear to become symptomatic at an earlier age compared to POTS patients without JHS. In addition patients with JHS had a greater incidence of migraine and syncope than their non JHS counterparts.

Investigation of an autologous blood treatment strategy for temporomandibular joint hypermobility in a pig model

Czech Academy of Sciences Publication Activity Database

Štembírek, Jan; Matalová, Eva; Buchtová, Marcela; Machoň, V.; Míšek, Ivan

2013-01-01

Roč. 42, č. 3 (2013), s. 369-375 ISSN 0901-5027 Grant - others:GA MŠk(CZ) 1M0528 Institutional support: RVO:67985904 Keywords : temporomandibular joint * pig * autologous blood * hypermobility Subject RIV: FF - HEENT, Dentistry Impact factor: 1.359, year: 2013

Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner

Science.gov (United States)

2011-01-01

Background Generalized joint hypermobility (JHM) refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS) often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated. The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described. Materials and methods This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2), Cobb angle range 10°-53° (mean 24.3 ± 11.7), 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1) selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double), number of vertebrae within the curvature (long versus short curves), treatment type (physiotherapy versus bracing) and age. Statistical analysis was performed with Statistica 8.1 (StatSoft, USA). The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi2 test, Pearson and Spermann correlation rank were conducted. The value p = 0.05 was adopted as the level of significance. Results JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%), whilst in the control group it was diagnosed in only 19% of cases (p

Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner

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Pawłowska Paulina

2011-10-01

Full Text Available Abstract Background Generalized joint hypermobility (JHM refers to increased joint mobility with simultaneous absence of any other systemic disease. JHM involves proprioception impairment, increased frequency of pain within joints and tendency to injure soft tissues while performing physical activities. Children with idiopathic scoliosis (IS often undergo intensive physiotherapy requiring good physical capacities. Further, some physiotherapy methods apply techniques that increase joint mobility and thus may be contraindicated. The aim of this paper was to assess JHM prevalence in children with idiopathic scoliosis and to analyze the relationship between JHM prevalence and the clinical and radiological parameters of scoliosis. The methods of assessment of generalized joint hypermobility were also described. Materials and methods This case-control study included 70 subjects with IS, aged 9-18 years (mean 13.2 ± 2.2, Cobb angle range 10°-53° (mean 24.3 ± 11.7, 34 presenting single curve thoracic scoliosis and 36 double curve thoracic and lumbar scoliosis. The control group included 58 children and adolescents aged 9-18 years (mean 12.6 ± 2.1 selected at random. The presence of JHM was determined using Beighton scale complemented with the questionnaire by Hakim and Grahame. The relationship between JHM and the following variables was evaluated: curve severity, axial rotation of the apical vertebra, number of curvatures (single versus double, number of vertebrae within the curvature (long versus short curves, treatment type (physiotherapy versus bracing and age. Statistical analysis was performed with Statistica 8.1 (StatSoft, USA. The Kolmogorov-Smirnov test, U Mann-Whitney test, Chi2 test, Pearson and Spermann correlation rank were conducted. The value p = 0.05 was adopted as the level of significance. Results JHM was diagnosed in more than half of the subjects with idiopathic scoliosis (51.4%, whilst in the control group it was diagnosed in

Quality of life, unmet needs, and iatrogenic injuries in rehabilitation of patients with Ehlers-Danlos Syndrome hypermobility type/Joint Hypermobility Syndrome.

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Bovet, Claire; Carlson, Matthew; Taylor, Matthew

2016-08-01

Ehlers-Danlos Syndrome, hypermobility type (EDS-HT) and the joint hypermobility syndrome (JHS) are connective tissue disorders that form an overlapping clinical syndrome and are associated with frequent medical visits and substantial morbidity. EDS-HT/JHS-associated pain correlates with poor quality of life. While physical therapy is the recommended treatment for EDS-HT/JHS, little is known about therapy-related patient experiences and iatrogenic injuries. We studied 38 adult EDS-HT/JHS patients, eliciting health-related quality of life (HRQoL) from 28 patients through the RAND SF-36 questionnaire. We also explored physical therapy experiences through focus groups with 13 patients. Our patients displayed poor HRQoL, with 71% reporting worse health over the past year. SF-36 scores were significantly lower than the scores of the average American population (P < 0.001 for 8 of 10 categories assessed), but were comparable to EDS-HT/JHS populations in Belgium, the Netherlands, Sweden, and Italy. Focus groups identified factors associated with: negative past physical therapy experiences, iatrogenic joint injuries, positive treatment experiences, and unmet rehabilitation needs. This group of EDS-HT/JHS patients has significant decrements in HRQoL and many unmet treatment needs, as well as a risk for iatrogenic injuries. We identify several approaches to help meet patients' needs and improve joint rehabilitation in patients with EDS-HT/JHS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome

DEFF Research Database (Denmark)

Engelbert, Raoul H; Juul-Kristensen, Birgit; Pacey, Verity

2017-01-01

New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in managem......New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role...... in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment...

Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

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Kozanoglu, Erkan; Coskun Benlidayi, Ilke; Eker Akilli, Rabia; Tasal, Abdurrahman

2016-04-01

The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton's scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0 % (n = 51) and 20.0 % (n = 15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p = 0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p = 0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95 % confidence interval (CI) 1.1-70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP.

Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge.

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Scheper, Mark C; de Vries, Janneke E; Verbunt, Jeanine; Engelbert, Raoul Hh

2015-01-01

Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).

Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial.

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Cömert Kiliç, S; Güngörmüş, M

2016-07-01

A randomized clinical trial involving adult patients with bilateral temporomandibular joint (TMJ) hypermobility referred for treatment was implemented. The sample comprised 30 consecutive patients, who were divided randomly into two groups. The TMJ hypermobility was treated with either saline (placebo group) or dextrose injections (study group). The solution was injected into five different TMJ areas in three sessions at monthly intervals. The predictor variable was the treatment technique. The outcome variables were visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO). Outcome variables were recorded preoperatively and at 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P-value of dextrose prolotherapy is no more effective than placebo treatment for any of the outcome variables of TMJ hypermobility assessed. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Association between joint hypermobility and anxiety in Brazilian university students: gender-related differences.

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Sanches, S B; Osório, F L; Louzada-Junior, P; Moraes, D; Crippa, J A S; Martín-Santos, R

2014-12-01

Anxiety disorders may be associated with several non-psychiatric disorders. Current literature has been investigating the association between anxiety and joint hypermobility (JHM), with special interest in non-articular symptoms that may be related to autonomic dysfunction. This study investigated the association between anxiety and JHM in a sample of Brazilian university students. Data were cross-sectionally collected in two Brazilian universities (N=2600). Participants completed three validated self-rating anxiety scales: Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN) and the brief-version of SPIN (Mini-SPIN). They also answered the self-rating screening questionnaire for JHM: the Five-part Questionnaire for Identifying Hypermobility. Hypermobile women showed significantly higher scores in all the anxiety scales, when compared with men: BAI total score (t=3.77; panxiety and JHM in women, showing specific gender-related features in this field. It also directs attention to non-articular symptoms that may be enrolled in this association. Copyright © 2014 Elsevier Inc. All rights reserved.

Spectrum of mucocutaneous manifestations in 277 patients with joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

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Castori, Marco; Dordoni, Chiara; Morlino, Silvia; Sperduti, Isabella; Ritelli, Marco; Valiante, Michele; Chiarelli, Nicola; Zanca, Arianna; Celletti, Claudia; Venturini, Marina; Camerota, Filippo; Calzavara-Pinton, Piergiacomo; Grammatico, Paola; Colombi, Marina

2015-03-01

Cutaneous manifestations are a diagnostic criterion of Ehlers-Danlos syndrome, hypermobility type (EDS-HT) and joint hypermobility syndrome (JHS). These two conditions, originally considered different disorders, are now accepted as clinically indistinguishable and often segregate as a single-familial trait. EDS-HT and JHS are still exclusion diagnoses not supported by any specific laboratory test. Accuracy of clinical diagnosis is, therefore, crucial for appropriate patients' classification and management, but it is actually hampered by the low consistency of many applied criteria including the cutaneous one. We report on mucocutaneous findings in 277 patients with JHS/EDS-HT with both sexes and various ages. Sixteen objective and five anamnestic items were selected and ascertained in two specialized outpatient clinics. Feature rates were compared by sex and age by a series of statistical tools. Data were also used for a multivariate correspondence analysis with the attempt to identify non-causal associations of features depicting recognizable phenotypic clusters. Our findings identified a few differences between sexes and thus indicated an attenuated sexual dimorphism for mucocutaneous features in JHS/EDS-HT. Ten features showed significantly distinct rates at different ages and this evidence corroborated the concept of an evolving phenotype in JHS/EDS-HT also affecting the skin. Multivariate correspondence analysis identified three relatively discrete phenotypic profiles, which may represent the cutaneous counterparts of the three disease phases previously proposed for JHS/EDS-HT. These findings could be used for revising the cutaneous criterion in a future consensus for the clinical diagnosis of JHS/EDS-HT. © 2015 Wiley Periodicals, Inc.

Relations between the occurrence of hypermobility and gender in the group of children aged 6 - 10 years

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Joanna Maryczkanicz

2018-01-01

Full Text Available Introduction:Hypermobility of joints in healthy people may be either acquired or congenital be a symptom of a connective tissue disorder such as Marfan syndrome, osteogenesis imperfecta, or Ehler-Danlos syndrome. If that occurs increased joint mobility does not have the characteristics previously mentioned teams innate, it may indicate the presence of articular hypermobility. Hypermobility otherwise called excessive joint laxity or increased their chattel. This dysfunction is based on a wider range of movement in large and small joints relative to the standards for age, gender and race, in the absence of rheumatic diseases. The aim of the study was to evaluate the relationship between hypermobility and gender of the children aged 6 - 10 years. Materials and Methods: The study was conducted in November and December 2017, in two primary schools in Szczecin. Studied 66 children, whose average age was 7 years and 10 months. To assess the prevalence of hypermobility used Beighton scale. It consists of preparation of 5 steps: slope forward from the position the hand flat on the floor, the passive hyperextension V above the finger 90, the passive thumb adduction to the volar side of the forearm hyperextension elbow joint and knee joint. The maximum number of points available is a ninth score 4 points or more indicates presence of hypermobility. Results: The results of 4 points or above on a scale Beighton was observed in 24 of 66 children. Boys was 10, and girls 14. Among girls male person with hypermobility accounted for 30.30%, and among female patients with hypermobility was 42.42% . Conclusions: There was an increased incidence of joint mobility of females than males. The need for screening tests in that group of children was also highlighted.

Ehlers-Danlos Syndrome, Hypermobility Type, Is Linked to Chromosome 8p22-8p21.1 in an Extended Belgian Family

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Delfien Syx

2015-01-01

Full Text Available Joint hypermobility is a common, mostly benign, finding in the general population. In a subset of individuals, however, it causes a range of clinical problems, mainly affecting the musculoskeletal system. Joint hypermobility often appears as a familial trait and is shared by several heritable connective tissue disorders, including the hypermobility subtype of the Ehlers-Danlos syndrome (EDS-HT or benign joint hypermobility syndrome (BJHS. These hereditary conditions provide unique models for the study of the genetic basis of joint hypermobility. Nevertheless, these studies are largely hampered by the great variability in clinical presentation and the often vague mode of inheritance in many families. Here, we performed a genome-wide linkage scan in a unique three-generation family with an autosomal dominant EDS-HT phenotype and identified a linkage interval on chromosome 8p22-8p21.1, with a maximum two-point LOD score of 4.73. Subsequent whole exome sequencing revealed the presence of a unique missense variant in the LZTS1 gene, located within the candidate region. Subsequent analysis of 230 EDS-HT/BJHS patients resulted in the identification of three additional rare variants. This is the first reported genome-wide linkage analysis in an EDS-HT family, thereby providing an opportunity to identify a new disease gene for this condition.

The role of narrative medicine in the management of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type.

Science.gov (United States)

Knight, Isobel

2015-03-01

Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a hereditary connective tissue disorder affecting every bodily system. It is largely underdiagnosed by many practitioners, with the result of a considerable delay in diagnosis and, consequently, in the onset of adequate management schedule and treatment. Patients may also experience to be misbelieved, erroneously considered affected by a psychiatric or psychosomatic disorders, and rejected by the medical profession, which can lead to feelings of anger and resentment. Patient journeys are often long and complicated, but if doctors allowed the patient time to tell the full story, and were more prepared to think holistically, there may be a far more positive outcome. Here, the patients' perspective is presented with a narrative medicine approach, illustrating the tri-dimensional experience of a JHS/EDS-HT patient, who is also a Bowen Practitioner and a medical writer/educator. Narrative medicine would be invaluable in working with JHS/EDS-HT so that the patient can tell the story, and offer the practitioner a whole picture of her/his suffering and, often, the key for understanding the cause(s). Once this has been achieved, it might be possible to build upon a more positive and therapeutic dialogue which would result in better treatment and more effective management. It is also important for doctors to communicate with JHS/EDS-HT experts who will ultimately improve the patient journey and treatment outcomes of such a complex connective tissue disorder. © 2015 Wiley Periodicals, Inc.

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

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Schmidt, Heidi; Pedersen, Trine Lykke; Junge, Tina; Engelbert, Raoul; Juul-Kristensen, Birgit

2017-01-01

STUDY DESIGN: Cross-sectional. BACKGROUND: Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. OBJECTIVE: To assess the prevalence of GJH in elite-level adolescent

Prevalence of Generalised Joint Hypermobility, Artralgia and Motor Competence in 10-year old school children

DEFF Research Database (Denmark)

Remvig, Lars; Kümmel, Christina; Halkjær-Kristensen, Jens

2011-01-01

were invited to be clinically examined and tested for motor competence, and to answer a questionnaire about musculoskeletal pain, injuries, and physical activity. Results: The final cohort comprised 315 Caucasian children, 50.5% girls and 54% boys. GJH prevalence was 35.6, 16.8, or 11.1%, depending...... the questionnaire, 56.5% girls and 43.5% boys. Nineteen fulfilled the criterion for BJHS, without difference in frequency of musculoskeletal pain and injuries, motor competence tests or physical activity compared with non-BJHS. Conclusion: GJH prevalence in this cohort is comparable to previous results. Increased......Objectives: Diverging results exist for children regarding the relation between generalized joint hypermobility (GJH) and musculoskeletal complaints, as well as relations between GJH and insufficient motor development, and/or reduced physical activity level. The main purposes were to (1) survey...

Altered knee joint neuromuscular control during landing from a jump in 10-15year old children with Generalised Joint Hypermobility. A substudy of the CHAMPS-study Denmark

DEFF Research Database (Denmark)

Junge, Tina; Wedderkopp, Niels; Thorlund, Jonas Bloch

2015-01-01

Generalised Joint Hypermobility (GJH) is considered an intrinsic risk factor for knee injuries. Knee neuromuscular control during landing may be altered in GJH due to reduced passive stability. The aim was to identify differences in knee neuromuscular control during landing of the Single-Leg-Hop-...

Benign joint hypermobility syndrome with postural orthostatic tachycardia syndrome and acrocyanosis

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Navjyot Kaur

2017-01-01

Full Text Available Benign joint hypermobility syndrome (BJHS and postural orthostatic tachycardia syndrome (POTS are two common conditions which are frequently overlooked. While patients with BJHS are known to attend rheumatology, orthopedic, and medical outpatient departments for years with polyarthralgia; POTS is commonly misdiagnosed as anxiety neurosis or panic attack. Described first in 1940, POTS is one of the common causes of orthostatic symptoms in females. POTS is defined as orthostatic intolerance associated with tachycardia exceeding 120 beats/min (bpm or an increase in the heart rate (HR of 30 bpm from baseline within 10 min of changing the posture from a lying to standing position, in the absence of long-term chronic diseases and medications that affect the autonomic or vascular tone. Classified as primary and secondary, the underlying pathophysiological mechanism is assumed to be a failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. This is compensated by an increase in HR and inotropy. We present a case of BJHS, who reported to us with recurrent episodes of syncope and presyncope and was diagnosed to have POTS secondary to his hypermobility syndrome. Although the tilt-table test is the gold standard for diagnosis of POTS, this case highlights the importance of bedside tests in evaluation of orthostatic symptoms and in diagnosis of relatively common but frequently overlooked syndrome.

Rating anthropometric parameters of children with polyarticular hypermobility

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Mario Cardinali

2018-03-01

Full Text Available Introduction: Polyarticular hypermobility manifests in an increased range of motion in the joints compared to standards that include gender and age. It is given that it occurs even in 30% of children. It can lead to many biomechanical disorders and injuries. Science, which describes the measurement of the different body parameters such as height, body weight or fat content in the body is anthropometry and it was used to characterize the child diagnosed with arthritis polyarticular hypermobility. Material and Methods: The study was conducted on the group of 35 children aged 6 to 11 years old with diagnosed polyarticular hypermobility. The control group were randomly selected children in the same age from the same school without diagnosed polyarticular hypermobility. Anthropometric parameters of all children were measured according to accepted methods. The children were tested for body weight, height, body mass index, WHR index and their skinfolds were measured by skinfolds calipers. Objective: The aim of this study was to evaluate the anthropometric parameters of children with diagnosed polyarticular hypermobility and to compare these results to their contemporaries with no identified polyarticular hypermobility. Results: All the examined parameters (height, body weight, BMI, WHR, skinfolds measurement in the two groups were on very similar levels, there were no statistically significant differences (BMI p = 0.3435, WHR p = 0.806. Conclusions: There is no significant difference between the study group and the control group in the examined anthropometric parameters (height, body weight and BMI. Children with diagnosed polyarticular hypermobility in terms of weight and height do not stand out from their peers.

United States Physical Therapists' Knowledge About Joint Hypermobility Syndrome Compared with Fibromyalgia and Rheumatoid Arthritis.

Science.gov (United States)

Russek, Leslie N; LaShomb, Emily A; Ware, Amy M; Wesner, Sarah M; Westcott, Vanessa

2016-03-01

Joint hypermobility syndrome (JHS) is one of the most common inherited connective tissue disorders. It causes significant pain and disability for all age groups, ranging from developmental delay among children to widespread chronic pain in adults. Experts in JHS assert that the condition is under-recognized and poorly managed. The aim of this study was to assess US physical therapists' knowledge about JHS compared with other causes of widespread pain and activity limitations: fibromyalgia, juvenile rheumatoid arthritis and adult rheumatoid arthritis. Cross-sectional, Internet-based survey of randomly selected members of the American Physical Therapy Association and descriptive statistics were used to explore physical therapists' knowledge about JHS, fibromyalgia, juvenile rheumatoid arthritis and adult rheumatoid arthritis, and chi square was used to compare knowledge about the different conditions. The response rate was 15.5% (496). Although 36% recognized the Beighton Scale for assessing joint hypermobility, only 26.8% of respondents were familiar with the Brighton Criteria for diagnosing JHS. Few respondents (11-19%) realized that JHS has extra-articular features such as anxiety disorder, fatigue, headache, delayed motor development, easy bruising and sleep disturbance. Physical therapists working in environments most likely to see patients with JHS underestimated the likely prevalence in their patient population. The results suggest that many physical therapists in the United States are not familiar with the diagnostic criteria, prevalence or common clinical presentation of JHS. Copyright © 2014 John Wiley & Sons, Ltd.

The Evidence-Based Rationale for Physical Therapy Treatment of Children, Adolescents, and Adults Diagnosed With Joint Hypermobility Syndrome/Hypermobile Ehlers Danlos Syndrome

NARCIS (Netherlands)

Engelbert, Raoul H. H.; Juul-Kristensen, Birgit; Pacey, Verity; de Wandele, Inge; Smeenk, Sandy; Woinarosky, Nicoleta; Sabo, Stephanie; Scheper, Mark C.; Russek, Leslie; Simmonds, Jane V.

2017-01-01

New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management

The natural history of children with joint hypermobility syndrome and Ehlers-Danlos hypermobility type: a longitudinal cohort study.

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Scheper, Mark C; Nicholson, Lesley L; Adams, Roger D; Tofts, Louise; Pacey, Verity

2017-12-01

The objective of the manuscript was to describe the natural history of complaints and disability in children diagnosed with joint hypermobility syndrome (JHS)/Ehlers-Danlos-hypermobility type (EDS-HT) and to identify the constructs that underlie functional decline. One hundred and one JHS/EDS-HT children were observed over 3 years and assessed at three time points on the following: functional impairments, quality of life, connective tissue laxity, muscle function, postural control and musculoskeletal and multi-systemic complaints. Cluster analysis was performed to identify subgroups in severity. Clinical profiles were determined for these subgroups, and differences were assessed by multivariate analysis of covariance. Mixed linear regression models were used to determine the subsequent trajectories. Finally, an exploratory factor analysis was used to uncover the underlying constructs of functional impairment. Three clusters of children were identified in terms of functional impairment: mild, moderately and severely affected. Functional impairment at baseline was predictive of worsening trajectories in terms of reduced walking distance and decreased quality of life (P ⩽ 0.05) over 3 years. Multiple interactions between the secondary outcomes were observed, with four underlying constructs identified. All four constructs (multi-systemic effects, pain, fatigue and loss of postural control) contributed significantly to disability (P ⩽ 0.046). Children diagnosed with JHS/EDS-HT who have a high incidence of multi-systemic complaints (particularly, orthostatic intolerance, urinary incontinence and diarrhoea) and poor postural control in addition to high levels of pain and fatigue at baseline are most likely to have a deteriorating trajectory of functional impairment and, accordingly, warrant clinical prioritization. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please

Ehlers–Danlos Syndrome—Hypermobility Type: A Much Neglected Multisystemic Disorder

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Yael Gazit

2016-10-01

Full Text Available Ehlers–Danlos syndrome (EDS—hypermobility type (HT is considered to be the most common subtype of EDS and the least severe one; EDS-HT is considered to be identical to the joint hypermobility syndrome and manifests with musculoskeletal complaints, joint instability, and soft tissue overuse injury. Musculoskeletal complaints manifest with joint pain of non-inflammatory origin and/or spinal pain. Joint instability leads to dislocation or subluxation and involves peripheral joints as well as central joints, including the temporomandibular joints, sacroiliac joints, and hip joints. Soft tissue overuse injury may lead to tendonitis and bursitis without joint inflammation in most cases. Ehlers–Danlos syndrome-HT carries a high potential for disability due to recurrent dislocations and subluxations and chronic pain. Throughout the years, extra-articular manifestations have been described, including cardiovascular, autonomic nervous system, gastrointestinal, hematologic, ocular, gynecologic, neurologic, and psychiatric manifestations, emphasizing the multisystemic nature of EDS-HT. Unfortunately, EDS-HT is under-recognized and inadequately managed, leading to neglect of these patients, which may lead to severe disability that almost certainly could have been avoided. In this review article we will describe the known manifestations of the extra-articular systems.

Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining Generalised Joint Hypermobility in primary school children

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Junge, Tina; Jespersen, Eva; Wedderkopp, Niels

2013-01-01

The assessment of Generalised Joint Hypermobility (GJH) is usually based on the Beighton tests, which consist of a series of nine tests. Possible methodological shortcomings can arise, as the tests do not include detailed descriptions of performance, interpretation nor classification of GJH. The ...

Keratectasia following laser in situ keratomileusis in a low-risk patient with benign joint hypermobility syndrome

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Gustavo Galperin

2014-04-01

Full Text Available Here we present the case of a 27-year-old woman with benign joint hypermobility (BJHS syndrome who developed keratectasia after laser in situ keratomileusis (LASIK in both eyes. Both eyes had identical low Randleman risk factor scores. To our knowledge, this is the first report of such a complication in a patient with BJHS. It highlights our incomplete knowledge of the risk factors for keratectasia following LASIK and suggests that BJHS should be considered as a risk factor for keratectasia.

Ehlers-Danlos Syndrome, Hypermobility Type: An Underdiagnosed Hereditary Connective Tissue Disorder with Mucocutaneous, Articular, and Systemic Manifestations

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Castori, Marco

2012-01-01

Ehlers-Danlos syndrome, hypermobility type, constituting a phenotypic continuum with or, perhaps, corresponding to the joint hypermobility syndrome (JHS/EDS-HT), is likely the most common, though the least recognized, heritable connective tissue disorder. Known for decades as a hereditary condition with predominant rheumatologic manifestations, it is now emerging as a multisystemic disorder with widespread manifestations. Nevertheless, the practitioners' awareness of this condition is generally poor and most patients await years or, perhaps, decades before reaching the correct diagnosis. Among the various sites of disease manifestations, skin and mucosae represent a neglected organ where the dermatologist can easily spot diagnostic clues, which consistently integrate joint hypermobility and other orthopedic/neurologic manifestations at physical examination. In this paper, actual knowledge on JHS/EDS-HT is summarized in various sections. Particular attention has been posed on overlooked manifestations, including cutaneous, mucosal, and oropharyngeal features, and early diagnosis techniques, as a major point of interest for the practicing dermatologist. Actual research progresses on JH/EDS-HT envisage an unexpected link between heritable dysfunctions of the connective tissue and a wide range of functional somatic syndromes, most of them commonly diagnosed in the office of various specialists, comprising dermatologists. PMID:23227356

Generalised joint hypermobility and knee joint hypermobility

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Junge, Tina; Henriksen, Peter; Hansen, Sebrina

2018-01-01

. Respondents with GJHk and KJH reported lower HRQoL. CONCLUSION: GJHk and KJH were frequently reported in the Danish adult population, mostly in women. Respondents with GJHk and KJH were two times more likely to report knee joint-related symptoms such as pain, reduced performance of usual activity and lower...

Cognitive, emotional, and behavioral considerations for chronic pain management in the Ehlers-Danlos syndrome hypermobility-type: a narrative review.

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Baeza-Velasco, Carolina; Bulbena, Antonio; Polanco-Carrasco, Roberto; Jaussaud, Roland

2018-01-22

Ehlers-Danlos syndrome (EDS) hypermobility-type is the most common hereditary disorder of the connective tissue. The tissue fragility characteristic of this condition leads to multi-systemic symptoms in which pain, often severe, chronic, and disabling, is the most experienced. Clinical observations suggest that the complex patient with EDS hypermobility-type is refractory toward several biomedical and physical approaches. In this context and in accordance with the contemporary conceptualization of pain (biopsychosocial perspective), the identification of psychological aspects involved in the pain experience can be useful to improve interventions for this under-recognized pathology. Review of the literature on joint hypermobility and EDS hypermobility-type concerning psychological factors linked to pain chronicity and disability. A comprehensive search was performed using scientific online databases and references lists, encompassing publications reporting quantitative and qualitative research as well as unpublished literature. Despite scarce research, psychological factors associated with EDS hypermobility-type that potentially affect pain chronicity and disability were identified. These are cognitive problems and attention to body sensations, negative emotions, and unhealthy patterns of activity (hypo/hyperactivity). As in other chronic pain conditions, these aspects should be more explored in EDS hypermobility-type, and integrated into chronic pain prevention and management programs. Implications for Rehabilitation Clinicians should be aware that joint hypermobility may be associated with other health problems, and in its presence suspect a heritable disorder of connective tissue such as the Ehlers-Danlos syndrome (EDS) hypermobility-type, in which chronic pain is one of the most frequent and invalidating symptoms. It is necessary to explore the psychosocial functioning of patients as part of the overall chronic pain management in the EDS hypermobility

Altered knee joint neuromuscular control during landing from a jump in 10-15year old children with Generalised Joint Hypermobility. A substudy of the CHAMPS-study Denmark

DEFF Research Database (Denmark)

Junge, Tina; Wedderkopp, Niels; Thorlund, Jonas Bloch

2015-01-01

Generalised Joint Hypermobility (GJH) is considered an intrinsic risk factor for knee injuries. Knee neuromuscular control during landing may be altered in GJH due to reduced passive stability. The aim was to identify differences in knee neuromuscular control during landing of the Single...... than controls, all significant findings. Although the groups performed equally in SLHD, GJH had a Gastrocnemius Medialis dominated neuromuscular strategy before landing, plausibly caused by reduced Semitendinosus activity. Reduced Semitendinosus activity was seen in GJH after landing...

Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases.

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Patzkowski, Michael S

2016-03-01

Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. Several sources advise against the use of regional anesthesia in these patients citing the 2 previous features. There have been reports of successful neuraxial anesthesia, but few concerning peripheral nerve blocks, none of which describe nerves of the lower extremity. This report describes 2 cases of successful peripheral regional anesthesia in the lower extremity. In case 1, a 16-year-old adolescent girl with hypermobility type presented for osteochondral grafting of tibiotalar joint lesions. She underwent a popliteal sciatic (with continuous catheter) and femoral nerve block under ultrasound guidance. She proceeded to surgery and tolerated the procedure under regional block and intravenous sedation. She did not require any analgesics for the following 15 hours. In case 2, an 18-year-old woman with hypermobility type presented for medial patellofemoral ligament reconstruction for chronic patella instability. She underwent a saphenous nerve block above the knee with analgesia in the distribution of the saphenous nerve lasting for approximately 18 hours. There were no complications in either case. Prohibitions against peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type, appear unwarranted. Published by Elsevier Inc.

Gait Strategy in Patients with Ehlers-Danlos Syndrome Hypermobility Type: A Kinematic and Kinetic Evaluation Using 3D Gait Analysis

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Galli, Manuela; Cimolin, Veronica; Rigoldi, Chiara; Castori, Marco; Celletti, Claudia; Albertini, Giorgio; Camerota, Filippo

2011-01-01

The aim of this study was to quantify the gait patterns of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome (JHS/EDS-HT) hypermobility type, using Gait Analysis. We quantified the gait strategy in 12 JHS/EDS-HT adults individuals (age: 43.08 + 6.78 years) compared to 20 healthy controls (age: 37.23 plus or minus 8.91 years), in…

[Temporomandibular disorders and Ehlers-Danlos syndrome, hypermobility type: A case-control study].

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Diep, D; Fau, V; Wdowik, S; Bienvenu, B; Bénateau, H; Veyssière, A

2016-09-01

The Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is a rare genetic disease. Diagnosis is based on a combination of clinical criteria described in the classification of Villefranche. Diagnosis is difficult to make because of the lack of specific clinical signs and the absence of genetic testing. The EDS-TH manifests itself manly by musculoskeletal pain and joint hypermobility. Temporomandibular disorders (TMD) are also reported. Our aim was to objectify the presence and to qualify the type of TMD associated with the EDS-HT in order to propose an additional diagnostic argument. A prospective, monocenter case-control study, comparing a cohort of patients suffering from EDS-HT to a paired control group of healthy volunteers has been conducted. Clinical examination was standardized, including a general questioning, an oral examination and a temporomandibular joint examination following the TMD/RDC (temporomandibular disorders/research diagnostic criteria). Fourteen EDS-HT patients and 58 control patients were examined. The prevalence of TMDs (n=13; 92.9% vs. n=4; 6.9%; P=10(-11)) was significantly higher in the EDS-HT group. TMDs occurring in the EDS-HT group were complex, combining several mechanisms in contrast to the control group, where only one mechanism was found in all the patients (n=13; 92.9% vs. n=0; 0.0%). TMDs are strongly associated with RDS-HT. TMDs could therefore be used in the diagnosis of this disease. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Attention-deficit/hyperactivity disorder, joint hypermobility-related disorders and pain: expanding body-mind connections to the developmental age.

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Baeza-Velasco, Carolina; Sinibaldi, Lorenzo; Castori, Marco

2018-02-14

Attention-deficit/hyperactivity disorder (ADHD) and generalized joint hypermobility (JH) are two separated conditions, assessed, and managed by different specialists without overlapping interests. Recently, some researchers highlighted an unexpected association between these two clinical entities. This happens in a scenario of increasing awareness on the protean detrimental effects that congenital anomalies of the connective tissue may have on human health and development. To review pertinent literature to identify possible connections between ADHD and GJH, special emphasis was put on musculoskeletal pain and syndromic presentations of GJH, particularly the hypermobile Ehlers-Danlos syndrome. A comprehensive search of scientific databases and references lists was conducted, encompassing publications based on qualitative and quantitative research. Impaired coordination and proprioception, fatigue, chronic pain, and dysautonomia are identified as potential bridges between ADHD and JH. Based on these findings, a map of the pathophysiological and psychopathological pathways connecting both conditions is proposed. Although ADHD and JH are traditionally separated human attributes, their association may testify for the dyadic nature of mind-body connections during critical periods of post-natal development. Such a mixed picture has potentially important consequences in terms of disability and deserves more clinical and research attention.

Altered knee joint neuromuscular control during landing from a jump in 10-15 year old children with Generalised Joint Hypermobility. A substudy of the CHAMPS-study Denmark.

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Junge, Tina; Wedderkopp, Niels; Thorlund, Jonas Bloch; Søgaard, Karen; Juul-Kristensen, Birgit

2015-06-01

Generalised Joint Hypermobility (GJH) is considered an intrinsic risk factor for knee injuries. Knee neuromuscular control during landing may be altered in GJH due to reduced passive stability. The aim was to identify differences in knee neuromuscular control during landing of the Single-Leg-Hop-for-Distance test (SLHD) in 25 children with GJH compared to 29 children without GJH (controls), all 10-15years. Inclusion criteria for GJH: Beighton score⩾5/9 and minimum one hypermobile knee. EMG was recorded from the quadriceps, the hamstring and the calf muscles, presented relative to Maximum Voluntary Electrical activity (MVE). There was no difference in jump length between groups. Before landing, GJH had 33% lower Semitendinosus, but 32% higher Gastrocnemius Medialis activity and 39% higher co contraction of the lateral knee muscles, than controls. After landing, GJH had 36% lower Semitendinosus activity than controls, all significant findings. Although the groups performed equally in SLHD, GJH had a Gastrocnemius Medialis dominated neuromuscular strategy before landing, plausibly caused by reduced Semitendinosus activity. Reduced Semitendinosus activity was seen in GJH after landing, but with no compensatory Gastrocnemius Medialis activity. Reduced pre and post-activation of the Semitendinosus may present a risk factor for traumatic knee injuries as ACL ruptures in GJH with knee hypermobility. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Pregnancy and Delivery in Ehlers-Danlos Syndrome (Hypermobility Type: Review of the Literature

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Indranil Dutta

2011-01-01

Full Text Available Ehlers-Danlos syndrome (EDS is a group of connective tissue disorders which are divided into various distinguishable phenotypes. The type of EDS determines the potential obstetric complications. Due to the spectrum of clinical manifestation and overlap between phenotypes, there are no standardised obstetric management guidelines. Existing literature illustrates different obstetric management in hypermobility type of EDS, including uneventful term vaginal deliveries as well as preterm cesarean section deliveries. This paper discusses obstetric management of a woman with EDS hypermobility type. Cesarean section was deemed the most appropriate delivery method in this patient due to the possible complications including risk of joint dislocation and pain morbidity. No obstetric complications were experienced, and good maternal and neonatal outcomes were achieved.

Orthostatic intolerance and fatigue in the hypermobility type of Ehlers-Danlos Syndrome.

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De Wandele, Inge; Rombaut, Lies; De Backer, Tine; Peersman, Wim; Da Silva, Hellen; De Mits, Sophie; De Paepe, Anne; Calders, Patrick; Malfait, Fransiska

2016-08-01

To investigate whether orthostatic intolerance (OI) is a significant predictor for fatigue in Ehlers-Danlos Syndrome, hypermobility type (EDS-HT). Eighty patients with EDS-HT and 52 controls participated in the first part of the study, which consisted of questionnaires. Fatigue was evaluated using the Checklist Individual Strength (CIS). As possible fatigue determinants OI [Autonomic Symptom Profile (ASP)], habitual physical activity (Baecke), affective distress [Hospital Anxiety and Depression Scale (HADS)], pain (SF36), medication use and generalized hypermobility (5-point score of Grahame and Hakim regarding generalized joint hypermobility) were studied. Next, a 20 min head-up tilt (70°) was performed in a subsample of 39 patients and 35 controls, while beat-to-beat heart rate and blood pressure were monitored (Holter, Finometer Pro). Before and after tilt, fatigue severity was assessed using a numeric rating scale. Patients scored significantly higher on the CIS [total score: EDS: 98.2 (18.63) vs controls: 45.8 (16.62), P < 0.001] and on the OI domain of the ASP [EDS: 22.78 (7.16) vs controls: 6.5 (7.78)]. OI was prevalent in EDS-HT (EDS: 74.4%, controls: 34.3%, P = 0.001), and frequently expressed as postural orthostatic tachycardia (41.0% of the EDS group). Patients responded to tilt with a higher heart rate and lower total peripheral resistance (p < 0.001; p = 0.032). This altered response correlated with fatigue in daily life (CIS). In the EDS-HT group, tilt provoked significantly more fatigue [numeric rating scale increase: EDS: +3.1 (1.90), controls: +0.5 (1.24), P < 0.001]. Furthermore, the factors OI, pain, affective distress, decreased physical activity and sedative use explained 47.7% of the variance in fatigue severity. OI is an important determinant of fatigue in EDS-HT. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Quality of life prediction in children with joint hypermobility syndrome.

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Pacey, Verity; Tofts, Louise; Adams, Roger D; Munns, Craig F; Nicholson, Leslie L

2015-07-01

To assess the child- and parent-reported health-related quality of life (HRQOL) of children with joint hypermobility syndrome (JHS), to compare these with other chronic paediatric conditions and to determine whether symptoms experienced by children with JHS can predict their HRQOL. Eighty-nine children with JHS and one of their parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Multidimensional Fatigue Scale and the Pediatric Pain Questionnaire. Anthropometric measures and reported symptoms were recorded. Child-reported HRQOL scores were compared with parent report, and both child- and parent-reported HRQOL scores of children with JHS were compared with those of children with other chronic conditions. Stepwise multiple regression was undertaken to determine whether any combination of measures could predict HRQOL. Parent- and child-reported HRQOL scores were strongly correlated (r = 0.6-0.84, all P children with JHS perceived lower overall HRQOL (mean difference = 4.44, P = 0.001), physical (mean difference = 7.11, P children. When considered together with previously reported HRQOL scores for children with other chronic conditions, parent and child scores were similarly strongly correlated (r = 0.93, P = 0.001). Multiple regression revealed that 75% of the variance in child-reported HRQOL scores was accounted for by a child's level of pain and fatigue, and presence of stress incontinence symptoms (P Children with JHS experience poor HRQOL and disabling fatigue, with parent scores providing a good proxy. Pain, fatigue and the presence of stress incontinence symptoms have the greatest impact on their HRQOL. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Altered knee joint neuromuscular control during landing from a jump in 10-15 year old children with generalised joint hypermobility. A substudy of the CHAMPS-study Denmark

DEFF Research Database (Denmark)

Junge, Tina; Juul-Kristensen, B; Bloch Thorlund, Jonas

Generalised Joint Hypermobility (GJH) is considered an intrinsic risk factor for knee injuries. Knee neuromuscular control during landing may be altered in GJH due to reduced passive stability. The aim was to identify differences in knee neuromuscular control during landing of the Single...... Electrical activity (MVE). There was no difference in jump length between groups. Before landing, GJH had 33% lower Semitendinosus, but 32% higher Gastrocnemius Medialis activity and 39% higher co-contraction of the lateral knee muscles, than controls. After landing, GJH had 36% lower Semitendinosus activity...... than controls, all significant findings. Although the groups performed equally in SLHD, GJH had a Gastrocnemius Medialis-dominated neuromuscular strategy before landing, plausibly caused by reduced Semitendinosus activity. Reduced Semitendinosus activity was seen in GJH after landing...

Physiotherapy management of joint hypermobility syndrome--a focus group study of patient and health professional perspectives.

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Palmer, S; Terry, R; Rimes, K A; Clark, C; Simmonds, J; Horwood, J

2016-03-01

To develop an understanding of patient and health professional views and experiences of physiotherapy to manage joint hypermobility syndrome (JHS). An explorative qualitative design. Seven focus groups were convened, audio recorded, fully transcribed and analysed using a constant comparative method to inductively derive a thematic account of the data. Four geographical areas of the U.K. 25 people with JHS and 16 health professionals (14 physiotherapists and two podiatrists). Both patients and health professionals recognised the chronic heterogeneous nature of JHS and reported a lack of awareness of the condition amongst health professionals, patients and wider society. Diagnosis and subsequent referral to physiotherapy services for JHS was often difficult and convoluted. Referral was often for acute single joint injury, failing to recognise the long-term multi-joint nature of the condition. Health professionals and patients felt that if left undiagnosed, JHS was more difficult to treat because of its chronic nature. When JHS was treated by health professionals with knowledge of the condition patients reported satisfactory outcomes. There was considerable agreement between health professionals and patients regarding an 'ideal' physiotherapy service. Education was reported as an overarching requirement for patients and health care professionals. Physiotherapy should be applied holistically to manage JHS as a long-term condition and should address injury prevention and symptom amelioration rather than cure. Education for health professionals and patients is needed to optimise physiotherapy provision. Further research is required to explore the specific therapeutic actions of physiotherapy for managing JHS. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history.

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Tinkle, Brad; Castori, Marco; Berglund, Britta; Cohen, Helen; Grahame, Rodney; Kazkaz, Hanadi; Levy, Howard

2017-03-01

The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries.

Science.gov (United States)

Schmidt, Heidi; Pedersen, Trine Lykke; Junge, Tina; Engelbert, Raoul; Juul-Kristensen, Birgit

2017-10-01

Study Design Cross-sectional. Background Generalized joint hypermobility (GJH) may increase pain and likelihood of injuries and also decrease function and health-related quality of life (HRQoL) in elite-level adolescent athletes. Objective To assess the prevalence of GJH in elite-level adolescent athletes, and to study the association of GJH with pain, function, HRQoL, and musculoskeletal injuries. Methods A total of 132 elite-level adolescent athletes (36 adolescent boys, 96 adolescent girls; mean ± SD age, 14.0 ± 0.9 years), including ballet dancers (n = 22), TeamGym gymnasts (n = 57), and team handball players (n = 53), participated in the study. Generalized joint hypermobility was classified by Beighton score as GJH4 (4/9 or greater), GJH5 (5/9 or greater), and GJH6 (6/9 or greater). Function of the lower extremity, musculoskeletal injuries, and HRQoL were assessed with self-reported questionnaires, and part of physical performance was assessed by 4 postural-sway tests and 2 single-legged hop-for-distance tests. Results Overall prevalence rates for GJH4, GJH5, and GJH6 were 27.3%, 15.9%, and 6.8%, respectively, with a higher prevalence of GJH4 in ballet dancers (68.2%) and TeamGym gymnasts (24.6%) than in team handball players (13.2%). There was no significant difference in lower extremity function, injury prevalence and related factors (exacerbation, recurrence, and absence from training), HRQoL, or lengths of hop tests for those with and without GJH. However, the GJH group had significantly larger center-of-pressure path length across sway tests. Conclusion For ballet dancers and TeamGym gymnasts, the prevalence of GJH4 was higher than that of team handball players. For ballet dancers, the prevalence of GJH5 and GJH6 was higher than that of team handball players and the general adolescent population. The GJH group demonstrated larger sway in the balance tests, which, in the current cross-sectional study, did not have an association with injuries or HRQo

Hipermobilidade articular em pacientes com prolapso da valva mitral Hipermovilidad articular en pacientes con prolapso de la válvula mitral Joint hypermobility in patients with mitral valve prolapse

Directory of Open Access Journals (Sweden)

Simone Cavenaghi

2009-09-01

Full Text Available Estudos sobre hipermobilidade têm despertado grande interesse, nas últimas décadas, por estarem associados a disfunções músculo-esqueléticas, bem como a anormalidades em vários sistemas orgânicos - como, por exemplo, o prolapso da valva mitral. Neste contexto, buscou-se agrupar e atualizar os conhecimentos da relação entre a hipermobilidade articular e o prolapso da valva mitral. Segundo a literatura, estudos mostram que alterações genéticas na composição do colágeno parecem ser a principal causa desta relação.Studies on hypermobility have aroused great interest in the last decades, as they are associated to musculoskeletal disorders, as well as abnormalities in several organic systems, such as the mitral valve prolapse. Therefore, in this study, data on the association between joint hypermobility and the mitral valve prolapse were investigated and reviewed. Studies in the literature have shown that genetic alterations in the collagen composition seem to be the main cause of this association.

Neonatal familial Evans syndrome associated with joint hypermobility and mitral valve regurgitation in three siblings in a Saudi Arab family

International Nuclear Information System (INIS)

Ahmed, Fathelrahman E.; AlBakrah, Mohameed S.

2009-01-01

The occurrence of autoimmune hemolytic anemia and immune thrombocytopenia in the absence of a known underlying cause led to the diagnosis of Evans syndrome in a 9 month old male. Subsequently, a similar diagnosis was made in two siblings (a 3 year old boy and a 1 day old girl). The 9 month old had a chronic course with exacerbations. He was treated with steroids, intravenous immunoglobulin and colchiccine with a variable response. He died of congestive heart failure at the age of 8 years. The brother's disease course was one of remission and exacerbation. With time, remissions were prolonged and paralleled an improvement in joint hypermobility. The sister died of sepsis after a chronic course with severe exacerbattions. Only two families with Evans syndrome have been reported in the English medical literature. In one report (in a Saudi Arab family), the disease was associated with hereditary spastic paraplegia. (author)

Nationwide population-based cohort study of celiac disease and risk of Ehlers-Danlos syndrome and joint hypermobility syndrome.

Science.gov (United States)

Laszkowska, Monika; Roy, Abhik; Lebwohl, Benjamin; Green, Peter H R; Sundelin, Heléne E K; Ludvigsson, Jonas F

2016-09-01

Patients with celiac disease (CD) often have articular complaints, and small prior studies suggest an association with Ehlers-Danlos syndrome (EDS)/joint hypermobility syndrome (JHS). This study examines the risks of EDS/JHS in patients with CD. This cohort study compared all individuals in Sweden diagnosed with CD based on small intestinal biopsy between 1969-2008 (n=28,631) to 139,832 matched reference individuals, and to a second reference group undergoing biopsy without having CD (n=16,104). Rates of EDS/JHS were determined based on diagnostic codes in the Swedish Patient Register. Hazard ratios (HRs) for EDS/JHS were estimated through Cox regression. There are 45 and 148 cases of EDS/JHS in patients with CD and reference individuals, respectively. This corresponds to a 49% increased risk of EDS/JHS in CD (95%CI=1.07-2.07). The HR for EDS was 2.43 (95%CI=1.20-4.91) and for JHS 1.34 (95%CI=0.93-1.95). Compared to reference individuals undergoing intestinal biopsy, CD was not a risk factor for EDS/JHS. A stronger association was seen in patients initially diagnosed with EDS/JHS and subsequently diagnosed with CD (odds ratio=2.29; 95%CI=1.21-4.34). Individuals with CD have higher risk of EDS/JHS than the general population, which may be due to surveillance bias or factors intrinsic to celiac development. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Anxiety and joint hypermobility association: a systematic review Associação entre ansiedade e hipermobilidade articular: uma revisão sistemática

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Simone H. Bianchi Sanches

2012-06-01

Full Text Available BACKGROUND: Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH. OBJECTIVES: To carry out a systematic review of the clinical association between anxiety disorders and JH. METHOD: A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. RESULTS: Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial. CONCLUSION: Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.INTRODUÇÃO: Os transtornos de ansiedade estão frequentemente associados a vários quadros clínicos não psiquiátricos. Dentre os quadros clínicos associados à ansiedade destaca-se a hipermobilidade articular (HA. Objetivo: Realizar uma revisão sistemática da associação entre os transtornos de ansiedade e a HA. MÉTODO: Foi realizada uma pesquisa nos bancos de dados MEDLINE, PsychINFO, LILACS e SciELO em busca de artigos publicados até dezembro de 2011. Usamos as palavras-chave anxiety , joint e hypermobility e os operadores boolianos. A revisão incluiu

Srovnání posturální stabilizace opakovaným provokačním testem ,,tři kroky - stoj na jedné noze" na posturomedu u hypermobilních osob a osob bez hypermobility

OpenAIRE

Lajnerová, Marcela

2010-01-01

5 ABSTRACT Title: Comparison of postural stability by repeated provocative test "3 steps, single leg stance" on Posturomed1 in a group of people with and without hypermobility syndrome. Aim of the work: The aim of my work was to find a specific parameter for poeple with joint hypermobility syndrome in repeated provocative test "3 steps, single-leg stance" on Posturomed, if there is any. And if the ability of postural stabilization of people with hypermobility syndrome is worse or different th...

Dermal fibroblast-to-myofibroblast transition sustained by αvß3 integrin-ILK-Snail1/Slug signaling is a common feature for hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders.

Science.gov (United States)

Zoppi, Nicoletta; Chiarelli, Nicola; Binetti, Silvia; Ritelli, Marco; Colombi, Marina

2018-04-01

Hypermobile Ehlers-Danlos syndrome (hEDS) is a heritable connective tissue disorder with unknown molecular basis mainly characterized by generalized joint hypermobility, joint instability complications, and minor skin changes. The phenotypic spectrum is broad and includes multiple associated symptoms shared with chronic inflammatory systemic diseases. The stricter criteria defined in the 2017 EDS nosology leave without an identity many individuals with symptomatic joint hypermobility and/or features of hEDS; for these patients, the term Hypermobility Spectrum Disorders (HSD) was introduced. We previously reported that in vitro cultured hEDS and HSD patients' skin fibroblasts show a disarray of several extracellular matrix (ECM) components and dysregulated expression of genes involved in connective tissue homeostasis and inflammatory/pain/immune responses. Herein, we report that hEDS and HSD skin fibroblasts exhibit in vitro a similar myofibroblast-like phenotype characterized by the organization of α-smooth muscle actin cytoskeleton, expression of OB-cadherin/cadherin-11, enhanced migratory capability associated with augmented levels of the ECM-degrading metalloproteinase-9, and altered expression of the inflammation mediators CCN1/CYR61 and CCN2/CTGF. We demonstrate that in hEDS and HSD cells this fibroblast-to-myofibroblast transition is triggered by a signal transduction pathway that involves αvβ3 integrin-ILK complexes, organized in focal adhesions, and the Snail1/Slug transcription factor, thus providing insights into the molecular mechanisms related to the pathophysiology of these protean disorders. The indistinguishable phenotype identified in hEDS and HSD cells resembles an inflammatory-like condition, which correlates well with the systemic phenotype of patients, and suggests that these multisystemic disorders might be part of a phenotypic continuum rather than representing distinct clinical entities. Copyright © 2018 Elsevier B.V. All rights reserved.

Síndrome de Brown bilateral associada com hipermobilidade articular benigna: relato de caso Bilateral Brown's syndrome associated with benign joint hypermobility: a case report

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David Kirsch

2007-03-01

Full Text Available A síndrome de Brown é caracterizada por grande limitação de elevação em adução, elevação ligeiramente diminuída ou normal na abdução, anisotropia em "Y" ou "V", intorção do olho em supraversão e ducção forçada positiva. Sua causa se deve à inelastibilidade do músculo oblíquo superior ou por sua contenção em sua própria bainha. A hipermobilidade articular benigna é doença hereditária do tecido conectivo caracterizada por aumento da mobilidade em diversas articulações. Sua prevalência é muito variável em relação à idade, sexo e etnia, variando de 2 a 35% em homens e de 5 a 57% e mulheres. Neste relato os autores descrevem um caso de síndrome de Brown associada com hipermobilidade articular benigna e atentam para a associação pouco referida na literatura. J.C.S, masculino, 6 anos de idade, pardo, estudante, foi encaminhado à Universidade de Santo Amaro com queixa de exotropia há dois anos que aumentava na supraversão. Paciente com o diagnóstico de síndrome de Brown bilateral teve o diagnóstico de hipermobilidade articular benigna pelo Reumatologista. O paciente com hipermobilidade articular benigna pode desenvolver sintomas articulares como artralgia devido a uma inflamação articular. Acreditamos na possibilidade de que síndrome de Brown possa ter ocorrido devido a processo inflamatório na tróclea que teve início devido a hipermobilidade articular benigna.Brown's syndrome is characterized by a limitation of elevation in adduction, slight or normal limitation of elevation in abduction, divergence in straight upgaze (V-pattern, intorsion in upgaze and positive forced duction. It is caused by a tight or inelastic superior oblique tendon. Benign joint hypermobility is a hereditary disease of the connective tissue characterized by an increase of mobility in diverse joints. Its prevalence is very changeable regarding age range, sex and ethnicity, varying from 2 to 35% in men and 5 to 57% in women. In

Recreational facilities: a guide to recreational facilities in the East Coast Area Health Board

LENUS (Irish Health Repository)

2012-02-01

OBJECTIVE: To determine whether persons with generalized joint hypermobility have an increased risk of lower limb joint injury during sport. DATA SOURCES: PubMed, CINAHL, EMBASE, and SportDiscus were searched through February 2009, without language restrictions, using terms related to risk; hip, ankle, and knee injuries; and joint instability. Reference lists of included studies and relevant reviews were searched by hand. STUDY SELECTION: Selection criteria were peer-reviewed studies with a prospective design that used an objective scale to measure generalized joint hypermobility; the participants were engaged in sport activity, and the injury data were quantitative and based on diagnosis by a health professional, were self-reported, or resulted in time lost to athletic participation. The studies were screened by 1 researcher and checked by a second. Study methods were independently assessed by 2 investigators using the 6-point scale for prognostic studies developed by Pengel. Disagreements were resolved through discussion. Of 4841 studies identified, 18 met inclusion criteria. Of these, 8 were included in random-effects meta-analyses. DATA EXTRACTION: The data extracted by 2 reviewers included participant and sport characteristics and details of joint hypermobility and injury measurements. More detailed data for 4 investigations were obtained from the study authors. Where possible, hypermobility was defined as >\\/=4 of 9 points on the British Society of Rheumatology Scale (BSRS). MAIN RESULTS: Lower limb joint injuries (3 studies, 1047 participants) occurred in 14% of participants. Using the BSRS of joint hypermobility, any lower limb injury was not associated with hypermobility [odds ratio (OR), 1.43; 95% confidence interval (CI), 0.56-3.67]. Using the original authors\\' definitions, hypermobility was associated with risk of knee joint injuries (OR, 2.62; 95% CI, 1.04-6.58) in 5 studies. In 4 studies in which the BSRS could be used (1167 participants; incidence

Hallux Valgus and the First Tarsometatarsal Joint: Clinical and Biomechanical Aspects

NARCIS (Netherlands)

F.W.M. Faber (Frank)

2003-01-01

textabstractThis thesis describes a series of cadaver, experimental, radiographic and clinical studies on the relation between a hallux valgus deformity and mobility of the first tarsometatarsal joint. Hypermobility of stiffnes of the joint was determined by Doppler imaging of vibrations and by

Multimodal Chiropractic Care for Pain and Disability in a Patient Diagnosed With Ehlers-Danlos Syndrome-Hypermobility Type: A Case Report.

Science.gov (United States)

Strunk, Richard G

2017-06-01

The purpose of this article is to describe the clinical response to multimodal chiropractic treatment of a patient diagnosed with Ehlers-Danlos syndrome, hypermobility type (EDS-HT), and chronic pain. A 22-year-old woman presented with severe chronic neck and low back pain, headaches, and bilateral hand pain and stiffness. In addition to these pain complaints, the patient had a family history of EDS, weekly or daily recurring joint dislocations, and upper and lower extremity joint hypermobility. As a result of her significant history and examination findings, which met the Brighton and Villefranche criteria, she was diagnosed with EDS-HT. Treatment primarily consisted of low force joint manipulative therapy and soft tissue therapy intermittently over 21 months concurrently with conventional and complementary medical care. Multiple outcome questionnaires were administered pragmatically at follow-up intervals of 3, 5½, 8½, 19, and 21 months, including but not limited to the Headache and Neck Disability Indices and the Oswestry Low Back Questionnaire. The patient had clinically meaningful improvements on the Neck Disability Index, the Headache Disability Index, and the Revised Oswestry after 3, 5½, 8½, and 21 months from baseline. This patient with EDS-HT had clinically meaningful decreases in disability, headache, and spine pain after a course of multimodal chiropractic care combined with conventional and complementary medical care.

Joint hypermobility in patients with chondromalacia patellae.

Science.gov (United States)

al-Rawi, Z; Nessan, A H

1997-12-01

The relationship between joint mobility and chondromalacia patellae was reported in a prospective study. A total of 115 patients with chondromalacia patellae were compared with 110 healthy individuals without chondromalacia patellae, matched for age and sex, who served as a control group. The degree of joint mobility was scored on a scale of 0-9. The number of individuals with hypermobile joints and the total mobility scores were significantly higher in patients with chondromalacia patellae when compared to the control group (P chondromalacia patellae when compared with the knees of the control group (P Chondromalacia patellae were bilateral in 57% of our patients. It occurred more frequently in the longer leg and was associated with quadriceps muscle wasting in 50% of patients. Flat feet and backache were reported significantly more often in patients compared with the control group (P chondromalacia patellae.

Comparison of dorsal and dorsomedial displacement in evaluation of first ray hypermobility in feet with and without hallux valgus.

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Singh, Dishan; Biz, Carlo; Corradin, Marco; Favero, Laura

2016-06-01

Hypermobility of the first ray, a probable primary cause of hallux valgus, has traditionally been evaluated in the dorsal direction only although the first tarso-metatarsal joint allows movement in a dorso-medial direction. 600 feet, divided according to the presence or absence of hallux valgus, were evaluated for both dorsal and dorso-medial displacement using a Klaue device. In the control group, the mean first ray displacement was 7.2mm (4.2-11.3) in the dorsal direction (sagittal plane) and 8.3mm (4.0-12.6) in the 45° dorso-medial direction. In the hallux valgus group, the mean first ray mobility was 9.8mm (5.2-14.1) in the dorsal direction compared to a mean of 11.0mm (5.9-16.2) in the 45° dorso-medial direction. It is a paradox that hypermobility of the first ray is measured in only a dorsal (vertical) direction whereas a hallux valgus angle and an intermetatarsal angle are only measured in a transverse plane. Furthermore, the weightbearing foot pronates during gait and the first metatarsal is displaced in a dorsomedial direction rather than a pure dorsal direction. It is suggested that measurement hypermobility of the first ray at a 45° dorso-medial direction is more appropriate. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Test-retest reliability and smallest detectable change of the Bristol Impact of Hypermobility (BIoH) questionnaire.

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Palmer, S; Manns, S; Cramp, F; Lewis, R; Clark, E M

2017-12-01

The Bristol Impact of Hypermobility (BIoH) questionnaire is a patient-reported outcome measure developed in conjunction with adults with Joint Hypermobility Syndrome (JHS). It has demonstrated strong concurrent validity with the Short Form-36 (SF-36) physical component score but other psychometric properties have yet to be established. This study aimed to determine its test-retest reliability and smallest detectable change (SDC). A test-retest reliability study. Participants were recruited from the Hypermobility Syndromes Association, a patient organisation in the United Kingdom. Recruitment packs were sent to 1080 adults who had given permission to be contacted about research. BIoH and SF-36 questionnaires were administered at baseline and repeated two weeks later. An 11-point global rating of change scale (-5 to +5) was also administered at two weeks. Test-retest analysis and calculation of the SDC was conducted on 'stable' patients (defined as global rating of change -1 to +1). 462 responses were received. 233 patients reported a 'stable' condition and were included in analysis (95% women; mean (SD) age 44.5 (13.9) years; BIoH score 223.6 (54.0)). The BIoH questionnaire demonstrated excellent test-retest reliability (ICC 0.923, 95% CI 0.900-0.940). The SDC was 42 points (equivalent to 19% of the mean baseline score). The SF-36 physical and mental component scores demonstrated poorer test-retest reliability and larger SDCs (as a proportion of the mean baseline scores). The results provide further evidence of the potential of the BIoH questionnaire to underpin research and clinical practice for people with JHS. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anterior disc displacement with reduction and symptomatic hypermobility in the human temporomandibular joint : Prevalence rates and risk factors in children and teenagers

NARCIS (Netherlands)

Slater, James J. R. Huddleston; Lobbezoo, Frank; Onland-Moret, N. Charlotte; Naeije, Machiel

2007-01-01

Aims: To assess the prevalence rates and risk factors of anterior disc displacement with reduction (ADDR) and symptomatic hypermobility in a large sample of children and teenagers. Prevalence rates were also established in samples of young adults and adults. Methods: Children from 7 Dutch primary

The functional consequences of Generalized Joint Hypermobility

DEFF Research Database (Denmark)

Scheper, Mark C; de Vries, Janneke E; Juul-Kristensen, Birgit

2014-01-01

among students from the Amsterdam School of Health Professions (ASHP) (n = 36) and the Amsterdam School of Arts (ASA), Academy for dance and theater (n = 36) in Amsterdam, The Netherlands. From each participant the following data was collected: Functional status performance (self-reported Physical...

Hypermobility and injuries in a professional ballet company.

Science.gov (United States)

Klemp, P.; Learmonth, I. D.

1984-01-01

A study was conducted on members of the Cape Performing Arts Board (CAPAB) professional ballet company to determine the prevalence of hypermobility and to document the injuries sustained over a ten year period. If forward flexion, which is acquired through training, is excluded as a parameter the difference in hypermobility between dancers and controls is not statistically significant. Considering the stresses imposed on the musculoskeletal system, the number of injuries was surprisingly low. Ligamentous injuries about the ankle and knee were both common and accounted for the major morbidity. There were minor differences in the nature and severity of injuries in the male and female dancers. Back injuries, fractures and osteoarthrosis were uncommon and shin splints was not recorded in any of the dancers. Images p143-a p143-b Figure 1 Figure 2 Figure 3 PMID:6435713

Skin signs in Ehlers-Danlos syndrome: clinical tests and para-clinical methods

DEFF Research Database (Denmark)

Remvig, Lars; Duhn, Ph; Ullman, S

2010-01-01

Objective: The criteria for Ehlers-Danlos syndrome (EDS) and the hypermobility syndrome (HMS) should be reliable. Examination for general joint hypermobility has high reliability but there is only sparse information on the reliability of skin tests, and no information on the level of normal skin...

Skin signs in Ehlers-Danlos syndrome: clinical tests and para-clinical methods

DEFF Research Database (Denmark)

Remvig, L; Duhn, Ph; Ullman, S

2010-01-01

The criteria for Ehlers-Danlos syndrome (EDS) and the hypermobility syndrome (HMS) should be reliable. Examination for general joint hypermobility has high reliability but there is only sparse information on the reliability of skin tests, and no information on the level of normal skin extensibility...

Development and initial validation of the Bristol Impact of Hypermobility questionnaire.

Science.gov (United States)

Palmer, S; Cramp, F; Lewis, R; Gould, G; Clark, E M

2017-06-01

Stage 1 - to identify the impact of joint hypermobility syndrome (JHS) on adults; Stage 2 - to develop a questionnaire to assess the impact of JHS; and Stage 3 - to undertake item reduction and establish the questionnaire's concurrent validity. A mixed methods study employing qualitative focus groups and interviews (Stage 1); a working group of patients, clinicians and researchers, and 'think aloud' interviews (Stage 2); and quantitative analysis of questionnaire responses (Stage 3). Stages 1 and 2 took place in one secondary care hospital in the UK. Members of a UK-wide patient organisation were recruited in Stage 3. In total, 15, four and 615 participants took part in Stages 1, 2 and 3, respectively. Inclusion criteria were: age ≥18 years; diagnosis of JHS; no other conditions affecting physical function; able to give informed consent; and able to understand and communicate in English. None. The development of a questionnaire to assess the impact of JHS. Stage 1 identified a wide range of impairments, activity limitations and participation restrictions In Stage 2, a draft questionnaire was developed and refined following 'think aloud' analysis, leaving 94 scored items. In Stage 3, items were removed on the basis of low severity and/or high correlation with other items. The final Bristol Impact of Hypermobility (BIoH) questionnaire had 55 scored items, and correlated well with the physical component score of the Short Form 36 health questionnaire (r=-0.725). The BIoH questionnaire demonstrated good concurrent validity. Further psychometric properties need to be established. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

State changes in posture and arch of the foot in children aged 4 - 6 years with hypermobility of the joints under the influence of rehabilitation activities in schools

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Kalinichenko I. O.

2013-08-01

Full Text Available The effect of the rehabilitation activities in educational institutions on the dynamics of changes in the state and posture of the foot arch in children. The study involved 446 children aged from 4 to 6 years. The rehabilitation program lasted 10 weeks and consisted of 3 periods. Found that 35.88% of healthy children had impaired posture in the sagittal plane. Flatfoot detected in 64.46% of children with joint hypermobility. After the implementation of the rehabilitation program the value of the brachial arch indicators declined in children 3 major groups, respectively, 32.85 cm, 33.24 cm and 33.92 cm in all major groups established downward trend in the proportion of children with kyphotic posture and flat feet. The positive dynamics of changes in the values of posture in the sagittal plane was observed among children of all 3 major groups: shoulder width increased respectively by 1.55%, 3.09%, 4.77%.

Ehlers-Danlos Syndrome—Hypermobility Type and Hemorrhoids

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Timothy P. Plackett

2014-01-01

Full Text Available Ehlers-Danlos syndrome-hypermobility type (EDS-HT is a connective tissue disorder associated with chronic musculoskeletal pain. The diagnosis is based on simple clinical examination, although it is easily overlooked. Herein we present a case of EDS-HT associated with hemorrhoids and suggest that there may be an association between the two conditions.

Síndrome da hipermobilidade articular em jovem

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Joana Neves

2016-03-01

We report the case of a 14 year old male patient, with chronic low back pain and generalized joint hypermobility. He also presented a marfanoid habitus, hand joint alterations and striae in the right dorsal region. He fulfilled the Brighton Criteria therefore, after excluding other connective tissue diseases, the diagnosis of JHS was established. JHS is an underestimated and underdiagnosed disease, and must be contemplated in front of musculoskeletal pain associated with generalized hypermobility. The authors describe this case highlighting the importance of looking for signs and symptoms which allow the earlier diagnosis and management.

Dynamic MRI evaluation of urethral hypermobility post-radical prostatectomy.

Science.gov (United States)

Suskind, Anne M; DeLancey, John O L; Hussain, Hero K; Montgomery, Jeffrey S; Latini, Jerilyn M; Cameron, Anne P

2014-03-01

One postulated cause of post-prostatectomy incontinence is urethral and bladder neck hypermobility. The objective of this study was to determine the magnitude of anatomical differences of urethral and bladder neck position at rest and with valsalva in continent and incontinent men post-prostatectomy based on dynamic MRI. All subjects underwent a dynamic MRI protocol with valsalva and non-valsalva images and a standard urodynamic evaluation. MRI measurements were taken at rest and with valsalva, including (1) bladder neck to sacrococcygeal inferior pubic point line (SCIPP), (2) urethra to pubis, and (3) bulbar urethra to SCIPP. Data were analyzed in SAS using two-tailed t tests. A total of 21 subjects (13 incontinent and 8 continent) had complete data and were included in the final analysis. The two groups had similar demographic characteristics. On MRI, there were no statistically significant differences in anatomic position of the bladder neck or urethra either at rest or with valsalva. The amount of hypermobility ranged from 0.8 to 2 mm in all measures. There were also no differences in the amount of hypermobility (position at rest minus position at valsalva) between groups. We found no statistically significant differences in bladder neck and urethral position or mobility on dynamic MRI evaluation between continent and incontinent men status post-radical prostatectomy. A more complex mechanism for post-prostatectomy incontinence needs to be modeled in order to better understand the continence mechanism in this select group of men. © 2013 Wiley Periodicals, Inc.

Focal hypermobility observed in cervical arthroplasty with Mobi-C.

Science.gov (United States)

Kerferd, Jack William; Abi-Hanna, David; Phan, Kevin; Rao, Prashanth; Mobbs, Ralph J

2017-12-01

In recent decades cervical arthroplasty, or cervical disc replacement, has been steadily increasing in popularity as a procedure for the treatment of degenerative pathologies of the cervical spine. This is based on an evolving body of literature that documents superior outcomes in cervical disc replacement over fusion, for both single and double level pathologies, in well selected patients. One of the more recent and popular implants currently on the market is the Mobi-C cervical artificial disc (LDR Medical; Troyes, France). In this paper we report on two cases where focal hypermobility was observed following total disc replacement using the Mobi-C cervical artificial disc. This is followed by a discussion as to potential contributing factors to this hypermobility in relation to both implant design, and operative technique, suggesting potential changes that might prevent this in future patients.

Disability in Adolescents and Adults Diagnosed With Hypermobility-Related Disorders

DEFF Research Database (Denmark)

Scheper, Mark C; Juul-Kristensen, Birgit; Rombaut, Lies

2016-01-01

OBJECTIVE: To (1) establish the association of the most common reported symptoms on disability; and (2) study the effectiveness of treatment on disability in patients with Ehlers-Danlos syndrome-hypermobility type (EDS-HT)/hypermobility syndrome (HMS). DATA SOURCES: An electronic search (Medical...... Subject Headings and free-text terms) was conducted in bibliographic databases CENTRAL/MEDLINE. STUDY SELECTION: Comparative, cross-sectional, longitudinal cohort studies and (randomized) controlled trials including patients with HMS/EDS-HT aged ≥17 years were considered for inclusion. A class of symptoms...... collaboration. Z-score transformations were applied to classify the extent of disability in comparison with healthy controls and to ensure comparability between studies. DATA SYNTHESIS: Initially, the electronic search yielded 714 publications, and 21 articles remained for analysis after selection...

Mechanisms underlying reflux symptoms and dysphagia in patients with joint hypermobility syndrome, with and without postural tachycardia syndrome.

Science.gov (United States)

Fikree, A; Aziz, Q; Sifrim, D

2017-06-01

The joint hypermobility syndrome (JHS) is a common non-inflammatory connective tissue disorder which frequently co-exists with postural tachycardia syndrome (PoTS), a form of orthostatic intolerance. Gastrointestinal symptoms and dysmotility have been reported in PoTS. Dysphagia and reflux are common symptoms in JHS, yet no studies have examined the physiological mechanism for these, subdivided by PoTS status. Thirty patients (28 female, ages: 18-62) with JHS and symptoms of reflux (n=28) ± dysphagia (n=25), underwent high-resolution manometry and 24 hour pH-impedance monitoring after questionnaire-based symptom assessment. Esophageal physiology parameters were examined in JHS, subdivided by PoTS status. Fifty-three percent of JHS patients with reflux symptoms had pathological acid reflux, 21% had reflux hypersensitivity, and 25% had functional heartburn. Acid exposure was more likely to be increased in the recumbent than upright position (64% vs 43%). The prevalence of hypotensive lower esophageal sphincter (33%) and hiatus hernia (33%) was low. Forty percent of patients with dysphagia had minor disorders of motility, 60% had functional dysphagia. Eighteen (60%) patients had coexistent PoTS-they had significantly higher dysphagia (21 vs 11.5, P=.04) and reflux scores (24.5 vs 16.5, P=.05), and double the prevalence of pathological acid reflux (64% vs 36%, P=.1) and esophageal dysmotility (50% vs 25%, P=.2) though this was not significant. A large proportion of JHS patients with esophageal symptoms have true reflux-related symptoms or mild esophageal hypomotility, and this is more likely if they have PoTS. © 2017 John Wiley & Sons Ltd.

Alterations in collagen structure in hypermobility and Ehlers-Danlos syndromes detected by Raman spectroscopy in vivo

Science.gov (United States)

Johansson, Carina K.; Gniadecka, Monika; Ullman, Susanne; Halberg, Poul; Kobayasi, Takasi; Wulf, Hans Christian

2000-11-01

Patients with hypermobility syndrome (HS) and Ehlers-Danlos syndrome (EDS) were investigated by means of in vivo near- infrared Fourier-transform Raman spectroscopy. HS is a benign and common condition (up to 5 percent of the population of the Western World). EDS is a rare, inherited connective tissue disease characterized by joint hypermobility, skin hyperextensibility, and other, occasionally serious, organ changes. EDS and HS may be related disorders. We investigated 13 patients with HS, 8 patients with EDS, and 24 healthy volunteers by means of in vivo Raman spectroscopy. The patients were classified according to Beighton and Holzberg et al. No difference in age between the three groups was found (HS 41 (33-49), EDS 36 (25-47), controls 37 (31-42); mean, 95% confidence intervals, respectively). Spectral differences were found in the intensity of the amide-III bands around 1245 and 1270 cm-1 in HS and EDS compared with healthy skin (Kruskal-Wallis, p equals 0,02 for intensity ratios (I1245/I1270) between the investigated groups). To elucidate the character of the alterations in the amide-III bands a curve fitting procedure was applied. In conclusion, Raman spectroscopy may aid in the diagnosis of HS and EDS. Moreover the technique may be useful for analyzing the molecular changes occurring in these syndromes.

Ehlers-Danlos Syndrome, Hypermobility Type: Impact of Somatosensory Orthoses on Postural Control (A Pilot Study

Directory of Open Access Journals (Sweden)

Emma G. Dupuy

2017-06-01

Full Text Available Elhers-Danlos syndrome (EDS is the clinical manifestation of connective tissue disorders, and comprises several clinical forms with no specific symptoms and selective medical examinations which result in a delay in diagnosis of about 10 years. The EDS hypermobility type (hEDS is characterized by generalized joint hypermobility, variable skin hyperextensibility and impaired proprioception. Since somatosensory processing and multisensory integration are crucial for both perception and action, we put forth the hypothesis that somatosensory deficits in hEDS patients may lead, among other clinical symptoms, to misperception of verticality and postural instability. Therefore, the purpose of this study was twofold: (i to assess the impact of somatosensory deficit on subjective visual vertical (SVV and postural stability; and (ii to quantify the effect of wearing somatosensory orthoses (i.e., compressive garments and insoles on postural stability. Six hEDS patients and six age- and gender-matched controls underwent a SVV (sitting, standing, lying on the right side evaluation and a postural control evaluation on a force platform (Synapsys, with or without visual information (eyes open (EO/eyes closed (EC. These two latter conditions performed either without orthoses, or with compression garments (CG, or insoles, or both. Results showed that patients did not exhibit a substantial perceived tilt of the visual vertical in the direction of the body tilt (Aubert effect as did the control subjects. Interestingly, such differential effects were only apparent when the rod was initially positioned to the left of the vertical axis (opposite the longitudinal body axis. In addition, patients showed greater postural instability (sway area than the controls. The removal of vision exacerbated this instability, especially in the mediolateral (ML direction. The wearing of orthoses improved postural stability, especially in the eyes-closed condition, with a particularly

Back mobility and interincisor distance ranges in racially diverse North American healthy children and relationship to generalized hypermobility

Directory of Open Access Journals (Sweden)

Woolston Sophie L

2012-06-01

Full Text Available Abstract Background Given the dearth of normal values, we conducted a cross-sectional study of North American racially diverse children to determine normal values of interincisor distance and lower spine flexion. Methods Demographs of 307 children aged 5–17 seeking treatment emergency care were obtained along with interincisor distance measured by incisor tooth-to-tooth gap, lower spine flexion measured by the Schober and modified Schober measurements, popliteal extension, hypermobility (Beighton score, weight and height. Results Normal range of motion values for the Schober was a mean of 14.3 cm (95% confidence interval (CI was 11.2 to 17. cm and the mean modified Schober’s was 21.6 cm (95% CI 18.4 cm to 24.8 cm. Retained lumbar lordosis on forward flexion was observed in 33%. Back mobility was associated with body mass index (BMI, popliteal angle, and Beighton score but not sex, race or retained lordosis. The mean interincisor distance measurement was 47 mm (95% CI 35 mm to 60 mm and was associated with height and BMI but not sex, race, or Beighton score. Conclusion Normal values for lower back range of motion and interincisor distance were obtained which are needed in pediatric rheumatologic clinics and do not significantly vary as to race or sex. Retained lordosis on forward flexion is a normal variant. Hamstring tightness, hypermobility and BMI need to be considered when ascertaining back mobility.

Physiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials.

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Smith, Toby O; Bacon, Holly; Jerman, Emma; Easton, Vicky; Armon, Kate; Poland, Fiona; Macgregor, Alex J

2014-01-01

This study assessed the literature to determine the efficacy and effectiveness of physiotherapy and occupational therapy interventions in the treatment of people with benign joint hypermobility syndrome (BJHS). Published literature databases including: AMED, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library, in addition to unpublished databases and trial registries were searched to October 2012. All clinical trials comparing the clinical outcomes of Occupational Therapy and Physiotherapy interventions compared to non-treatment or control intervention for people with BJHS were included. Of the 126 search results, 3 clinical studies satisfied the eligibility criteria. The data provides limited support for the use of wrist/hand splints for school children. While there is some support for exercise-based intervention, there is insufficient research to determine the optimal mode, frequency, dosage or type of exercise which should be delivered. The current evidence-base surrounding Occupational Therapy and Physiotherapy in the management of BJHS is limited in size and quality. There is insufficient research exploring the clinical outcomes of a number of interventions including sensory integration, positioning and posture management and education. Longer term, rigorous multi-centre randomised controlled trials are warranted to begin to assess the clinical and cost-effectiveness of interventions for children and adults with BJHS. Implications for Rehabilitation There is an evidence-base to support clinician's use of proprioceptive-based exercises in adults, and either tailored or generalised physiotherapy regimes for children with BJHS. Clinicians should be cautious when considering the prescription of hand/wrist splints for school age children with BJHS, based on the current research. Until further multi-centre trials are conducted assessing the clinical and cost-effectiveness of interventions for children and adult with BJHS, clinical decision-making should be

Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings.

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Cederlöf, Martin; Larsson, Henrik; Lichtenstein, Paul; Almqvist, Catarina; Serlachius, Eva; Ludvigsson, Jonas F

2016-07-04

To assess the risk of psychiatric disorders in Ehlers-Danlos syndrome (EDS) and hypermobility syndrome. Nationwide population-based matched cohort study. EDS, hypermobility syndrome and psychiatric disorders were identified through Swedish national registries. Individuals with EDS (n = 1,771) were matched with comparison individuals (n = 17,710). Further, siblings to individuals with EDS who did not have an EDS diagnosis themselves were compared with matched comparison siblings. Using conditional logistic regression, risk of autism spectrum disorder (ASD), bipolar disorder, attention deficit hyperactivity disorder (ADHD), depression, attempted suicide, suicide and schizophrenia were estimated. The same analyses were conducted in individuals with hypermobility syndrome (n = 10,019) and their siblings. EDS was associated with ASD: risk ratio (RR) 7.4, 95 % confidence interval (95 % CI) 5.2-10.7; bipolar disorder: RR 2.7, CI 1.5-4.7; ADHD: RR 5.6, CI 4.2-7.4; depression: RR 3.4, 95 % CI 2.9-4.1; and attempted suicide: RR 2.1, 95 % CI 1.7-2.7, but not with suicide or schizophrenia. EDS siblings were at increased risk of ADHD: RR 2.1, 95 % CI 1.4-3.3; depression: RR 1.5, 95 % CI 1.1-1.8; and suicide attempt: RR 1.8, 95 % CI 1.4-2.3. Similar results were observed for individuals with hypermobility syndrome and their siblings. Individuals with EDS and hypermobility syndrome are at increased risks of being diagnosed with psychiatric disorders. These risk increases may have a genetic and/or early environmental background as suggested by evidence showing that siblings to patients have elevated risks of certain psychiatric disorders.

[The Ehlers-Danlos syndrome: hystory of a clinical hendiadys].

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Brazzaventre, Cristina; Celletti, Claudia; Gobattoni, Paolo; Santilli, Valter; Camerota, Filippo

2013-01-01

Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility and tissue fragility, which results in easy bruising and abnormal scarring. The condition shows a phenotypic variance from milder to serious presentations. Complaints related to activity (hypermobility, dislocations, impaired balance), to pain (general pain, headache, jaw and tooth pain) and to skin (bruises, fragility, impaired wound healing) are frequent. It was first noted by Hippocrates in 400 BC in his writing 'Airs Water and Places' that the nomads Scythians had lax joints and multiple scars. Whereas the additional flexibility can give benefits in term of mobility and agility, adverse effects of tissue laxity and fragility can give rise to clinical consequences. We recognize that it is important that, in those hypermobility patients, who develop potentially debilitating symptoms of chronicfatigue or widespread pain, there should be prompt an appropriate intervention.

Muscle strength assessment among children and adolescents with growing pains and joint hypermobility Avaliação da força muscular em crianças e adolescentes com dores de crescimento e hipermobilidade articular

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ALV Marcolin

2009-04-01

Full Text Available OBJECTIVE: To compare the muscle strength of children and adolescents with growing pains, with and without joint hypermobility, to healthy controls by means of quantitative tests. METHOD: Forty-seven children and adolescents were monitored because of growing pains: 24 with joint hypermobility (GP-JH group and 23 without joint hypermobility (GP group. These cases, along with 47 healthy controls matched for age and gender, underwent two quantitative tests for muscle strength evaluation: the Childhood Myositis Assessment Scale (CMAS and the Manual Muscle Strength Test (MMT. Anthropometric data such as height, weight, body mass index, triceps skinfold, mean arm circumference and arm muscle area were compared between the three groups. RESULTS: The three groups did not present any statistical differences in anthropometric measurements. There were significant differences in median CMAS scores, which were lower in the GP (47; range 39-52 and GP-JH (46; range 40-51 groups than the control group (50; range 45-52; pOBJETIVO: Avaliar, por meio de teste quantitativo, a força muscular em crianças e adolescentes com dores de crescimento, associada ou não com hipermobilidade articular e comparadas com controles saudáveis. MÉTODO: Quarenta e sete casos de crianças e adolescentes acompanhados por dores de crescimento, sendo 24 com hipermobilidade articular (DC-HA, 23 sem hipermobilidade articular (DC e 47 controles saudáveis pareados por idade e gênero foram submetidos a dois testes quantitativos para a avaliação da força muscular, o Childhood Myositis Assessment Scale (CMAS e o Manual Muscle Strength Test (MMT. Os dados antropométricos como altura, peso, índice de massa corporal, prega cutânea tricipital, circunferência média do braço e a área muscular do braço foram comparados entre os três grupos. RESULTADOS: Os três grupos não apresentaram diferença estatística entre as medidas antropométricas. Houve diferença significante entre a

Functional disorders of the temporomandibular joints: Internal derangement of the temporomandibular joint.

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Chang, Chih-Ling; Wang, Ding-Han; Yang, Mu-Chen; Hsu, Wun-Eng; Hsu, Ming-Lun

2018-04-01

Temporomandibular joint (TMJ) is one of the most complex joints of the human body. Due to its unique movement, in terms of combination of rotation and translator movement, disc of the joint plays an important role to maintain its normal function. In order to sustain the normal function of the TMJ, disc must be kept in proper position as well as maintain normal shape in all circumstances. Once the disc is not any more in its normal position during function of the joint, disturbance of the joint can be occurred which will lead to subsequent distortion of the disc. Shape of the disc can be influenced by many factors i.e.: abnormal function or composition of the disc itself. Etiology of the internal derangement of the disc remains controversial. Multifactorial theory has been postulated in most of previous manuscripts. Disc is composed of mainly extracellular matrix. Abnormal proportion of collagen type I & III may also leads to joint hypermobility which may be also a predisposing factor of this disorder. Thus it can be recognized as local manifestation of a systemic disorder. Different treatment modalities with from conservative treatment to surgical intervention distinct success rate have been reported. Recently treatment with extracellular matrix injection becomes more and more popular to strengthen the joint itself. Since multifactorial in character, the best solution of the treatment modalities should be aimed to resolve possible etiology from different aspects. Team work may be indication to reach satisfied results. Copyright © 2018. Published by Elsevier Taiwan.

Ehlers-Danlos syndrome in a young woman with anorexia nervosa and complex somatic symptoms.

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Lee, Michelle; Strand, Mattias

2018-03-01

The Ehler-Danlos syndromes (EDS) are a group of clinically heterogeneous connective tissue disorders characterized by joint hypermobility, hyperextensibility of the skin, and a general connective tissue fragility that can induce symptoms from multiple organ systems. We present a case of comorbid anorexia nervosa and EDS in a 23-year old woman with a multitude of somatic symptoms that were initially attributed to the eating disorder but that were likely caused by the underlying EDS. Various EDS symptoms, such as gastrointestinal complaints, smell and taste abnormalities, and altered somatosensory awareness may resemble or mask an underlying eating disorder, and vice versa. Because of the large clinical heterogeneity, correctly identifying symptoms of EDS presents a challenge for clinicians, who should be aware of this group of underdiagnosed and potentially serious syndromes. The Beighton Hypermobility Score is an easily applicable screening instrument in assessing potential EDS in patients with joint hypermobility. © 2017 Wiley Periodicals, Inc.

Paralyse af nervus peroneus hos patient med Ehlers-Danlos syndrom

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Al-Aubaidi, Zaid; Skov, Ole

2011-01-01

Ehlers-Danlos syndrome (EDS) is a hereditary generalized connective tissue disorder characterized by skin hyperextensibility, joint hypermobility and tissue fragility. Peripheral neuropathy is described sporadically. Although the exact mechanism of the neuropathy is not well-known, excessive...

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

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Popelka Stanislav

2012-08-01

Full Text Available Abstract Background Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability. Methods The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Results Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3% in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%. Conclusion The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis.

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Kimura, Tadashi; Kubota, Makoto; Suzuki, Naoki; Hattori, Asaki; Marumo, Keishi

2018-03-01

An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet. Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions. Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion ( P = .0067) and inversion ( P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint. This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint. Level III, case-control study.

Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome.

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Roma, Maria; Marden, Colleen L; De Wandele, Inge; Francomano, Clair A; Rowe, Peter C

2018-03-05

To review the association between orthostatic intolerance syndromes and both joint hypermobility and Ehlers-Danlos syndrome, and to propose reasons for identifying hereditary connective tissue disorders in those with orthostatic intolerance in the context of both clinical care and research. We searched the published peer-reviewed medical literature for papers reporting an association between joint hypermobility or Ehlers-Danlos syndrome and orthostatic intolerance. We identified 10 relevant papers. Although methodological variability between studies introduces some limitations, the published literature consistently identifies a significantly higher prevalence of orthostatic intolerance symptoms in patients with joint hypermobility or Ehlers-Danlos syndrome than in healthy controls, and a significantly higher prevalence of cardiovascular and autonomic abnormalities both at rest and during orthostatic challenge. Postural tachycardia syndrome is the most commonly recognized circulatory disorder. The severity of orthostatic symptoms in those with EDS correlates with impairments in quality of life. There is a strong association between several forms of cardiovascular dysfunction, most notably postural tachycardia syndrome, and joint hypermobility or Ehlers-Danlos syndrome. We propose that recognition of joint hypermobility and Ehlers-Danlos syndrome among those with orthostatic intolerance syndromes has the potential to improve clinical care and the validity of research findings. Copyright © 2018 Elsevier B.V. All rights reserved.

Gait Strategy in Patients with Ehlers-Danlos Syndrome Hypermobility Type and Down Syndrome

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Rigoldi, Chiara; Galli, Manuela; Cimolin, Veronica; Camerota, Filippo; Celletti, Claudia; Tenore, Nunzio; Albertini, Giorgio

2012-01-01

People suffering from Ehlers-Danlos syndrome (EDS) hypermobility type present a severe ligament laxity that results in difficulties in muscle force transmission. The same condition is present in people suffering from Down syndrome (DS) even if their clumsy movements are due to cerebral and cognitive impairments. The aim of this study was to…

Ehlers-Danlos syndrome

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Wakhloo Tulika

2015-01-01

Full Text Available Ehlers-Danlos syndrome is a group of clinically and genetically heterogeneous inherited connective tissue disorders with widespread manifestations. The prevalence of this syndrome is 1:5000 worldwide without gender, racial or ethnic associations. This syndrome is characterized by joint hypermobility, dermal hyperelasticity and tissue fragility caused by mutations in genes encoding collagen type I, III, V and enzymes involved in the posttranslational modifications of collagen. The oral manifestations include increased mucosal fragility, delayed wound healing, early onset generalized periodontitis and temporomandibular joint hypermobility. Children presenting with this syndrome are often misdiagnosed for hematological problem as they present with bruising, malignancy and/or child abuse. A thorough assessment of the patient is, therefore, essential for early diagnosis and patient referral. This paper reviews current literature, oral manifestations, diagnostic investigations and effective dental management.

Measurement properties of clinical assessment methods for classifying generalized joint hypermobility

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Juul-Kristensen, Birgit; Schmedling, Karoline; Rombaut, Lies

2017-01-01

methods. For BS-self, the validity showed unknown evidence compared with test assessment methods. In conclusion, following recommended uniformity of testing procedures, the recommendation for clinical use in adults is BS with cut-point of 5 of 9 including historical information, while in children it is BS...... with cut-point of at least 6 of 9. However, more studies are needed to conclude on the validity properties of these assessment methods, and before evidence-based recommendations can be made for clinical use on the "best" assessment method for classifying GJH. © 2017 Wiley Periodicals, Inc....... for evaluating the methodological quality of the identified studies, all included studies were rated "fair" or "poor." Most studies were using BS, and for BS the reliability most of the studies showed limited positive to conflicting evidence, with some shortcomings on studies for the validity. The three other...

[Two cases of rehabilitation in Ehler-Danlos syndrome].

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Le Tallec, H; Lassalle, A; Khenioui, H; Durufle, A; Plassat, R; Gallien, P

2006-03-01

Ehlers-Danlos syndrome is rare and little known. It comprises a heterogeneous group of heritable connective tissue disorders characterized by articular hypermobility, skin extensibility and tissue fragility. Diagnosis may be difficult and often delayed. Here we describe 2 cases of women with Ehlers-Danlos syndrome. The first had scoliosis with back pain and joint hypermobility. The second presented with hypermobility and joint dislocation, which increased during pregnancy. In these 2 cases, rehabilitation management produced clinical improvement. Orthopaedic complications such joint pain, joint swelling, joint dislocation, back pain, with walking and hand function disability are the main problems in Ehlers-Danos syndrome. Surgery may be necessary to correct dislocated joints but is often not sufficient to resolve the handicap, and physical therapy has an important place in management. Ehlers-Danlos syndrome is an evolving disease that can lead to great impairment. Thus, physicians must be aware of this syndrome to offer the best management, with the appropriate use of orthotic devices, specific strengthening routines, education in proper body mechanics and assistive devices, to prevent joint dislocation and subluxations responsible for pain and handicap.

Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers.

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Longworth, Brooke; Fary, Robyn; Hopper, Diana

2014-09-01

To determine any differences between the prevalence of adolescent idiopathic scoliosis in ballet dancers who are girls compared with age-matched nondancers, and to establish if any relations exist between the presence of scoliosis and generalized joint hypermobility, age of menarche, body mass index (BMI), and the number of hours of dance training per week. Cross-sectional, matched pair study. Dance school. Dancers (n=30) between the ages of 9 and 16 years were recruited from a certified dance school in Western Australia; each dancer provided a consenting age-matched nondancer (n=30). Not applicable. Measurements were taken for angle of trunk rotation using a scoliometer (presence of scoliosis) and for height and weight to produce generalized joint hypermobility using Beighton criteria and an age-adjusted BMI, respectively. A subjective questionnaire regarding age of menarche and participation in dance and other sports was completed. Thirty percent of dancers tested positive for scoliosis compared with 3% of nondancers. Odds ratio calculations suggest that dancers were 12.4 times more likely to have scoliosis than nondancers of the same age. There was a higher rate of hypermobility in the dancer group (70%) compared with the nondancers (3%); however, there were no statistically significant relations between scoliosis and hypermobility, age of menarche, BMI, or hours of dance per week. Adolescent dancers, similar to adult dancers, are at significantly higher risk of developing scoliosis than nondancers of the same age. Vigilant screening and improved education of dance teachers and parents of dance students may be beneficial in earlier detection and, consequently, reducing the risk of requiring surgical intervention. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Hip Joint Effusion-Synovitis Is Associated With Hip Pain and Sports/Recreation Function in Female Professional Ballet Dancers.

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Mayes, Susan; Ferris, April-Rose; Smith, Peter; Cook, Jill

2018-03-23

To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. Case-control study. Elite ballet and sport. Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.

A novel surgical correction and innovative splint for swan neck deformity in hypermobility syndrome

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Karthik Vishwanathan

2018-01-01

Full Text Available Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an uncommon condition, and it can be seen in rheumatoid arthritis, cerebral palsy, and after trauma. Conservative treatment of the swan neck deformity is available by different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. This case report describes the result of novel surgical intervention and an innovative hand splint in a 20-year-old female with a history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work sometimes for as static and some time as dynamic for positional and correction of the finger. After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and can work independently.

Generalized dysplasia epiphysealis hemimelica with contralateral sacro-iliac joint involvement

International Nuclear Information System (INIS)

Karam, Adib R.; Birjawi, Ghina A.; Khoury, Nabil J.; Saghieh, Said; Tawil, Ayman

2008-01-01

Dysplasia epiphysealis hemimelica (or Trevor's disease) is a rare developmental bone dysplasia characterized by benign osteocartilaginous overgrowth involving one or multiple epiphyses, usually of a single lower extremity. It is classified as localized form, classical form (most common), and generalized form. In this report we describe a case of generalized form of dysplasia epiphysealis hemimelica with involvement of the contralateral sacroiliac joint, which is an extremely rare presentation. (orig.)

Generalized dysplasia epiphysealis hemimelica with contralateral sacro-iliac joint involvement

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Karam, Adib R.; Birjawi, Ghina A.; Khoury, Nabil J. [American University of Beirut Medical Center, Department of Diagnostic Radiology, Beirut (Lebanon); Saghieh, Said [American University of Beirut Medical Center, Department of Orthopedic Surgery, Beirut (Lebanon); Tawil, Ayman [American University of Beirut Medical Center, Department of Pathology, Beirut (Lebanon)

2008-12-15

Dysplasia epiphysealis hemimelica (or Trevor's disease) is a rare developmental bone dysplasia characterized by benign osteocartilaginous overgrowth involving one or multiple epiphyses, usually of a single lower extremity. It is classified as localized form, classical form (most common), and generalized form. In this report we describe a case of generalized form of dysplasia epiphysealis hemimelica with involvement of the contralateral sacroiliac joint, which is an extremely rare presentation. (orig.)

A comparative study on scapular static position between femaleswith and without generalized joint hyper mobility

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Afsun Nodehi Moghadam

2012-08-01

Full Text Available Abstract Background: Generalized joint hyper mobility predisposes some individuals to a wide variety of musculoskeletal complaints. Given the critical role of scapular position in function of shoulder, the aim of this study was to compare scapular position between persons with and without general joint hyper mobility. Methods: By nonprobability sampling 30 hyper mobile persons at average of 22.86 ±2.77 years of age and 30 non hyper mobile persons (age 23.6 ± 2.73years through a case-control design participated in the study. Scapular position was assessed according to the lateral scapular slide test. Independent t test and repeated measures ANOVA were used to statistically analyze scapular position differences between groups.  Results: Compared to non hyper mobile persons, those with General joint hyper mobility demonstrated a significantly higher superior scapula slide in dependent arm position (p=0.03. However, no significant difference was found between another scores between two groups (p>0.05. Conclusion: The results suggest that altered scapular position may be an important aspect of General joint hyper mobility.

Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques.

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Harwich, Andrew S

2017-12-01

The objective of this study was to describe the initial stage of a generalized theory of high-velocity, low-amplitude thrust (HVLAT) techniques for joint manipulation. This study examined the movements described by authors from the fields of osteopathy, chiropractic, and physical therapy to produce joint cavitation in both the metacarpophalangeal (MCP) joint and the cervical spine apophysial joint. This study qualitatively compared the kinetics, the similarities, and the differences between MCP cavitation and cervical facet joint cavitation. A qualitative vector analysis of forces and movements was undertaken by constructing computer-generated, simplified graphical models of the MCP joint and a typical cervical apophysial joint and imposing the motions dictated by the clinical technique. Comparing the path to cavitation of 2 modes of HVLAT for the MCP joint, namely, distraction and hyperflexion, it was found that the hyperflexion method requires an axis of rotation, the hinge axis, which is also required for cervical HVLAT. These results show that there is an analogue of cervical HVLAT in one of the MCP joint HVLATs. The study demonstrated that in a theoretical model, the path to joint cavitation is the same for asymmetric separation of the joint surfaces in the cervical spine and the MCP joints.

Trabeculectomy with scleral patch graft for advanced glaucoma in ehler–danlos syndrome

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Dhanya Cheriyath; Shabana Bharathi; Ganesh V Raman

2016-01-01

We report a case of secondary glaucoma in Ehler–Danlos syndrome (EDS) Type VI, which was uncontrolled with maximal medical therapy, and was subsequently managed surgically. EDS comprises a subgroup of heritable connective tissue disorders characterized by generalized joint hypermobility, skin hyperextensibility, and tissue fragility. The surgical challenges in these patients are presence of scleral thinning, vascular fragility, and poor wound healing. Surgical intervention such as trabeculect...

A novel missense mutation of COL5A2 in a patient with Ehlers-Danlos syndrome.

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Watanabe, Miki; Nakagawa, Ryuji; Naruto, Takuya; Kohmoto, Tomohiro; Suga, Ken-Ichi; Goji, Aya; Kagami, Shoji; Masuda, Kiyoshi; Imoto, Issei

2016-01-01

Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders characterized by hyperextensible skin, joint hypermobility and soft tissue fragility. For molecular diagnosis, targeted exome sequencing was performed on a 9-year-old male patient who was clinically suspected to have EDS. The patient presented with progressive kyphoscoliosis, joint hypermobility and hyperextensible skin without scars. Ultimately, classical EDS was diagnosed by identifying a novel, mono-allelic mutation in COL5A2 [NM_000393.3(COL5A2_v001):c.682G>A, p.Gly228Arg].

A novel missense mutation of COL5A2 in a patient with Ehlers–Danlos syndrome

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Watanabe, Miki; Nakagawa, Ryuji; Naruto, Takuya; Kohmoto, Tomohiro; Suga, Ken-ichi; Goji, Aya; Kagami, Shoji; Masuda, Kiyoshi; Imoto, Issei

2016-01-01

Ehlers–Danlos syndrome (EDS) is a group of inherited connective tissue disorders characterized by hyperextensible skin, joint hypermobility and soft tissue fragility. For molecular diagnosis, targeted exome sequencing was performed on a 9-year-old male patient who was clinically suspected to have EDS. The patient presented with progressive kyphoscoliosis, joint hypermobility and hyperextensible skin without scars. Ultimately, classical EDS was diagnosed by identifying a novel, mono-allelic mutation in COL5A2 [NM_000393.3(COL5A2_v001):c.682G>A, p.Gly228Arg]. PMID:27656288

Measuring Regularity of Human Postural Sway Using Approximate Entropy and Sample Entropy in Patients with Ehlers-Danlos Syndrome Hypermobility Type

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Rigoldi, Chiara; Cimolin, Veronica; Camerota, Filippo; Celletti, Claudia; Albertini, Giorgio; Mainardi, Luca; Galli, Manuela

2013-01-01

Ligament laxity in Ehlers-Danlos syndrome hypermobility type (EDS-HT) patients can influence the intrinsic information about posture and movement and can have a negative effect on the appropriateness of postural reactions. Several measures have been proposed in literature to describe the planar migration of CoP over the base of support, and the…

75 FR 28656 - New United Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation, and...

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2010-05-21

... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation, and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, and Toyota Engineering and Manufacturing... joint venture of General Motors Corporation and Toyota Motor Corporation, including on-site leased...

75 FR 62424 - New United Motor Manufacturing, Inc. Formerly a Joint Venture of General Motors Corporation and...

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2010-10-08

... Manufacturing, Inc. Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor Corporation...

76 FR 10396 - New United Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and...

Science.gov (United States)

2011-02-24

... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor...

A comparative study on scapular static position between females with and without generalized joint hyper mobility.

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Moghadam, Afsun Nodehi; Salimee, Maryam Moghadam

2012-08-01

Generalized joint hyper mobility predisposes some individuals to a wide variety of musculoskeletal complaints. Given the critical role of scapular position in function of shoulder, the aim of this study was to compare scapular position between persons with and without general joint hyper mobility. By nonprobability sampling 30 hyper mobile persons at average of 22.86 ±2.77 years of age and 30 non hyper mobile persons (age 23.6 ± 2.73years) through a case-control design participated in the study. Scapular position was assessed according to the lateral scapular slide test. Independent t test and repeated measures ANOVA were used to statistically analyze scapular position differences between groups. Compared to non hyper mobile persons, those with General joint hyper mobility demonstrated a significantly higher superior scapula slide in dependent arm position (p = 0.03). However, no significant difference was found between another scores between two groups (p > 0.05). The results suggest that altered scapular position may be an important aspect of General joint hyper mobility.

Neurovisceral phenotypes in the expression of psychiatric symptoms

Directory of Open Access Journals (Sweden)

Jessica Anne Eccles

2015-02-01

Full Text Available This review explores the proposal that vulnerability to psychological symptoms, particularly anxiety, originates in constitutional differences in the control of bodily state, exemplified by a set of conditions that include Joint Hypermobility, Postural Tachycardia Syndrome and Vasovagal Syncope. Research is revealing how brain-body mechanisms underlie individual differences in psychophysiological reactivity that can be important s for predicting, stratifying and treating individuals with anxiety disorders and related conditions. One common constitutional difference is Joint Hypermobility, in which there is an increased range of joint movement as a result of a variant of collagen. Joint hypermobility is over-represented in people with anxiety, mood and neurodevelopmental disorders. It is also linked to stress-sensitive medical conditions such as irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia. Structural differences in ‘emotional’ brain regions are reported in hypermobile individuals, and many people with joint hypermobility manifest autonomic abnormalities, typically Postural Tachycardia Syndrome. Enhanced heart rate reactivity is characteristic of Postural Tachycardia Syndrome, and there is a phenomenological overlap with anxiety disorders, which may be partially accounted for by exaggerated neural reactivity within ventromedial prefrontal cortex. People who experience Vasovagal Syncope, a heritable tendency to fainting induced by emotional challenges (and needle/ blood phobia, are also more vulnerable to anxiety disorders. Neuroimaging implicates brainstem differences in vulnerability to faints, yet the structural integrity of the caudate nucleus appears important for the control of fainting frequency in relation to parasympathetic tone and anxiety. Together there is clinical and neuroanatomical evidence to show that common constitutional differences affecting autonomic responsivity are linked to psychiatric symptoms

75 FR 26794 - New United Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and...

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2010-05-12

... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation... United Motor Manufacturing, Inc., formerly a joint venture of General Motors Corporation and Toyota Motor... reviewed the certification for workers of the subject firm. The workers assemble the Toyota Corolla and the...

Injuries and disorders among young ice skaters: relationship with generalized joint laxity and tightness

Directory of Open Access Journals (Sweden)

Okamura S

2014-08-01

Full Text Available Shinobu Okamura,1 Naoki Wada,1 Masayuki Tazawa,1 Makoto Sohmiya,1 Yoko Ibe,1 Toru Shimizu,1 Shigeru Usuda,2 Kenji Shirakura1 1Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; 2Department of Physical Therapy, Gunma University School of Health Science, Maebashi, Gunma, Japan Abstract: This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters. Keywords: sports injury, skating, junior athlete, tightness, joint laxity, medical checkup

Creep simulation of adhesively bonded joints using modified generalized time hardening model

Energy Technology Data Exchange (ETDEWEB)

Sadigh, Mohammad Ali Saeimi [Azarbaijan Shahid Madani University, Tabriz (Iran, Islamic Republic of)

2016-04-15

Creep behavior of double lap adhesively bonded joints was investigated using experimental tests and numerical analysis. Firstly, uniaxial creep tests were carried out to obtain the creep characteristics and constitutive parameters of the adhesive at different stress and temperature levels. Generalized time hardening model was used to predict the creep behavior of the adhesive. This model was modified to simulate the creep behavior at different stress and temperature levels. Secondly, the developed model was used to simulate the creep behavior of bonded joints using finite element based numerical analysis. Creep deformations of the joints were measured experimentally and good agreement was observed in comparison with the results obtained using numerical simulation. Afterward, stress redistribution due to the creep along the adhesively bonded joint was obtained numerically. It was observed that temperature level had a significant effect on the stress redistribution along the adhesive thickness.

Analysis of Financial Ratio to Distinguish Indonesia Joint Venture General Insurance Company Performance using Discriminant Analysis

Directory of Open Access Journals (Sweden)

Subiakto Soekarno

2012-01-01

Full Text Available Insurance industry stands as a service business that plays a significant role in Indonesiaeconomical condition. The development of insurance industry in Indonesia, both of generalinsurance and life insurance, has increased very fast. The general insurance industry itselfdivided into two major players which are local private company and Joint Venture Company.Lately, the use of statistical techniques and financial ratios models to asses financial institutionsuch as insurance company have been used as one of the appropriate combination inpredicting the performance of an industry. This research aims to distinguish between JointVenture General Insurance Companies that have a good performance and those who are lessperforming well using Discriminant Analysis. Further, the findings led that DiscriminantAnalysis is able to distinguish Joint Venture General Insurance Companies that have a goodperformance and those who are not performing well. There are also six ratios which are RBC,Technical Reserve to Investment Ratio, Debt Ratio, Return on Equity, Loss Ratio, and ExpenseRatio that stand as the most influential ratios to distinguish the performance of joint venturegeneral insurance companies. In addition, the result suggest business people to be concernedtoward those six ratios, to increase their companies’ performance.Key words: general insurance, financial ratio, discriminant analysis

Peripheral nerve block in patients with Ehlers-Danlos syndrome, hypermobility type: a case series.

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Neice, Andrew E; Stubblefield, Eryn E; Woodworth, Glenn E; Aziz, Michael F

2016-09-01

Ehlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy. Case series, chart review. Academic medical center. Patients with a confirmed or probable diagnosis of EDS who had received a peripheral nerve block in the last 3 years were identified by searching our institutions electronic medical record system. The patients were classified by their subtype of EDS. Patients with no diagnosed subtype were given a probable subtype based on a chart review of the patient's symptoms. Patient charts were reviewed for any evidence of complications or reduced block efficacy. A total of 21 regional anesthetics, on 16 unique patients were identified, 10 of which had a EDS subtype diagnosis. The majority of these patients had a diagnosis of hypermobility-type EDS. No block complications were noted in any patients. Two block failures requiring repeat block were noted, and four patients reported uncontrolled pain on postoperative day one despite successful placement of a peripheral nerve catheter. Additionally, blocks were performed without incident in patients with classical-type and vascular-type EDS although the number was so small that no conclusions can be drawn about relative safety of regional anesthesia in these groups. This series fails to show an increased risk of complications of peripheral nerve blockade in patients with hypermobility-type EDS. Copyright © 2016 Elsevier Inc. All rights reserved.

Computational stability of human knee joint at early stance in Gait: Effects of muscle coactivity and anterior cruciate ligament deficiency.

Science.gov (United States)

Sharifi, M; Shirazi-Adl, A; Marouane, H

2017-10-03

As one of the most complex and vulnerable structures of body, the human knee joint should maintain dynamic equilibrium and stability in occupational and recreational activities. The evaluation of its stability and factors affecting it is vital in performance evaluation/enhancement, injury prevention and treatment managements. Knee stability often manifests itself by pain, hypermobility and giving-way sensations and is usually assessed by the passive joint laxity tests. Mechanical stability of both the human knee joint and the lower extremity at early stance periods of gait (0% and 5%) were quantified here for the first time using a hybrid musculoskeletal model of the lower extremity. The roles of muscle coactivity, simulated by setting minimum muscle activation at 0-10% levels and ACL deficiency, simulated by reducing ACL resistance by up to 85%, on the stability margin as well as joint biomechanics (contact/muscle/ligament forces) were investigated. Dynamic stability was analyzed using both linear buckling and perturbation approaches at the final deformed configurations in gait. The knee joint was much more stable at 0% stance than at 5% due to smaller ground reaction and contact forces. Muscle coactivity, when at lower intensities (knee joint at the heel strike. It also markedly diminishes forces in lateral hamstrings (by up to 39%) and contact forces on the lateral plateau (by up to 17%). Current work emphasizes the need for quantification of the lower extremity stability margin in gait. Copyright © 2017 Elsevier Ltd. All rights reserved.

Relative efficiency of joint-model and full-conditional-specification multiple imputation when conditional models are compatible: The general location model.

Science.gov (United States)

Seaman, Shaun R; Hughes, Rachael A

2018-06-01

Estimating the parameters of a regression model of interest is complicated by missing data on the variables in that model. Multiple imputation is commonly used to handle these missing data. Joint model multiple imputation and full-conditional specification multiple imputation are known to yield imputed data with the same asymptotic distribution when the conditional models of full-conditional specification are compatible with that joint model. We show that this asymptotic equivalence of imputation distributions does not imply that joint model multiple imputation and full-conditional specification multiple imputation will also yield asymptotically equally efficient inference about the parameters of the model of interest, nor that they will be equally robust to misspecification of the joint model. When the conditional models used by full-conditional specification multiple imputation are linear, logistic and multinomial regressions, these are compatible with a restricted general location joint model. We show that multiple imputation using the restricted general location joint model can be substantially more asymptotically efficient than full-conditional specification multiple imputation, but this typically requires very strong associations between variables. When associations are weaker, the efficiency gain is small. Moreover, full-conditional specification multiple imputation is shown to be potentially much more robust than joint model multiple imputation using the restricted general location model to mispecification of that model when there is substantial missingness in the outcome variable.

Recommendations for anesthesia and perioperative management in patients with Ehlers-Danlos syndrome(s)

Science.gov (United States)

2014-01-01

Ehlers-Danlos syndrome (EDS, ORPHA98249) comprises a group of clinically and genetically heterogeneous heritable connective tissue disorders, chiefly characterized by joint hypermobility and instability, skin texture anomalies, and vascular and soft tissue fragility. As many tissues can be involved, the underlying molecular defect can manifest itself in many organs and with varying degrees of severity, with widespread implications for anesthesia and perioperative management. This review focuses on issues relevant for anesthesia for elective and emergency surgery in EDS. We searched the literature for papers related to all EDS variants; at the moment most of the published data deals with the vascular subtype and, to a lesser extent, classic and hypermobility EDS. Knowledge is fragmented and consists mostly of case reports, small case series and expert opinion. Because EDS patients commonly require surgery, we have summarized some recommendations for general, obstetrical and regional anesthesia, as well as for hemostatic therapy. PMID:25053156

75 FR 47632 - New United Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and...

Science.gov (United States)

2010-08-06

... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... of General Motors Corporation and Toyota Motor Corporation, including on-site leased workers from...

Motor competence and physical activity in 8-year-old school children with generalized joint hypermobility

DEFF Research Database (Denmark)

Juul-Kristensen, Birgit; Kristensen, Jens Halkjaer; Frausing, Britt

2009-01-01

regarding motor competence, self-reported physical activity, and incidence of musculoskeletal pain and injuries. METHODS: A cross-sectional study of 524 children in the second grade from 10 public schools was performed. A positive response rate was obtained for 416 (79.4%) children, and 411 (78.4%) children...... were clinically examined and tested for motor competence, whereas questionnaire response to items comprising musculoskeletal pain and injuries, in addition to daily level and duration of physical activity, corresponded to 377 (71.9%) children. RESULTS: In total, 29% of the children had GJH4, 19% had...... in the motor competence tests. CONCLUSION: Motor competence and physical activity are not reduced in primary school children at 8 years of age with GJH or BJHS. It is recommended that a potential negative influence on the musculoskeletal system over time, as a result of GJH, be investigated by longitudinal...

The use of a cine-technique in the MRT investigation of the temporo-mandibular joint

International Nuclear Information System (INIS)

Vogl, T.J.; Assal, J.; Eberhard, D.; Weigl, P.; Randzio, J.

1992-01-01

A new cine-technique in a prospective study using rapid gradient echo sequences was evaluated for the MRT investigation of the temporo-mandibular joint. A newly developed hydraulic apparatus was used to produce progressive opening of the jaw and MRT appearances were recorded during predetermined points of mandibular movement. The investigation included 16 normals and 34 patients. A modified gradient echo sequence was combined with an optimised surface coil or a special double coil and this provided good spatial resolution of the articular disc and of the muscular and bony structure. Amongst the abnormal findings were luxation of the disc (15 cases), tears in the disc (5 cases), late effects of internal derangements (12 cases) and condylar hypermobility (7 cases). The new cine-technique provides specific images in any chosen position of the mandible depending on the clinical disability of the patient. (orig.) [de

Genetics Home Reference: dopamine beta-hydroxylase deficiency

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... common features include an unusually large range of joint movement (hypermobility) and muscle weakness. Related Information What ... Dopamine beta-hydroxylase deficiency Washington Univeristy, St. Louis: Neuromuscular Disease Center Patient Support and Advocacy Resources (1 ...

Ehlers-Danlos Syndrome in Orthopaedics

Science.gov (United States)

Shirley, Eric D.; DeMaio, Marlene; Bodurtha, Joanne

2012-01-01

Ehlers-Danlos syndrome is a heterogeneous connective tissue condition characterized by varying degrees of skin hyperextensibility, joint hypermobility, and vascular fragility. Joint dislocations, musculoskeletal pain, atrophic scars, easy bleeding, vessel/viscera rupture, severe scoliosis, and obstetric complications may occur. These manifestations are secondary to abnormal collagen, with specific molecular defects in types I, III, and V collagen; they may also be related to tenascin-X, which has been identified in some patients. Ehlers-Danlos syndrome has been classified into 6 types, with variable degrees of joint instability, skin hyperextensibility, wound healing difficulty, and vascular fragility. Diagnosis begins with recognition of the signs and symptoms of global hypermobility and referring appropriate patients for genetic consultation. It is important to accurately identify patients with Ehlers-Danlos syndrome to initiate appropriate musculoskeletal treatment, optimize anesthetic and postoperative management, perform appropriate vascular screening, and help families address their concerns with other families and advocacy groups. PMID:23016112

A joint-constraint model for human joints using signed distance-fields

DEFF Research Database (Denmark)

Engell-Nørregård, Morten Pol; Abel, Sarah Maria Niebe; Erleben, Kenny

2012-01-01

We present a local joint-constraint model for a single joint which is based on distance fields. Our model is fast, general, and well suited for modeling human joints. In this work, we take a geometric approach and model the geometry of the boundary of the feasible region, i.e., the boundary of all...... allowed poses. A region of feasible poses can be built by embedding motion captured data points in a signed distance field. The only assumption is that the feasible poses form a single connected set of angular values. We show how signed distance fields can be used to generate fast and general joint......-joint dependencies, or joints with more than three degrees of freedom. The resolution of the joint-constraints can be tweaked individually for each degree of freedom, which can be used to optimize memory usage. We perform a comparative study of the key-properties of various joint-constraint models, as well...

Neuromuscular involvement in various types of Ehlers-Danlos syndrome.

NARCIS (Netherlands)

Voermans, N.C.; Alfen, N. van; Pillen, S.; Lammens, M.M.Y.; Schalkwijk, J.; Zwarts, M.J.; Rooij, I.A.L.M. van; Hamel, B.C.J.; Engelen, B.G.M. van

2009-01-01

OBJECTIVE: Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Muscle involvement is plausible based on recently discovered interactions between

Compound heterozygous mutations of the TNXB gene cause primary myopathy

NARCIS (Netherlands)

Penisson-Besnier, I.; Allamand, V.; Beurrier, P.; Martin, L.; Schalkwijk, J.; Vlijmen-Willems, I. van; Gartioux, C.; Malfait, F.; Syx, D.; Macchi, L.; Marcorelles, P.; Arbeille, B.; Croue, A.; Paepe, A. de; Dubas, F.

2013-01-01

Complete deficiency of the extracellular matrix glycoprotein tenascin-X (TNX) leads to recessive forms of Ehlers-Danlos syndrome, clinically characterized by hyperextensible skin, easy bruising and joint hypermobility. Clinical and pathological studies, immunoassay, and molecular analyses were

Mobile Cecum in a Young Woman with Ehlers-Danlos Syndrome Hypermobility type: A Case Report and Review of the Literature.

Science.gov (United States)

Fukuda, Yoshihisa; Higuchi, Yusuke; Shinozaki, Kanae; Tanigawa, Yuji; Abe, Taro; Hanaoka, Nobuyoshi; Matsubayashi, Sunao; Yamaguchi, Tomomi; Kosho, Tomoki; Nakamichi, Koji

2017-10-15

Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is unexpectedly common and is associated with a high rate of gastrointestinal manifestations. We herein report the first documented case of mobile cecum associated with EDS-HT. A 21-year-old woman with repeated right lower abdominal pain was initially diagnosed with EDS-HT. Abdominal examinations performed in the supine position, such as CT and ultrasonography, showed no gross abnormalities. In contrast, oral barium gastrointestinal transit X-ray images obtained with changes in the patient's body position revealed position-dependent cecal volvulus with mobile cecum. She was finally discharged with a dramatic resolution of her symptoms after laparoscopic cecopexy for mobile cecum.

Recognizing the tenascin-X deficient type of Ehlers-Danlos syndrome: a cross-sectional study in 17 patients.

Science.gov (United States)

Demirdas, S; Dulfer, E; Robert, L; Kempers, M; van Beek, D; Micha, D; van Engelen, B G; Hamel, B; Schalkwijk, J; Loeys, B; Maugeri, A; Voermans, N C

2017-03-01

The tenascin-X (TNX) deficient type Ehlers-Danlos syndrome (EDS) is similar to the classical type of EDS. Because of the limited awareness among geneticists and the challenge of the molecular analysis of the TNXB gene, the TNX-deficient type EDS is probably to be under diagnosed. We therefore performed an observational, cross-sectional study. History and physical examination were performed. Results of serum TNX measurements were collected and mutation analysis was performed by a combination of next-generation sequencing (NGS), Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA). Included were 17 patients of 11 families with autosomal recessive inheritance and childhood onset. All patients had hyperextensible skin without atrophic scarring. Hypermobility of the joints was observed in 16 of 17 patients. Deformities of the hands and feet were observed frequently. TNX serum level was tested and absent in 11 patients (seven families). Genetic testing was performed in all families; 12 different mutations were detected, most of which are suspected to lead to non-sense mRNA mediated decay. In short, patients with the TNX-deficient type EDS typically have generalized joint hypermobility, skin hyperextensibility and easy bruising. In contrast to the classical type, the inheritance pattern is autosomal recessive and atrophic scarring is absent. Molecular analysis of TNXB in a diagnostic setting is challenging. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Fatigue is associated with muscle weakness in Ehlers-Danlos syndrome: an explorative study

NARCIS (Netherlands)

Voermans, N.C.; Knoop, H.; Bleijenberg, G.; Engelen, B.G.M. van

2011-01-01

OBJECTIVES: Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that

THE RELATIONSHIP BETWEEN TEMPOROMANDIBULAR-JOINT MOBILITY AND PERIPHERAL JOINT MOBILITY RECONSIDERED

NARCIS (Netherlands)

Dijkstra, P.U.; DEBONT, L.G.M.; VANDERWEELE, L.T.; Boering, G.

The purpose of this paper was to study the relationship between temporomandibular joint (TMJ) mobility and mobility of joints and to study the general character of joint mobility in 83 subjects, 55 females and 28 males (mean age 26.7, range 13-46 years). The subjects were recruited from the

Variabilidade da frequência cardíaca em mulheres com hipermobilidade articular Heart rate variability in women with joint hipermobility

Directory of Open Access Journals (Sweden)

Mariane de Oliveira Nunes

2011-09-01

Full Text Available A hipermobilidade é a capacidade de desempenhar movimentos articulares com amplitude maior que o normal. A prevalência possui variações determinadas pela etnia, sexo, idade, atividade física e variações nos critérios de caracterização. Aproximadamente 30% dos adultos são portadores e apresentam feedback proprioceptivo, sensorial diminuído e espacial alterado da articulação levando a maior frequência de ativação e deformação dos mecanorreceptores nos músculos esqueléticos e na pele. O aumento dos impulsos aferentes dos mecanorreceptores sobre a área cardiovascular no bulbo altera o controle autonômico sobre o coração. O objetivo do estudo foi avaliar o balanço simpatovagal durante manobra de ortostatismo em mulheres com hipermobilidade. Participaram do estudo 27 voluntárias, com 19,97±1,79 anos, índice de massa corpórea abaixo de 25 kg/m², sedentárias e sem uso de medicação. Após diagnóstico da hipermobilidade articular, segundo o escore de Beighton, foram divididas em 2 grupos: 12 hipermóveis (GH e 15 não hipermóveis (GC. O eletrocardiograma foi realizado durante 10 minutos em supino e em pé para análise da variabilidade da frequência cardíaca. A banda de alta frequência (un apresentou diminuição da atividade vagal no GH, pJoint hypermobility is the ability to make joint movements greater than normal. The prevalence has large variations determined by race, sex, age, physical activity and variations in characterization criteria. Approximately 30% of adults are considered carriers and present proprioceptive feedback and sensory decreased and joint space positioning altered leading to greater frequency of activation and deformation on the mechanoreceptors in the skeletal muscles and skin. The increase of afferent impulses of the receptors on the bulb cardiovascular area alters the autonomic control on the heart. The objective of the study was to evaluate sympathovagal balance during orthosthatic

Is chronic fatigue syndrome a connective tissue disorder? A cross-sectional study in adolescents

NARCIS (Netherlands)

van de Putte, E. M.; Uiterwaal, C. S. P. M.; Bots, M. L.; Kuis, W.; Kimpen, J. L. L.; Engelbert, R. H. H.

2005-01-01

To investigate whether constitutional laxity of the connective tissues is more frequently present in adolescents with chronic fatigue syndrome (CFS) than in healthy controls. Increased joint hypermobility in patients with CFS has been previously described, as has lower blood pressure in fatigued

Spinal complications in osteogenesis imperfecta: 47 patients 1-16 years of age

NARCIS (Netherlands)

Engelbert, R. H.; Gerver, W. J.; Breslau-Siderius, L. J.; van der Graaf, Y.; Pruijs, H. E.; van Doorne, J. M.; Beemer, F. A.; Helders, P. J.

1998-01-01

We examined in a cross-sectional study, 47 children (mean age 7.7 (1-16) years) with osteogenesis imperfecta (OI) to find the prevalence of spinal deformities and to correlate these observations with anthropometry. The associations between dentinogenesis imperfecta, joint hypermobility and spinal

75 FR 39045 - New United Motor Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and...

Science.gov (United States)

2010-07-07

... Manufacturing, Inc., Formerly a Joint Venture of General Motors Corporation and Toyota Motor Corporation, Including On- Site Leased Workers From Corestaff, ABM Janitorial, Toyota Engineering and Manufacturing North... Corporation and Toyota Motor Corporation, including on-site leased workers from Corestaff, ABM Janitorial, and...

Joint Duty Prerequisite for Promotion to 07 (Brigadier General

Science.gov (United States)

1989-03-13

NUMBER)(O LTC Julius E. Coats, Jr. 9. PERFORMING ORGANIZATIN NAME AND ADDRESS I0. PROGRAM ELEMENT. PROJECT. tASK U.S. Army War College AREA 4 WORK...new personnel policy; to wit, the Army leadership at all levels should view joint duty re- quirement for selection for flag officer with a positive...the Army leadership at all levels should view joint duty requirement for selection for flag officer with a positive attitude, not as a means for

Part I. Remembering No. 2 (Ladislav Loerinc). EMO joint venture, joint-stock company - really completely useless organ?

International Nuclear Information System (INIS)

Blaha, M.

2008-01-01

In this chapter author reviewed the story of the EMO joint venture, joint-stock company, between Slovenske elektrarne, a. s. and EdF. EMO joint venture, joint-stock company, was established to complete the Mochovce nuclear power plant. EMO joint venture, joint-stock company was closed after one year of work. History of EMO joint venture, joint-stock company, was described by its former general manager Mr. Ladislav Loerinc.

Juvenile muscular atrophy of the distal upper extremities associated with x-linked periventricular heterotopia with features of Ehlers-Danlos syndrome.

Science.gov (United States)

Hommel, Alyson L; Jewett, Tamison; Mortenson, Megan; Caress, James B

2016-10-01

Juvenile muscular atrophy of the distal upper extremities (JMADUE) is a rare, sporadic disorder that affects adolescent males and is characterized by progressive but self-limited weakness of the distal upper extremities. The etiology is unknown, but cervical hyperflexion has been hypothesized. We report a case of an adolescent male who presented with typical JMADUE but also had joint hypermobility and multiple congenital anomalies, including periventricular heterotopias, suggesting a multisystem syndrome. Subsequent diagnostic testing confirmed a diagnosis of JMADUE, and sequencing of the filamin-A gene showed a novel, pathogenic mutation that confirmed an additional diagnosis of X-linked periventricular heterotopias with features of Ehlers-Danlos syndrome (XLPH-EDS). The concurrent diagnosis of these 2 rare conditions suggests a pathogenic connection. It is likely that the joint hypermobility from XLPH-EDS predisposed this patient to developing JMADUE. This supports the cervical hyperflexion theory of pathogenesis. This case also expands the phenotype associated with FLNA mutations. Muscle Nerve 54: 794-797, 2016. © 2016 Wiley Periodicals, Inc.

The 2017 international classification of the Ehlers-Danlos syndromes

DEFF Research Database (Denmark)

Malfait, Fransiska; Francomano, Clair; Byers, Peter H

2017-01-01

The Ehlers-Danlos syndromes (EDS) are a clinically and genetically heterogeneous group of heritable connective tissue disorders (HCTDs) characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Over the past two decades, the Villefranche Nosology, which delineated six s...... that the revised International EDS Classification will serve as a new standard for the diagnosis of EDS and will provide a framework for future research purposes. © 2017 Wiley Periodicals, Inc......., and mutations have been identified in an array of novel genes. The International EDS Consortium proposes a revised EDS classification, which recognizes 13 subtypes. For each of the subtypes, we propose a set of clinical criteria that are suggestive for the diagnosis. However, in view of the vast genetic...... revised the clinical criteria for hypermobile EDS in order to allow for a better distinction from other joint hypermobility disorders. To satisfy research needs, we also propose a pathogenetic scheme, that regroups EDS subtypes for which the causative proteins function within the same pathway. We hope...

Design of joints in steel and composite structures Eurocode 3 : design of steel structures : part 1-8 : design of joints, Eurocode 4 : design of composite steel and concrete structures : part 1-1 : general rules and rules for buildings

CERN Document Server

Jaspart, Jean-Pierre

2016-01-01

This book details the basic concepts and the design rules included in Eurocode 3 Design of steel structures Part 1-8 Design of joints. Joints in composite construction are also addressed through references to Eurocode 4 Design of composite steel and concrete structures Part 1-1 General rules and rules for buildings. Attention has to be duly paid to the joints when designing a steel or composite structure, in terms of the global safety of the construction, and also in terms of the overall cost, including fabrication, transportation and erection. Therefore, in this book, the design of the joints themselves is widely detailed, and aspects of selection of joint configuration and integration of the joints into the analysis and the design process of the whole construction are also fully covered. Connections using mechanical fasteners, welded connections, simple joints, moment-resisting joints and lattice girder joints are considered. Various joint configurations are treated, including beam-to-column, beam-to-beam, ...

Ehlers danlos syndrome in two siblings

Directory of Open Access Journals (Sweden)

Das M

2005-01-01

Full Text Available Two cases of Ehlers-Danlos syndrome affecting two real brothers are being reported. Both of them presented with features of atrophy and hyperextensibility of skin, hypermobility of joints and scarring at the sites of trauma. The elder brother also had kyphoscoliosis and hypogonadism with testicular failure.

Trabeculectomy with scleral patch graft for advanced glaucoma in ehler–danlos syndrome

Directory of Open Access Journals (Sweden)

Dhanya Cheriyath

2016-01-01

Full Text Available We report a case of secondary glaucoma in Ehler–Danlos syndrome (EDS Type VI, which was uncontrolled with maximal medical therapy, and was subsequently managed surgically. EDS comprises a subgroup of heritable connective tissue disorders characterized by generalized joint hypermobility, skin hyperextensibility, and tissue fragility. The surgical challenges in these patients are presence of scleral thinning, vascular fragility, and poor wound healing. Surgical intervention such as trabeculectomy in EDS has not been reported in the literature. With this case report, we share our trials and tribulations in managing this patient with trabeculectomy without antimetabolites, with unexpected modification in the surgery and success.

The value of decision tree analysis in planning anaesthetic care in obstetrics.

Science.gov (United States)

Bamber, J H; Evans, S A

2016-08-01

The use of decision tree analysis is discussed in the context of the anaesthetic and obstetric management of a young pregnant woman with joint hypermobility syndrome with a history of insensitivity to local anaesthesia and a previous difficult intubation due to a tongue tumour. The multidisciplinary clinical decision process resulted in the woman being delivered without complication by elective caesarean section under general anaesthesia after an awake fibreoptic intubation. The decision process used is reviewed and compared retrospectively to a decision tree analytical approach. The benefits and limitations of using decision tree analysis are reviewed and its application in obstetric anaesthesia is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

A cross-sectional survey assessing sources of movement-related fear among people with fibromyalgia syndrome.

Science.gov (United States)

Russek, Leslie; Gardner, Sarah; Maguire, Kelly; Stevens, Caitlin; Brown, Erica Z; Jayawardana, Veroni; Mondal, Sumona

2015-06-01

Fear of movement may contribute to functional limitations and loss of well-being among individuals with fibromyalgia (FM). The objectives of this study were to assess factors contributing to movement-related fear and to explore relationships among these factors, function and wellness, in a widespread population of people with FM. This was an internet survey of individuals with FM. Respondents completed a battery of surveys including the Fibromyalgia Impact Questionnaire--Revised (FIQR), Tampa Scale of Kinesiophobia (TSK), Activities-Specific Balance Confidence Scale (ABC), Primary Care Posttraumatic Stress Disorder screen (PC-PTSD), Vertigo Symptom Scale (VSS-SF), a joint hypermobility syndrome screen (JHS), and screening questions related to obsessive-compulsive personality disorder (OCPD), physical activity, work status, and demographics. Analysis included descriptive statistics, Pearson product-moment correlations, and linear regression. Over a 2-year period, 1,125 people (97.6 % female) completed the survey battery. Kinesiophobia was present in 72.9 % of the respondents, balance confidence was compromised in 74.8 %, PTSD likely in 60.4 %, joint hypermobility syndrome likely in 46.6 %, and OCPD tendencies in 26.8 %. The total FIQR and FIQR perceived function subscores were highly correlated (p  0.4) with pain, kinesiophobia, balance confidence, and vertigo. Reported activity level had poor correlation (r < 0.25) with all measured variables. Pain, ABC, VSS, and TSK predicted FIQR and FIQR-pf, explaining 65 and 48 % of the variance, respectively. Kinesiophobia, balance complaints, vertigo, PTSD, and joint hypermobility were common in this population of people with FM. Sources of movement-related fear correlated to overall wellness and perceived function as measured by the FIQR and FIQR-pf.

26 CFR 1.6015-1 - Relief from joint and several liability on a joint return.

Science.gov (United States)

2010-04-01

... they claim losses attributable to H's limited partnership interest in Partnership A. In January 2006... 26 Internal Revenue 13 2010-04-01 2010-04-01 false Relief from joint and several liability on a... joint and several liability on a joint return. (a) In general. (1) An individual who qualifies and...

The use of a cine-technique in the MRT investigation of the temporo-mandibular joint. Die Anwendung der 'Cine-Technik' in der MRT-Diagnostik des Kiefergelenkes

Energy Technology Data Exchange (ETDEWEB)

Vogl, T.J.; Assal, J. (Univ. Muenchen, Radiologische Klinik Innenstadt (Germany)); Eberhard, D.; Weigl, P.; Randzio, J. (Univ. Muenchen, Klinik und Poliklinik fuer Kieferchirurgie (Germany))

1992-03-01

A new cine-technique in a prospective study using rapid gradient echo sequences was evaluated for the MRT investigation of the temporo-mandibular joint. A newly developed hydraulic apparatus was used to produce progressive opening of the jaw and MRT appearances were recorded during predetermined points of mandibular movement. The investigation included 16 normals and 34 patients. A modified gradient echo sequence was combined with an optimised surface coil or a special double coil and this provided good spatial resolution of the articular disc and of the muscular and bony structure. Amongst the abnormal findings were luxation of the disc (15 cases), tears in the disc (5 cases), late effects of internal derangements (12 cases) and condylar hypermobility (7 cases). The new cine-technique provides specific images in any chosen position of the mandible depending on the clinical disability of the patient. (orig.).

Chronic pain in a patient with Ehlers-Danlos syndrome (hypermobility type): The role of myofascial trigger point injections.

Science.gov (United States)

Tewari, Saipriya; Madabushi, Rajashree; Agarwal, Anil; Gautam, Sujeet K; Khuba, Sandeep

2017-01-01

Chronic widespread musculoskeletal pain is a cardinal symptom in hypermobility type of Ehler Danlos Syndrome (EDS type III). The management of pain in EDS, however, has not been studied in depth. A 30 year old female, known case of EDS, presented to the pain clinic with complaints of severe upper back pain for 6 months. Physical examination of the back revealed two myofascial trigger points over the left rhomboids and the left erector spinae. Local anaesthetic trigger point injections were given at these points, followed by stretching exercises under analgesic cover for the first week. After 1 week the patient reported 60-80% pain relief. This case highlights that we must keep a high index of suspicion for the more treatable causes of pain like myofascial pain syndrome in patients suffering from EDS, and should address it promptly and appropriately in order to maximise patient comfort. Copyright © 2016 Elsevier Ltd. All rights reserved.

15 CFR 296.8 - Joint venture agreement.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Joint venture agreement. 296.8 Section... PROGRAM General § 296.8 Joint venture agreement. NIST shall not issue a TIP award to a joint venture and no costs shall be incurred under a TIP project by the joint venture members until such time as a...

Attributed community mining using joint general non-negative matrix factorization with graph Laplacian

Science.gov (United States)

Chen, Zigang; Li, Lixiang; Peng, Haipeng; Liu, Yuhong; Yang, Yixian

2018-04-01

Community mining for complex social networks with link and attribute information plays an important role according to different application needs. In this paper, based on our proposed general non-negative matrix factorization (GNMF) algorithm without dimension matching constraints in our previous work, we propose the joint GNMF with graph Laplacian (LJGNMF) to implement community mining of complex social networks with link and attribute information according to different application needs. Theoretical derivation result shows that the proposed LJGNMF is fully compatible with previous methods of integrating traditional NMF and symmetric NMF. In addition, experimental results show that the proposed LJGNMF can meet the needs of different community minings by adjusting its parameters, and the effect is better than traditional NMF in the community vertices attributes entropy.

15 CFR 296.7 - Joint venture registration.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Joint venture registration. 296.7 Section 296.7 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade NATIONAL... PROGRAM General § 296.7 Joint venture registration. Joint ventures selected for assistance under the...

FEATURES OF CLINICAL COURSE OF GASTROESOPHAGEAL REFLUX DISEASE IN NEWLY RECRUITED WITH CONNECTIVE TISSUE UNDIFFERENTIATED DYSPLASIA SYNDROME

Directory of Open Access Journals (Sweden)

E.I. Kashkina

2008-12-01

Full Text Available The presence of connective tissue undifferentiated dysplasia syndrome against a background of psychological stress at newly recruited can promote the risk of gastroesophageal reflux disease occurrence. To the utmost, correlation between the gastroesophageal reflux disease and such manifestations of connective tissue undifferentiated dysplasia syndrome as asthenic constitution, chest deformation, Gothic palate and hypermobility of joints was found

The temporomandibular joint

International Nuclear Information System (INIS)

Campbell, W.

1984-01-01

Whilst the temporomandibular joint is in many ways unique, it is subject to all the diseases and disorders found in joints in other parts of the human skeleton. By far the most common disorder is injury, followed by arthropathy, acute and chronic dislocations, ankylosis, and in rare instances, neoplasms. The diagnosis and management of the temporomandibular joint are the primary responsibility of the oral surgeon. Nevertheless, this anatomical region is an area in which the cooperation of medical and dental disciplines may be required for the satisfactory conclusion of treatment. The more so when the disease process involves either associated psychosomatic illness or malignancy. The mainstay of the diagnosis is a careful radiological examination of the joint. There exists a delicate relationship between the dentition, the muscles of mastication, and the temporomandibular articulation, which is controlled by arthrokinetic reflex activity of the branches of the 5th cranial nerve. Imbalance between one or more of the components of this integrated system frequently leads to disturbances in function. Pain-dysfunction disorders constitute the larger part of temporomandibular joint disturbances generally encountered

Joint Chiefs of Staff > Directorates > J6 | C4 & Cyber

Science.gov (United States)

Joint Staff Structure Joint Staff Inspector General Origin of Joint Concepts U.S. Code | Joint Chiefs of Management J1 | Manpower and Personnel J2 | Joint Staff Intelligence J3 | Operations J4 | Logistics► the Joint Staff Chief Information Officer (CIO), the J-6 provides business class Information

Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint

OpenAIRE

McQuade, Kevin; Price, Robert; Liu, Nelson; Ciol, Marcia A

2012-01-01

Examination of articular joints is largely based on subjective assessment of the “end-feel” of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral...

14 CFR 399.37 - Joint fares.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Joint fares. 399.37 Section 399.37 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) POLICY STATEMENTS STATEMENTS OF GENERAL POLICY Policies Relating to Rates and Tariffs § 399.37 Joint fares. There...

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency.

Science.gov (United States)

Macura, Katarzyna Jadwiga; Thompson, Richard Eugene; Bluemke, David Alan; Genadry, Rene

2015-11-28

To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI). The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2O. The ISD incontinence was defined with MUCP pressure below 20 cm H2O, and VLPP pressure less or equal to 60 cm H2O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX). In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P continent volunteers and incontinent patients in body habitus as assessed by the body mass

Seismic Strengthening of Carpentry Joints in Traditional Timber Structures

International Nuclear Information System (INIS)

Parisi, Maria A.; Cordie, Cinzia; Piazza, Maurizio

2008-01-01

The static and dynamic behavior of timber structures largely depends on their connections. In traditional timber construction, elements are usually connected with carpentry joints based on contact pressure and friction, often with only minor reinforcement generically intended to avoid disassembling. In current practice, interventions for the upgrading of carpentry joints are mainly based on empirical knowledge according to tradition. Often they produce a general strengthening of the connection, but are not specific for the case of seismic action. Strengthening on heuristic bases may be only partially effective or possibly disproportioned. The behavior of the carpentry joints most used in roof structures is examined. The birdsmouth joint, connecting rafters to the tie beam, has been studied first, characterizing its behavior numerically and experimentally in monotonic and cyclic conditions. Other forms of the rafter-to-tie connection, the double notch joint and the case of parallel rafters, are discussed. Some general criteria for the seismic strengthening of these joints are presented

Seismic Strengthening of Carpentry Joints in Traditional Timber Structures

Science.gov (United States)

Parisi, Maria A.; Cordié, Cinzia; Piazza, Maurizio

2008-07-01

The static and dynamic behavior of timber structures largely depends on their connections. In traditional timber construction, elements are usually connected with carpentry joints based on contact pressure and friction, often with only minor reinforcement generically intended to avoid disassembling. In current practice, interventions for the upgrading of carpentry joints are mainly based on empirical knowledge according to tradition. Often they produce a general strengthening of the connection, but are not specific for the case of seismic action. Strengthening on heuristic bases may be only partially effective or possibly disproportioned. The behavior of the carpentry joints most used in roof structures is examined. The birdsmouth joint, connecting rafters to the tie beam, has been studied first, characterizing its behavior numerically and experimentally in monotonic and cyclic conditions. Other forms of the rafter-to-tie connection, the double notch joint and the case of parallel rafters, are discussed. Some general criteria for the seismic strengthening of these joints are presented.

Ehler Danlos syndrome with cervical dislocation: An unusual case

OpenAIRE

Neeraj Awasthy; Karam Chand

2008-01-01

Ehler-Danlos syndrome (EDS) is heritable connective tissue disorders with varied manifestations whose primary clinical features include soft, hyperextensible skin, dystrophic scarring, easy bruising, and joint hypermobility. Os odontoideum describes a condition in which the dens is separated from the axis body. The exact frequency is unknown. Known cases are either incidentally detected or are diagnosed when patients become symptomatic. Cervical dislocation has been described with type VI les...

Generalized formulation of an encryption system based on a joint transform correlator and fractional Fourier transform

International Nuclear Information System (INIS)

Vilardy, Juan M; Millán, María S; Pérez-Cabré, Elisabet; Torres, Yezid

2014-01-01

We propose a generalization of the encryption system based on double random phase encoding (DRPE) and a joint transform correlator (JTC), from the Fourier domain to the fractional Fourier domain (FrFD) by using the fractional Fourier operators, such as the fractional Fourier transform (FrFT), fractional traslation, fractional convolution and fractional correlation. Image encryption systems based on a JTC architecture in the FrFD usually produce low quality decrypted images. In this work, we present two approaches to improve the quality of the decrypted images, which are based on nonlinear processing applied to the encrypted function (that contains the joint fractional power spectrum, JFPS) and the nonzero-order JTC in the FrFD. When the two approaches are combined, the quality of the decrypted image is higher. In addition to the advantages introduced by the implementation of the DRPE using a JTC, we demonstrate that the proposed encryption system in the FrFD preserves the shift-invariance property of the JTC-based encryption system in the Fourier domain, with respect to the lateral displacement of both the key random mask in the decryption process and the retrieval of the primary image. The feasibility of this encryption system is verified and analyzed by computer simulations. (paper)

Continuum description for jointed media

International Nuclear Information System (INIS)

Thomas, R.K.

1982-04-01

A general three-dimensional continuum description is presented for a material containing regularly spaced and approximately parallel jointing planes within a representative elementary volume. Constitutive relationships are introduced for linear behavior of the base material and nonlinear normal and shear behavior across jointing planes. Furthermore, a fracture permeability tensor is calculated so that deformation induced alterations to the in-situ values can be measured. Examples for several strain-controlled loading paths are presented

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: the impact of proprioception.

Science.gov (United States)

Scheper, Mark; Rombaut, Lies; de Vries, Janneke; De Wandele, Inge; van der Esch, Martin; Visser, Bart; Malfait, Franciska; Calders, Patrick; Engelbert, Raoul

2017-07-01

The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. Muscle strength was associated with 30CRT (r = 0.67, p = <0.001), 6MWT (r = 0.58, p = <0.001) and HAQ (r = 0.63, p= <0.001). Proprioception was associated with 30CRT (r = 0.55, p < 0.001), 6MWT (r = 0.40, p = <0.05) and HAQ (r = 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. Implications for rehabilitation Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most

Constructing quantum games from symmetric non-factorizable joint probabilities

International Nuclear Information System (INIS)

Chappell, James M.; Iqbal, Azhar; Abbott, Derek

2010-01-01

We construct quantum games from a table of non-factorizable joint probabilities, coupled with a symmetry constraint, requiring symmetrical payoffs between the players. We give the general result for a Nash equilibrium and payoff relations for a game based on non-factorizable joint probabilities, which embeds the classical game. We study a quantum version of Prisoners' Dilemma, Stag Hunt, and the Chicken game constructed from a given table of non-factorizable joint probabilities to find new outcomes in these games. We show that this approach provides a general framework for both classical and quantum games without recourse to the formalism of quantum mechanics.

Structure Assembly by a Heterogeneous Team of Robots Using State Estimation, Generalized Joints, and Mobile Parallel Manipulators

Science.gov (United States)

Komendera, Erik E.; Adhikari, Shaurav; Glassner, Samantha; Kishen, Ashwin; Quartaro, Amy

2017-01-01

Autonomous robotic assembly by mobile field robots has seen significant advances in recent decades, yet practicality remains elusive. Identified challenges include better use of state estimation to and reasoning with uncertainty, spreading out tasks to specialized robots, and implementing representative joining methods. This paper proposes replacing 1) self-correcting mechanical linkages with generalized joints for improved applicability, 2) assembly serial manipulators with parallel manipulators for higher precision and stability, and 3) all-in-one robots with a heterogeneous team of specialized robots for agent simplicity. This paper then describes a general assembly algorithm utilizing state estimation. Finally, these concepts are tested in the context of solar array assembly, requiring a team of robots to assemble, bond, and deploy a set of solar panel mockups to a backbone truss to an accuracy not built into the parts. This paper presents the results of these tests.

Five question to... Stanislav Reguli, chairman of the board of directors and general director of the GovCo, joint-stock association

International Nuclear Information System (INIS)

Stuller, P.

2006-01-01

In this paper the interview with the MR. Stanislav Reguli, chairman of the board of directors and general director of the GovCo, joint-stock association is published. The state company GovCo, a.s. was originated on April 1, 2006. Process of severance of property from the Slovenske elektrarne, a.s., personnel management of new company as well as organisation of property management are presented

Management of Prosthetic Joint Infection.

Science.gov (United States)

Tande, Aaron J; Gomez-Urena, Eric O; Berbari, Elie F; Osmon, Douglas R

2017-06-01

Although uncommon, prosthetic joint infection is a devastating complication. This challenging condition requires a coordinated management approach to achieve good patient outcomes. This review details the general principles to consider when managing patients with prosthetic joint infection. The different medical/surgical treatment strategies and how to appropriately select a strategy are discussed. The data to support each strategy are presented, along with discussion of antimicrobial strategies in specific situations. Copyright © 2017 Elsevier Inc. All rights reserved.

The Case for a Joint Evaluation

Science.gov (United States)

2017-01-01

The Capstone Concept of Joint Operations stresses that “the strength of any Joint Force has always been the combining of unique Service...order. Status Quo of Service Evaluations Across the Services, officers’ careers generally begin with a focus on entry- level technical, managerial ...would retain full control of their current evalu- ation systems. However, the Services’ evaluation systems and information would be fed directly

Constructing quantum games from symmetric non-factorizable joint probabilities

Energy Technology Data Exchange (ETDEWEB)

Chappell, James M., E-mail: james.m.chappell@adelaide.edu.a [School of Chemistry and Physics, University of Adelaide, South Australia 5005 (Australia); School of Electrical and Electronic Engineering, University of Adelaide, South Australia 5005 (Australia); Iqbal, Azhar [School of Electrical and Electronic Engineering, University of Adelaide, South Australia 5005 (Australia); Centre for Advanced Mathematics and Physics, National University of Sciences and Technology, Peshawar Road, Rawalpindi (Pakistan); Abbott, Derek [School of Electrical and Electronic Engineering, University of Adelaide, South Australia 5005 (Australia)

2010-09-06

We construct quantum games from a table of non-factorizable joint probabilities, coupled with a symmetry constraint, requiring symmetrical payoffs between the players. We give the general result for a Nash equilibrium and payoff relations for a game based on non-factorizable joint probabilities, which embeds the classical game. We study a quantum version of Prisoners' Dilemma, Stag Hunt, and the Chicken game constructed from a given table of non-factorizable joint probabilities to find new outcomes in these games. We show that this approach provides a general framework for both classical and quantum games without recourse to the formalism of quantum mechanics.

Development of niobium alloy/stainless steel joint by friction welding, (1)

International Nuclear Information System (INIS)

Kikuchi, Taiji; Kawamura, Hiroshi.

1988-08-01

The niobium alloy and stainless steel have been jointed by the nicrobrazing method generally. However the strength of the jointed part is weaker than that of the mother material. Therefore we developed the niobium alloy(Nb-1 % Zr)/stainless steel(SUS 304) transition joint by the friction welding method. As the tests for the development. We conducted the mechanical tests (tensile test at room temperature, 300 deg C, 500 deg C and 700 deg C, torsion fatigue test and burst test), metallographical observation and electron prove X-ray microanalysis observation. Those tests proved jointed part by the friction welding had enough properties for general uses. (author)

Диспластические синдромы и фенотипы в оценке изменений интервала QT при малых аномалиях сердца

Directory of Open Access Journals (Sweden)

А. В. Ягода

2011-01-01

Full Text Available To assess relation of dysplastic syndromes and phenotypes to pathological QT interval in patients with minor cardiac anomalies, 128 patients aged 18–35 years were examined. A statistically significant increase in the prevalence of QT interval disorder was found. Pathological QT interval without clinical features was observed more frequently. Correlations were revealed between the QT interval disorder and myxomatous mitral valve prolapse, phenotype similar to Marfan syndrome, and benign joints hypermobility.

New lethal disease involving type I and III collagen defect resembling geroderma osteodysplastica, De Barsy syndrome, and Ehlers-Danlos syndrome IV.

OpenAIRE

Jukkola, A; Kauppila, S; Risteli, L; Vuopala, K; Risteli, J; Leisti, J; Pajunen, L

1998-01-01

We describe the clinical findings and biochemical features of a male child suffering from a so far undescribed lethal connective tissue disorder characterised by extreme hypermobility of the joints, lax skin, cataracts, severe growth retardation, and insufficient production of type I and type III procollagens. His features are compared with Ehlers-Danlos type IV, De Barsy syndrome, and geroderma osteodysplastica, as these disorders show some symptoms and signs shared with our patient. The chi...

Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series.

Science.gov (United States)

Cezairli, Burak; Sivrikaya, Efe Can; Omezli, Mehmet Melih; Ayranci, Ferhat; Seyhan Cezairli, Neslihan

2017-10-01

Arthrocentesis and prolotherapy are nonsurgical treatments for temporomandibular joint (TMJ) diseases. This study aimed to evaluate the treatment of hypermobility, pain, and displacement of the TMJ by consecutively performing arthrocentesis and prolotherapy in the same session. In this study, 10 adults with disc displacement and painful, hypermobile TMJ were selected. Arthrocentesis and prolotherapy were consecutively performed using a 30% dextrose solution that was simultaneously injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament. Paired t-test, McNemar test, and chi-square test were used to assess the maximum mouth opening, clicking sounds, pain, and subluxation of the TMJ. Patients with rheumatoid arthritis and parafunctional habits such as teeth clenching and grinding and biting of the cheeks or any other objects and those who had undergone surgery were excluded from this study. A total of 10 participants (36.20 ± 7.06 years old, 7 women and 3 men) received a single treatment session of combined arthrocentesis and prolotherapy at the same office visit. Subluxation frequency and pain significantly decreased after the first week of treatment (p < 0.05). Subluxation also decreased at the 3-month follow-up (p < 0.05). Clicking sound values did not significantly change at any of the follow-up time points. Maximum mouth opening values decreased at all follow-up time points compared to baseline (p < 0.05). A single session of combined arthrocentesis and prolotherapy to treat symptomatic TMJ safely and significantly improved the subluxation and pain after 1 week and subluxation after 3 months compared to baseline status. The maximum mouth opening significantly decreased at all follow-up time points. Future studies assessing multiple treatment sessions are warranted.

Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint.

Science.gov (United States)

McQuade, Kevin; Price, Robert; Liu, Nelson; Ciol, Marcia A

2012-08-30

Examination of articular joints is largely based on subjective assessment of the "end-feel" of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral joint during three common manual joint examination tests with the arm in six positions. An electromagnetic tracking system recorded three-dimensional positions of sensors attached to a clinician examiner and a patient. A hand-held force transducer recorded manually applied translational forces. The force and joint displacement were time-synchronized and the joint stiffness was calculated as a quantitative representation of the joint "end-feel." A methodology and specific system checks were developed to enhance clinical testing reproducibility and precision. The device and testing protocol were tested on 31 subjects (15 with healthy shoulders, and 16 with a variety of shoulder impairments). Results describe the stiffness responses, and demonstrate the feasibility of using the device and methods in clinical settings.

Cancer risk among patients with finger and hand joint and temporo-mandibular joint prostheses in Denmark.

Science.gov (United States)

Fryzek, J P; Mellemkjaer, L; McLaughlin, J K; Blot, W J; Olsen, J H

1999-05-31

The use of artificial joint implants has risen greatly over the past years. However, few investigations of the cancer risk associated with implants have been performed. We investigated cancer risk in patients with finger and hand joint and temporo-mandibular (TMJ) joint implants. A nationwide cohort in Denmark of patients with finger and hand joint prostheses (n = 858) or TMJ implants (n = 389) was followed from January 1, 1977, to December 31, 1995, to evaluate any potential cancer risks subsequent to receiving these implants. Standardized incidence ratios (SIRs) for all cancers were 1.0 (95% CI = 0.8-1.2) for the finger and hand joint cohort and 1.1 (95% CI = 0.8-1.7) for the TMJ cohort. A significant risk for non-Hodgkin's lymphoma was found in the finger and hand joint cohort (SIR = 3.8, 95% CI = 1.5-7.8). When the finger and hand joint cohort was stratified by diagnosis of rheumatoid arthritis, the excess risk was seen only in the group with rheumatoid arthritis. This is consistent with past studies, which have found an association between rheumatoid arthritis and non-Hodgkin's lymphoma. Our results provide evidence that the cancer risk for patients with finger and hand joint prostheses and TMJ implants is similar to that for the general population.

Chondrocyte deformations as a function of tibiofemoral joint loading predicted by a generalized high-throughput pipeline of multi-scale simulations.

Directory of Open Access Journals (Sweden)

Scott C Sibole

Full Text Available Cells of the musculoskeletal system are known to respond to mechanical loading and chondrocytes within the cartilage are not an exception. However, understanding how joint level loads relate to cell level deformations, e.g. in the cartilage, is not a straightforward task. In this study, a multi-scale analysis pipeline was implemented to post-process the results of a macro-scale finite element (FE tibiofemoral joint model to provide joint mechanics based displacement boundary conditions to micro-scale cellular FE models of the cartilage, for the purpose of characterizing chondrocyte deformations in relation to tibiofemoral joint loading. It was possible to identify the load distribution within the knee among its tissue structures and ultimately within the cartilage among its extracellular matrix, pericellular environment and resident chondrocytes. Various cellular deformation metrics (aspect ratio change, volumetric strain, cellular effective strain and maximum shear strain were calculated. To illustrate further utility of this multi-scale modeling pipeline, two micro-scale cartilage constructs were considered: an idealized single cell at the centroid of a 100×100×100 μm block commonly used in past research studies, and an anatomically based (11 cell model of the same volume representation of the middle zone of tibiofemoral cartilage. In both cases, chondrocytes experienced amplified deformations compared to those at the macro-scale, predicted by simulating one body weight compressive loading on the tibiofemoral joint. In the 11 cell case, all cells experienced less deformation than the single cell case, and also exhibited a larger variance in deformation compared to other cells residing in the same block. The coupling method proved to be highly scalable due to micro-scale model independence that allowed for exploitation of distributed memory computing architecture. The method's generalized nature also allows for substitution of any macro

Chondrocyte Deformations as a Function of Tibiofemoral Joint Loading Predicted by a Generalized High-Throughput Pipeline of Multi-Scale Simulations

Science.gov (United States)

Sibole, Scott C.; Erdemir, Ahmet

2012-01-01

Cells of the musculoskeletal system are known to respond to mechanical loading and chondrocytes within the cartilage are not an exception. However, understanding how joint level loads relate to cell level deformations, e.g. in the cartilage, is not a straightforward task. In this study, a multi-scale analysis pipeline was implemented to post-process the results of a macro-scale finite element (FE) tibiofemoral joint model to provide joint mechanics based displacement boundary conditions to micro-scale cellular FE models of the cartilage, for the purpose of characterizing chondrocyte deformations in relation to tibiofemoral joint loading. It was possible to identify the load distribution within the knee among its tissue structures and ultimately within the cartilage among its extracellular matrix, pericellular environment and resident chondrocytes. Various cellular deformation metrics (aspect ratio change, volumetric strain, cellular effective strain and maximum shear strain) were calculated. To illustrate further utility of this multi-scale modeling pipeline, two micro-scale cartilage constructs were considered: an idealized single cell at the centroid of a 100×100×100 μm block commonly used in past research studies, and an anatomically based (11 cell model of the same volume) representation of the middle zone of tibiofemoral cartilage. In both cases, chondrocytes experienced amplified deformations compared to those at the macro-scale, predicted by simulating one body weight compressive loading on the tibiofemoral joint. In the 11 cell case, all cells experienced less deformation than the single cell case, and also exhibited a larger variance in deformation compared to other cells residing in the same block. The coupling method proved to be highly scalable due to micro-scale model independence that allowed for exploitation of distributed memory computing architecture. The method’s generalized nature also allows for substitution of any macro-scale and/or micro

Tearing down the Berlin wall: social workers' perspectives on joint working with general practice.

Science.gov (United States)

Kharicha, Kalpa; Iliffe, Steve; Levin, Enid; Davey, Barbara; Fleming, Cass

2005-08-01

The arrangements for delivering social work and primary health care to older people in England and Wales are currently subject to rapid re-configuration, with the development of integrated primary care and social services trusts. To investigate perceptions of joint working in social services and general practice. The study setting was two London boroughs covered by one health authority, one NHS Community Health Services Trust, four Primary Care Groups and two social services departments. All social work team managers in both areas were interviewed together with a purposive sample of social workers with a high number of older clients on their caseloads. A sample of GPs was sought using a sampling frame of practice size in each borough. Structured interviews with open and closed questions were used. Tape-recorded interviews were transcribed and subject to thematic analysis. Analysis of emergent themes was aided by the use of Atlas-ti. Social workers and GPs agree on the need for joint working, but have different understandings of it, each profession wanting the other to change its organizational culture. Co-location of social and health care is seen as desirable, but threatening to social work. Concerns about differences in power and hierarchical authority are evident and explicit in social work perspectives. Conflict resolution strategies include risk minimization, adopting pragmatic, case-specific solutions rather than remaining consistent with policy, using nurses as mediators, and resorting to authority. Although this is a study from urban areas in England, its findings may have wider significance since we have found that resources and professional skills may be more important than organizational arrangements in collaborative working between disciplines. Primary Care Trusts in England and Wales should promote awareness of these different perspectives, perceived risks and conflict minimization strategies in their work on clinical governance and professional

Carbon Taxes and Joint Implementation. An Applied General Equilibrium Analysis for Germany and India

Energy Technology Data Exchange (ETDEWEB)

Boehringer, C.; Loeschel, A. [Centre for European Economic Research ZEW, Mannheim (Germany); Conrad, K. [Department of Economics, Mannheim University, Mannheim (Germany)

2003-01-01

Germany has committed itself to reducing its carbon emissions by 25% in 2005 as compared to 1990 emission levels. To achieve this goal, the government has recently launched an environmental tax reform which entails a continuous increase in energy taxes in conjunction with a revenue-neutral cut in non-wage labor costs. This policy is supposed to yield a double dividend, reducing both, the problem of global warming and high unemployment rates. In addition to domestic actions, international treaties on climate protection allow for the supplementary use of flexible instruments to exploit cheaper emission reduction possibilities elsewhere. One concrete option for Germany would be to enter joint implementation (JI) with developing countries such as India where Germany pays emission reduction abroad rather than meeting its reduction target solely by domestic action. In this paper, we investigate whether an environmental tax reform cum JI provides employment and overall efficiency gains as compared to an environmental tax reform stand-alone. We address this question in the framework of a large-scale general equilibrium model for Germany and India where Germany may undertake JI with the Indian electricity sector. Our main finding is that JI offsets largely the adverse effects of carbon emission constraints on the German economy. JI significantly lowers the level of carbon taxes and thus reduces the total costs of abatement as well as negative effects on labor demand. In addition, JI triggers direct investment demand for energy efficient power plants produced in Germany. This provides positive employment effects and additional income for Germany. For India, joint implementation equips its electricity industry with scarce capital goods leading to a more efficient power production with lower electricity prices for the economy and substantial welfare gains.

The influence of Ehlers-Danlos syndrome - hypermobility type, on motherhood: A phenomenological, hermeneutical study.

Science.gov (United States)

De Baets, Stijn; Vanhalst, Marieke; Coussens, Marieke; Rombaut, Lies; Malfait, Fransiska; Van Hove, Geert; Calders, Patrick; Vanderstraeten, Guy; van de Velde, Dominique

2017-01-01

The consequences of the Ehlers-Danlos Syndrome hypermobility type (EDS-HT) affect many aspects of daily life. "Living with limitations" is a central theme in the life of patients affected by this heritable disorder of connective tissue. The aim of the present study was to explore the lived experiences of women with EDS-HT concerning diagnosis, influence on daily life and becoming and being a mother. A phenomenological-hermeneutical study, using in-depth interviews. Patients were selected by a purposive sampling strategy. This study shows that the EDS-HT syndrome affects daily life. Ten woman between 31 and 65 years were interviewed. They have between 2 and 5 children. The data analysis results in six themes. (1) Getting a diagnosis is a relief and supports the choice to become a mother; (2) EDS-HT causes emotional distress, imposes a physical burden and has a major impact on social behavior; (3) EDS-HT demands a restructuring of everyday activities; (4) Children's and mothers' expectations do not correspond; (5) Having a supportive social and physical environment is of major importance; (6) The presence of the child reduces the feeling of illness of the mother. The diagnosis of EDS-HT is a catalysing factor in the choice of whether or not to become a mother. EDS-HT has a huge impact on bodily functions, which in turn influences activities and participation. This study gives insight in the activities of daily life of persons with EDS-HT. Health care professionals can be of great importance to help patients in (re)organizing their lives according to the available energy and in supporting their choices. They can help defining goals and setting priorities in daily life. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of statistical distribution of joint trace length on the stability of tunnel excavated in jointed rock mass

Directory of Open Access Journals (Sweden)

Kayvan Ghorbani

2015-12-01

Full Text Available The rock masses in a construction site of underground cavern are generally not continuous, due to the presence of discontinuities, such as bedding, joints, faults, and fractures. The performance of an underground cavern is principally ruled by the mechanical behaviors of the discontinuities in the vicinity of the cavern. During underground excavation, many surrounding rock failures have close relationship with joints. The stability study on tunnel in jointed rock mass is of importance to rock engineering, especially tunneling and underground space development. In this study, using the probability density distribution functions of negative exponential, log-normal and normal, we investigated the effect of joint trace length on the stability parameters such as stress and displacement of tunnel constructed in rock mass using UDEC (Universal Distinct Element Code. It was obtained that normal distribution function of joint trace length is more critical on the stability of tunnel, and exponential distribution function has less effect on the tunnel stability compared to the two other distribution functions.

Austenitic stainless steel-to-ferritic steel transition joint welding for elevated temperature service

International Nuclear Information System (INIS)

King, J.F.; Goodwin, G.M.; Slaughter, G.M.

1978-01-01

Transition weld joints between ferritic steels and austenitic stainless steels are required for fossil-fired power plants and proposed nuclear plants. The experience with these dissimilar-metal transition joints has been generally satisfactory, but an increasing number of failures of these joints is occurring prematurely in service. These concerns with transition joint service history prompted a program to develop more reliable joints for application in proposed nuclear power plants

Joint Force Quarterly. Number 34, Spring 2003

Science.gov (United States)

2003-07-01

Office of the Chairman LTG George W. Casey, Jr., USA ■ The Joint Staff MG Reginal G. Clemmons , USA ■ National War College A. Denis Clift ■ Joint...vol. 138, no. 91 (June 23, 1992), p. S 8602. 2 Maurice Matloff, editor, American Military History (Washington: Government Printing Office, 1969), p...was basically flawed and historically inac- curate. During the late 1930s General Maurice Gamelin exacerbated a faulty doctrine by shut- ting off all

Human bones obtained from routine joint replacement surgery as a tool for studies of plutonium, americium and {sup 90}Sr body-burden in general public

Energy Technology Data Exchange (ETDEWEB)

Mietelski, Jerzy W., E-mail: jerzy.mietelski@ifj.edu.pl [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Edward B. [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Department of Physical Therapy Basics, Faculty of Physical Therapy, Administration College, Bielsko-Biala (Poland); Tomankiewicz, Ewa [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Joanna [Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Nowak, Sebastian [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Szczygiel, Elzbieta [Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Brudecki, Kamil [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland)

2011-06-15

The paper presents a new sampling method for studying in-body radioactive contamination by bone-seeking radionuclides such as {sup 90}Sr, {sup 239+240}Pu, {sup 238}Pu, {sup 241}Am and selected gamma-emitters, in human bones. The presented results were obtained for samples retrieved from routine surgeries, namely knee or hip joints replacements with implants, performed on individuals from Southern Poland. This allowed to collect representative sets of general public samples. The applied analytical radiochemical procedure for bone matrix is described in details. Due to low concentrations of {sup 238}Pu the ratio of Pu isotopes which might be used for Pu source identification is obtained only as upper limits other then global fallout (for example Chernobyl) origin of Pu. Calculated concentrations of radioisotopes are comparable to the existing data from post-mortem studies on human bones retrieved from autopsy or exhumations. Human bones removed during knee or hip joint surgery provide a simple and ethical way for obtaining samples for plutonium, americium and {sup 90}Sr in-body contamination studies in general public. - Highlights: > Surgery for joint replacement as novel sampling method for studying in-body radioactive contamination. > Proposed way of sampling is not causing ethic doubts. > It is a convenient way of collecting human bone samples from global population. > The applied analytical radiochemical procedure for bone matrix is described in details. > The opposite patient age correlations trends were found for 90Sr (negative) and Pu, Am (positive).

Functional outcome from sacroiliac joint prolotherapy in patients with sacroiliac joint instability.

Science.gov (United States)

Hoffman, Martin D; Agnish, Vikram

2018-04-01

Examine the effectiveness of sacroiliac (SI) joint prolotherapy for SI joint instability, and characterize the patients most likely to benefit from this treatment. Retrospective cohort study. Department of Veterans Affairs outpatient physical medicine clinic. Patients referred for low back pain and diagnosed with SI joint instability received a series of three SI joint prolotherapy injections (15% dextrose in lidocaine) at approximately a one-month interval. The outcome of those completing treatment was retrospectively examined, and characteristics were compared between those with at least a minimum clinically important improvement and those without improvement. Patients completed the Oswestry Disability Index (ODI) before treatment was initiated, immediately preceding each prolotherapy injection, and at 3-4 month follow-up. Of 103 treated patients returning for post-treatment follow-up at a median of 117 days, 24 (23%) showed a minimum clinically important improvement despite a median of 2 years with low back pain and a mean (±SD) pre-intervention ODI of 54 ± 15 points. Much of the improvement was evident after the initial prolotherapy injection, and a 15-point improvement in ODI prior to the second prolotherapy injection had a sensitivity of 92% and specificity of 80% for determining which patients would improve. A satisfactory proportion of patients with symptomatic SI joint instability as an etiology of low back pain can have clinically meaningful functional gains with prolotherapy treatment. The patients who are not likely to improve with prolotherapy are generally evident by lack of improvement following the initial prolotherapy injection. Published by Elsevier Ltd.

The emotional state in benign joint hypermobility syndrome and associated factors

Directory of Open Access Journals (Sweden)

Serda Em

2014-12-01

Full Text Available Objective: In this study, we aimed to investigate the difference of uric acid levels between metabolically healthy and unhealthy obese individuals. Methods: Patients of internal medicine and endocrinology outpatient clinics who admitted with the complaint of overweight were separated into two groups, by diagnostic criteria for metabolic syndrome, as metabolically healthy obese and metabolically unhealthy obese individuals. Total of 193 women aged between 18 to 70 years were enrolled into study. Results: Statistically significant differences were determined regarding waist circumference (p=0.038, HOMA-IR (p0.05 were not differ between these groups. When patients were separated into two groups according to uric acid median, the rate of metabolic syndrome found to be increased in high uric acid group (p=0.021. A correlation analysis showed that uric acid was significantly associated with number of metabolic syndrome parameters (r=0.270, p<0.001 beyond presence of metabolic syndrome. Conclusion: In the fact of determined relation of uric acid with the insulin resistance and significant difference of uric acid levels between metabolically healthy and non-healthy obese groups, uric acid can be considered as a cheap, accessible and sensitive parameter for metabolic syndrome and cardiovascular risk factor in obese individuals.

Joint Laxity in Preschool Children Born Preterm.

Science.gov (United States)

Romeo, Domenico M; Velli, Chiara; Lucibello, Simona; Ferrantini, Gloria; Leo, Giuseppina; Brogna, Claudia; Cota, Francesco; Ricci, Daniela; Gallini, Francesca; Romagnoli, Costantino; Vento, Giovanni; Mercuri, Eugenio

2018-06-01

To evaluate the prevalence of joint laxity in children born preterm assessed in the first 2 years, the relationship between joint laxity and motor performance at preschool age, and possible changes over time in a subgroup of children followed longitudinally. The revised scale of Beighton Score was used to evaluate joint laxity in a population of 132 preschool children born preterm between 24 and 32 weeks of gestational age. All were assessed for joint laxity between 12 and 24 months of age. Children also performed the Movement Assessment Battery for Children-Second Edition between the age of 3 years and 6 months and 4 years; the age at onset of independent walking also was recorded. The total Beighton Score ranged between 0 and 8. Twenty percent of the cohort showed joint laxity. No differences related to sex or gestational age were observed. Children born preterm with joint laxity achieved later independent walking and achieved lower scores on Movement Assessment Battery for Children-Second Edition than those without joint laxity. In 76 children born preterm, an assessment for joint laxity was repeated once between 25 and 36 months and again after >36 months. No statistically significant difference was observed between the 3 assessments. The Beighton Score can be used to assess generalized joint laxity in children born preterm. As the presence of joint laxity influenced motor competences, the possibility to early identify these infants in the first 2 years is of interest to benefit from early intervention and potentially improve gross motor skills and coordination. Copyright © 2018 Elsevier Inc. All rights reserved.

An analysis of a joint shear model for jointed media with orthogonal joint sets

International Nuclear Information System (INIS)

Koteras, J.R.

1991-10-01

This report describes a joint shear model used in conjunction with a computational model for jointed media with orthogonal joint sets. The joint shear model allows nonlinear behavior for both joint sets. Because nonlinear behavior is allowed for both joint sets, a great many cases must be considered to fully describe the joint shear behavior of the jointed medium. An extensive set of equations is required to describe the joint shear stress and slip displacements that can occur for all the various cases. This report examines possible methods for simplifying this set of equations so that the model can be implemented efficiently form a computational standpoint. The shear model must be examined carefully to obtain a computationally efficient implementation that does not lead to numerical problems. The application to fractures in rock is discussed. 5 refs., 4 figs

Mind-Body Interactions in Anxiety and Somatic Symptoms.

Science.gov (United States)

Mallorquí-Bagué, Núria; Bulbena, Antonio; Pailhez, Guillem; Garfinkel, Sarah N; Critchley, Hugo D

2016-01-01

Anxiety and somatic symptoms have a high prevalence in the general population. A mechanistic understanding of how different factors contribute to the development and maintenance of these symptoms, which are highly associated with anxiety disorders, is crucial to optimize treatments. In this article, we review recent literature on this topic and present a redefined model of mind-body interaction in anxiety and somatic symptoms, with an emphasis on both bottom-up and top-down processes. Consideration is given to the role played in this interaction by predisposing physiological and psychological traits (e.g., interoception, anxiety sensitivity, and trait anxiety) and to the levels at which mindfulness approaches may exert a therapeutic benefit. The proposed model of mind-body interaction in anxiety and somatic symptoms is appraised in the context of joint hypermobility syndrome, a constitutional variant associated with autonomic abnormalities and vulnerability to anxiety disorders.

Impact of mechanical heterogeneity on joint density in a welded ignimbrite

Science.gov (United States)

Soden, A. M.; Lunn, R. J.; Shipton, Z. K.

2016-08-01

Joints are conduits for groundwater, hydrocarbons and hydrothermal fluids. Robust fluid flow models rely on accurate characterisation of joint networks, in particular joint density. It is generally assumed that the predominant factor controlling joint density in layered stratigraphy is the thickness of the mechanical layer where the joints occur. Mechanical heterogeneity within the layer is considered a lesser influence on joint formation. We analysed the frequency and distribution of joints within a single 12-m thick ignimbrite layer to identify the controls on joint geometry and distribution. The observed joint distribution is not related to the thickness of the ignimbrite layer. Rather, joint initiation, propagation and termination are controlled by the shape, spatial distribution and mechanical properties of fiamme, which are present within the ignimbrite. The observations and analysis presented here demonstrate that models of joint distribution, particularly in thicker layers, that do not fully account for mechanical heterogeneity are likely to underestimate joint density, the spatial variability of joint distribution and the complex joint geometries that result. Consequently, we recommend that characterisation of a layer's compositional and material properties improves predictions of subsurface joint density in rock layers that are mechanically heterogeneous.

A comparative study of generalized linear mixed modelling and artificial neural network approach for the joint modelling of survival and incidence of Dengue patients in Sri Lanka

Science.gov (United States)

Hapugoda, J. C.; Sooriyarachchi, M. R.

2017-09-01

Survival time of patients with a disease and the incidence of that particular disease (count) is frequently observed in medical studies with the data of a clustered nature. In many cases, though, the survival times and the count can be correlated in a way that, diseases that occur rarely could have shorter survival times or vice versa. Due to this fact, joint modelling of these two variables will provide interesting and certainly improved results than modelling these separately. Authors have previously proposed a methodology using Generalized Linear Mixed Models (GLMM) by joining the Discrete Time Hazard model with the Poisson Regression model to jointly model survival and count model. As Aritificial Neural Network (ANN) has become a most powerful computational tool to model complex non-linear systems, it was proposed to develop a new joint model of survival and count of Dengue patients of Sri Lanka by using that approach. Thus, the objective of this study is to develop a model using ANN approach and compare the results with the previously developed GLMM model. As the response variables are continuous in nature, Generalized Regression Neural Network (GRNN) approach was adopted to model the data. To compare the model fit, measures such as root mean square error (RMSE), absolute mean error (AME) and correlation coefficient (R) were used. The measures indicate the GRNN model fits the data better than the GLMM model.

Second carpal bone slab fracture and subluxation of the middle carpal joint in a horse subsequent to arthrodesis of the carpometacarpal joint.

Science.gov (United States)

MacKay, Angela V; Panizzi, Luca; Sparks, Holly D; Barber, Spencer M

2015-02-01

To report complications of arthrodesis of the carpometacarpal (CMC) joint using a drilling technique in an adult horse. Case report. Horse (n = 1). A 12-year-old Quarter Horse mare with CMC osteoarthritis (CMC-OA) had arthrodesis under general anesthesia in right lateral recumbency. Under fluoroscopic guidance, a 4.5 mm drill bit was inserted at 3 drilling sites 5-6 cm into the CMC joint and was fanned 30-45° in the plane of the joint and 5-10° in the long axis of the limb to destroy articular cartilage and expose the subchondral bone. The horse presented 2 weeks after surgery for severe lameness of the operated limb. A slab fracture of the 2nd carpal bone (C2) and subluxation of the middle carpal (MC) joint was diagnosed. The horse was humanely euthanatized due to poor prognosis. The fanning technique of arthrodesis of the CMC joint may lead to fracture of carpal bones, joint instability, and MC joint subluxation. A balance between articular surface destruction and maintenance of joint stability should be achieved when using this technique. © Copyright 2014 by The American College of Veterinary Surgeons.

15 CFR 296.9 - Activities not permitted for joint ventures.

Science.gov (United States)

2010-01-01

... joint venture of any product, process, or service, other than the distribution among the parties to such venture, in accordance with such venture, of a product, process, or service produced by such venture, the... INNOVATION PROGRAM General § 296.9 Activities not permitted for joint ventures. The following activities are...

Computed tomography of the knee joint

International Nuclear Information System (INIS)

Jang, Byung Won; Kwon, Jung Hyeok; Park, Sung Hak; Kim, Tae Hun; Park, In Kyu; Kim, Yong Joo; Kang, Duk Sik; Kwon, Sae Hong

1986-01-01

Diagnosis of knee joint pathology has been mainly dependent on clinical manifestations and invasive procedures such as arthrography and arthroscopy etc. However, these procedures are invasive. Arthroscopy is performed under general anesthesia. Recently, with development of high resolution CT with thin slices and multiplanar reconstructions capability, CT could be used to verify the internal structures of knee joint in noninvasive or less invasive way. From June to December 1985, authors have experienced 19 cases of the knee joint CT. Among them, 13 cases were operated and confirmed. We concluded as follows. 1. The diagnostic accuracy of the knee CT was 100% in lateral meniscal tearing, 92.3% in medial mensical tearing, 92.3% in detachment of lateral collateral ligament, 92.3% in medial collateral ligament, 100% in tearing of cruciate ligaments. 2. CT could be considered as a primary diagnostic procedure in the knee pathology rather than more invasive arthroscopy or arthrography. 3. For the accurate diagnosis of knee joint pathology, CT, which can obtain thin slies, high resolution, multiplanar reconstructions, is indispensable.

MR diagnosis of temporomandibular joint. A study of joint effusion

International Nuclear Information System (INIS)

Kaneda, Takashi; Yamashiro, Mitsuaki; Ozawa, Kaoru; Suzuki, Hiromi; Okada, Hiroyuki; Yamamoto, Hirotsugu

1998-01-01

The purposes of this study were to evaluate the relationship between correlation of MR joint effusion of the temporomandibular joint and disk position, to evaluate the relationship between joint effusion and aging, and to assess the frequency of MR joint effusion of bilateral temporomandibular joints. The temporomandibular joints of 192 patients with clinical symptoms of temporomandibular joint disorders were imaged bilaterally using high field, surface-coil MR imaging. Oblique sagittal and coronal proton density-weighted and T2-weighted images were obtained. Imaging findings of joint effusion were correlated with disk position, aging, and bilateral temporomandibular joints. MR showed effusion in 4% of the joints with normal superior disk position, 36% of the joints with disk displacement with reduction, and 45% of the joints with disk displacement without reduction. There were significant differences in the incidence of joint effusion between normal disk position and anterior disk displacement with or without reduction. Younger patients less than 40 years were significant higher the incidence of joint effusion than those of older patients. A significant association was seen between joint effusion and aging. MR showed effusion in 17% of the unilateral temporomandibular joint, 24% of the bilateral temporomandibular joints. There was no significant difference between unilateral and bilateral case. These results indicated that joint effusion using MR imaging was associated with varied temporomandibular joint pathologic states. (author)

Joint disease in children of Asiatic origin

International Nuclear Information System (INIS)

Tan, T.H.; Ong, K.L.

2000-01-01

Joint disorders in Asian children are varied due to the diversity of the Asian population and show some ethnic trends. The ethnic diversity, socio-economic and geographic factors in Asia have limited the availability of data from some of the ethnic groups, many of whom live in remote and relatively underdeveloped areas, are not subjected to epidemiological surveillance and have little awareness of these diseases and their consequences. Geographic and socio-economic factors also play a significant role in some of the joint diseases peculiar to Asian children. In general, the current available data suggests that there are no large differences in the epidemiology and clinical features between the Western and Asian children. This article reviews the available literature on joint diseases in Asian children

The influence of the Peroneus Longus muscle on the foot under axial loading: A CT evaluated dynamic cadaveric model study.

Science.gov (United States)

Dullaert, K; Hagen, J; Klos, K; Gueorguiev, B; Lenz, M; Richards, R G; Simons, P

2016-05-01

Subtle hypermobility of the first tarsometatarsal joint can occur concomitantly with other pathologies and may be difficult to diagnose. Peroneus Longus muscle might influence stability of this joint. Collapse of the medial longitudinal arch is common in flatfoot deformity and the muscle might also play a role in correcting Meary's angle. A radiolucent frame was used to simulate weightbearing during CT examination. Eight pairs fresh-frozen lower legs were imaged in neutral position under non-weightbearing (75N), weightbearing (700N) and with 15kg weights hung from Peroneus Longus tendon. Measurements included first metatarsal rotation, intermetatarsal angle, first tarsometatarsal joint subluxation and Meary's angle. Weightbearing significantly increased Meary's angle and significantly decreased first tarsometatarsal joint subluxation (both Pfoot pathology. Weightbearing affects anatomy of the foot. No reliable information is available concerning the influence of the Peroneus muscle. This study investigates the influence of weightbearing and the impact the Peroneus muscle on the anatomy of the foot. Copyright © 2016. Published by Elsevier Ltd.

Exercise tolerance in children and adolescents with musculoskeletal pain in joint hypermobility and joint hypomobility syndrome

NARCIS (Netherlands)

Engelbert, Raoul H. H.; van Bergen, Monique; Henneken, Thamar; Helders, Paul J. M.; Takken, Tim

2006-01-01

Musculoskeletal pain is a common complaint in a pediatric health care practice, but exercise tolerance has never been described in detail in these children. Our objectives for this study were to evaluate the maximal exercise capacity, including peak heart rate and oxygen consumption, of children

CLASSIFICATION OF TEMPOROMANDIBULAR-JOINT OSTEOARTHROSIS AND INTERNAL DERANGEMENT .2. SPECIFIC DIAGNOSTIC-CRITERIA

NARCIS (Netherlands)

STEGENGA, B; DEBONT, LGM; BOERING, G

Separate entities of temporomandibular joint osteoarthrosis and internal derangement are operationally defined. Criteria are based on an analysis of the diagnostic significance of symptoms and signs, principles of synovial joint pathology in general, and on therapeutic considerations. The primary

Analysis of the Contingency Contracting Support Plan within the Joint Planning Process Framework

National Research Council Canada - National Science Library

Anderson, Michael

2003-01-01

...) flexibility and responsiveness. Current OPLANS at the Joint-level generally discuss how forces will be contractually supported in-theater, but are not specific enough within the framework of the Joint Planning Process (JPP...

Joint measurements of spin, operational locality and uncertainty

International Nuclear Information System (INIS)

Andersson, E.; Barnett, S.M.; Aspect, A.

2005-01-01

Full text: Joint measurements of non-commuting observables are possible within quantum mechanics, if one accepts an increase in the variances of the jointly measured observables. In this contribution, we discuss joint measurements of spin 1/2 along any two directions. Starting from an operational locality principle, we show how to obtain the known bound on how sharp the joint measurement can be. Operational locality here means, that no operation performed at a quantum system at one location can instantaneously affect a system at another location. The measurement bound is general and is here obtained without reference to any quantum measurement formalism. We find that the bound is formally identical to a Bell inequality of the CHSH type, and we also give a direct interpretation of the measurement bound in terms of an uncertainty relation. A simple way to realise the joint measurement for the case of photon polarization is presented. Further to their fundamental interest, quantum joint measurements of non-commuting observables can be related to state estimation. They are also of interest in quantum information, e.g. as strategies for eavesdropping in quantum cryptography. (author)

Dependency models and probability of joint events

International Nuclear Information System (INIS)

Oerjasaeter, O.

1982-08-01

Probabilistic dependencies between components/systems are discussed with reference to a broad classification of potential failure mechanisms. Further, a generalized time-dependency model, based on conditional probabilities for estimation of the probability of joint events and event sequences is described. The applicability of this model is clarified/demonstrated by various examples. It is concluded that the described model of dependency is a useful tool for solving a variety of practical problems concerning the probability of joint events and event sequences where common cause and time-dependent failure mechanisms are involved. (Auth.)

29 CFR 570.115 - Joint applicability.

Science.gov (United States)

2010-07-01

... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS CHILD LABOR REGULATIONS, ORDERS AND STATEMENTS OF INTERPRETATION General Statements of Interpretation of the Child Labor... 12(a) and 12(c) § 570.115 Joint applicability. The child labor coverage provisions contained in...

Dermal Ultrastructure in Low Beighton Score Members of 17 Families with Hypermobile-Type Ehlers-Danlos Syndrome

Science.gov (United States)

Hermanns-Lê, Trinh; Reginster, Marie-Annick; Piérard-Franchimont, Claudine; Delvenne, Philippe; Piérard, Gérald E.; Manicourt, Daniel

2012-01-01

The distinction between the Ehlers-Danlos syndrome hypermobile type (EDSH) and the benign joint hypermobility syndrome (BJHS) is unclear. The aim of the present study was to compare skin ultrastructural abnormalities of EDSH and BJHS among different families. Skin of 23 EDSH, 27 BJHS, and 41 asymptomatic subjects from 17 families was examined using transmission electron microscopy. Similar ultrastructural abnormalities were found irrespective of the Beighton score. Flower-like collagen fibrils represented the key change and elastic fibers were altered as well. Beighton score is a clinical parameter rating joint mobility that appeared unrelated to quantitative and qualitative collagen ultrastructural alterations in the skin. Some EDSH family members fit with BJHS diagnosis. BJHS possibly represents a mild variant of EDSH. PMID:23091361

Dermal Ultrastructure in Low Beighton Score Members of 17 Families with Hypermobile-Type Ehlers-Danlos Syndrome

Directory of Open Access Journals (Sweden)

Trinh Hermanns-Lê

2012-01-01

Full Text Available The distinction between the Ehlers-Danlos syndrome hypermobile type (EDSH and the benign joint hypermobility syndrome (BJHS is unclear. The aim of the present study was to compare skin ultrastructural abnormalities of EDSH and BJHS among different families. Skin of 23 EDSH, 27 BJHS, and 41 asymptomatic subjects from 17 families was examined using transmission electron microscopy. Similar ultrastructural abnormalities were found irrespective of the Beighton score. Flower-like collagen fibrils represented the key change and elastic fibers were altered as well. Beighton score is a clinical parameter rating joint mobility that appeared unrelated to quantitative and qualitative collagen ultrastructural alterations in the skin. Some EDSH family members fit with BJHS diagnosis. BJHS possibly represents a mild variant of EDSH.

Clinical evaluation of joint scintigraphy in rheumatoid arthritis

International Nuclear Information System (INIS)

Shimabukuro, Kunisada; Sakata, Hiromichi; Shirono, Kazuo; Nakajo, Masataka; Shinohara, Shinji

1983-01-01

Pertechnetate (sup(99m)TcO 4 - ) joint scintigraphy was performed on 45 patients with rheumatoid arthritis, 3 with nonspecific arthritis and 6 normal subjects. 1) The sites of radioisotopic accumulation were generally in agreement with those of clinical involvement in rheumatoid arthritis. 2) By analysis of build-up curves in the wrist joint, tracer was found to be concentrated more rapidly in rheumatoid arthritis (T 1/2 = 0.67 min.) than in nonspecific arthritis (T 1/2 = 2.66 min.) 3) The degree of radioisotopic accumulation correlated well with the value of CRP and erythrocyte sedimentation rate. It could be cosidered that pertechnetate joint scintigraphy is useful for clinical evaluation of rheumatoid arthritis. (author)

Experimental Investigation of the Influence of Joint Geometric Configurations on the Mechanical Properties of Intermittent Jointed Rock Models Under Cyclic Uniaxial Compression

Science.gov (United States)

Liu, Yi; Dai, Feng; Fan, Pengxian; Xu, Nuwen; Dong, Lu

2017-06-01

Intermittent joints in rock mass are quite sensitive to cyclic loading conditions. Understanding the fatigue mechanical properties of jointed rocks is beneficial for rational design and stability analysis of rock engineering projects. This study experimentally investigated the influences of joint geometry (i.e., dip angle, persistency, density and spacing) on the fatigue mechanism of synthetic jointed rock models. Our results revealed that the stress-strain curve of jointed rock under cyclic loadings is dominated by its curve under monotonic uniaxial loadings; the terminal strain in fatigue curve is equal to the post-peak strain corresponding to the maximum cyclic stress in the monotonic stress-strain curve. The four joint geometrical parameters studied significantly affect the fatigue properties of jointed rocks, including the irreversible strains, the fatigue deformation modulus, the energy evolution, the damage variable and the crack coalescence patterns. The higher the values of the geometrical parameters, the lower the elastic energy stores in this jointed rock, the higher the fatigue damage accumulates in the first few cycles, and the lower the fatigue life. The elastic energy has certain storage limitation, at which the fatigue failure occurs. Two basic micro-cracks, i.e., tensile wing crack and shear crack, are observed in cyclic loading and unloading tests, which are controlled principally by joint dip angle and persistency. In general, shear cracks only occur in the jointed rock with higher dip angle or higher persistency, and the jointed rock is characterized by lower fatigue strength, larger damage variable and lower fatigue life.

Dynamic modeling and optimal joint torque coordination of advanced robotic systems

Science.gov (United States)

Kang, Hee-Jun

The development is documented of an efficient dynamic modeling algorithm and the subsequent optimal joint input load coordination of advanced robotic systems for industrial application. A closed-form dynamic modeling algorithm for the general closed-chain robotic linkage systems is presented. The algorithm is based on the transfer of system dependence from a set of open chain Lagrangian coordinates to any desired system generalized coordinate set of the closed-chain. Three different techniques for evaluation of the kinematic closed chain constraints allow the representation of the dynamic modeling parameters in terms of system generalized coordinates and have no restriction with regard to kinematic redundancy. The total computational requirement of the closed-chain system model is largely dependent on the computation required for the dynamic model of an open kinematic chain. In order to improve computational efficiency, modification of an existing open-chain KIC based dynamic formulation is made by the introduction of the generalized augmented body concept. This algorithm allows a 44 pct. computational saving over the current optimized one (O(N4), 5995 when N = 6). As means of resolving redundancies in advanced robotic systems, local joint torque optimization is applied for effectively using actuator power while avoiding joint torque limits. The stability problem in local joint torque optimization schemes is eliminated by using fictitious dissipating forces which act in the necessary null space. The performance index representing the global torque norm is shown to be satisfactory. In addition, the resulting joint motion trajectory becomes conservative, after a transient stage, for repetitive cyclic end-effector trajectories. The effectiveness of the null space damping method is shown. The modular robot, which is built of well defined structural modules from a finite-size inventory and is controlled by one general computer system, is another class of evolving

BEHAVIOR OF GLUED JOINTS OF EUCALYPTUS sp. SAWN WOOD

Directory of Open Access Journals (Sweden)

Octávio Barbosa Plaster

2008-09-01

Full Text Available This research evaluated eucalypt wood adhesion capacity. The material evaluated was a commercial sawn wood composed by a blend of species of the genus Eucalyptus. The adhesives used were resorcinol-formaldehyde and polyvinila acetate (PVAc. The wood was segregated in three density with 0% of moisture content: class 1; 2 and 3 that, when combined (class1 x class1; 2x2; 3x3; 1x2; 1x3; 2x3 resulted in six treatments. The performance of the adhesion was evaluated by the shear strength to parallel compression and by wood failure in the glue line. The obtained results allowed to conclude that the adhesion of the combinations of wood/adhesive presented satisfactory performance. The average shear strength of the joints were shown equivalent to the shear strength of the solid wood with similar performance of adhesion in the two adhesives. In general, resorcinol-formaldheyde adhesive presented higher values (74.41% for wood failure in the joints, but similar to all treatments. The adhesion of samples of higher density presented lower performance probably when only the values of wood failure are considered. The values for the strength of glued joints, in general, were similar when analyzed the results achieved with the resorcinol-formaldehyde adhesive- base 140,56 Kgf/cm2. To polyvinila acetate the values of wood failure decrease when the density increase (65.94%, but the resistance in the glue line was positively affected (140.25 Kgf/cm2. In general, the density influenced the adhesion of the joints for the employed adhesives.

26 CFR 1.401(a)-11 - Qualified joint and survivor annuities.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Qualified joint and survivor annuities. 1.401(a...)-11 Qualified joint and survivor annuities. (a) General rule—(1) Required provisions. A trust, to...), which is a part of a plan providing for the payment of benefits in any form of a life annuity (as...

Are Purple DoD Civilians in Our Future? Completing the Joint Development on DoD

National Research Council Canada - National Science Library

Crowell, Cynthia A

2006-01-01

.... It created an environment that promoted joint exchanges, training, and operations. Joint experience became a requirement for senior military leaders who wished to reach the general officer level...

On joint numerical radius II

Czech Academy of Sciences Publication Activity Database

Drnovšek, R.; Müller, Vladimír

2014-01-01

Roč. 62, č. 9 (2014), s. 1197-1204 ISSN 0308-1087 R&D Projects: GA ČR GA201/09/0473; GA AV ČR IAA100190903 Institutional support: RVO:67985840 Keywords : joint numerical range * numerical radius Subject RIV: BA - General Mathematics Impact factor: 0.738, year: 2014 http://www.tandfonline.com/doi/abs/10.1080/03081087.2013.816303

26 CFR 11.401(a)-11 - Qualified joint and survivor annuities.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Qualified joint and survivor annuities. 11.401... SECURITY ACT OF 1974 § 11.401(a)-11 Qualified joint and survivor annuities. (a) In general—(1) General rule... annuity (i.e., an annuity requiring survival of the participant or his spouse as a condition for payment...

Practical issues in selecting a joint venture partner

International Nuclear Information System (INIS)

Hillary, R.B.

1999-01-01

Some general issues regarding joint ventures and how they come about were discussed. The first section of the presentation identified potential joint venture candidates as being gas suppliers, project developers, steam hosts, financiers, facility owners, fuel managers and non-regulated utility affiliates. An explanation of the joint venture process and the motives driving it was then presented. There are many sources of potential conflicts of interest in a cogeneration venture. These include changes in either deregulation, prices markets, competitive environment or financial position of participants. Another section of this paper discussed some of the lessons learned from forced cogeneration restructuring and buyouts. Three examples of cogeneration projects which did not survive the challenges of partnership were presented. These included the New York cogeneration project at a manufacturing plant, the Pacific Northwest cogeneration project at a refinery, and the Quebec City cogeneration project at a pulp and paper mill. The last section of this paper discussed the pros and cons of joint venture and other types of deals

Directorate of Management - Special Staff - Joint Staff - Leadership - The

Science.gov (United States)

NGB Official March Today in Guard History Leadership CNGB VCNGB SEA DANG DARNG Joint Staff J-1 J-2 J-3 J-4 J-5 J-6 J-7 J-8 Personal Staff Inspector General Judge Advocate General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff Directorate of Management

Determination of Parachute Joint Factors using Seam and Joint Testing

Science.gov (United States)

Mollmann, Catherine

2015-01-01

This paper details the methodology for determining the joint factor for all parachute components. This method has been successfully implemented on the Capsule Parachute Assembly System (CPAS) for the NASA Orion crew module for use in determining the margin of safety for each component under peak loads. Also discussed are concepts behind the joint factor and what drives the loss of material strength at joints. The joint factor is defined as a "loss in joint strength...relative to the basic material strength" that occurs when "textiles are connected to each other or to metals." During the CPAS engineering development phase, a conservative joint factor of 0.80 was assumed for each parachute component. In order to refine this factor and eliminate excess conservatism, a seam and joint testing program was implemented as part of the structural validation. This method split each of the parachute structural joints into discrete tensile tests designed to duplicate the loading of each joint. Breaking strength data collected from destructive pull testing was then used to calculate the joint factor in the form of an efficiency. Joint efficiency is the percentage of the base material strength that remains after degradation due to sewing or interaction with other components; it is used interchangeably with joint factor in this paper. Parachute materials vary in type-mainly cord, tape, webbing, and cloth -which require different test fixtures and joint sample construction methods. This paper defines guidelines for designing and testing samples based on materials and test goals. Using the test methodology and analysis approach detailed in this paper, the minimum joint factor for each parachute component can be formulated. The joint factors can then be used to calculate the design factor and margin of safety for that component, a critical part of the design verification process.

Temporomandibular joint space in children without joint disease

International Nuclear Information System (INIS)

Larheim, T.A.

1981-01-01

Bilateral assessment of the temporomandibular joint space in children without joint disease is reported. Twenty-eight children were examined with conventional radiography and 23 with tomography. High prevalence of asymmetric joint spaces with both techniques indicated that great care should be taken when using narrowing or widening of the joint space as a diagnostic criterion in children with juvenile rheumatoid arthritis. Other signs, such as restricted translation of the mandibular head, and clinical symptoms should be evaluated. (Auth.)

'Soft' human resource management in small international joint ventures

DEFF Research Database (Denmark)

Dao, Li

2012-01-01

This paper examines the value creation aspects of HRM in international joint ventures of a relatively small size and their implications for strategic management. We assume that HRM in this context is rather a process than a function, and a ‘soft’ – humanistic rather than a ‘hard’, instrumentalist...... of joint venture autonomy. A conceptual framework developed from these empirical insights invites further generalizing efforts, and more importantly, contributes to a dynamic understanding of HRM in small IJVs....

Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc- and facet joint pain.

Science.gov (United States)

van Tilburg, Cornelis W J; Groeneweg, Johannes G; Stronks, Dirk L; Huygen, Frank J P M

2017-01-01

Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc- or facet joint pain. Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc- and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically ``Abnormal sensory and motor examination, hyperactive or diminished reflexes'', ``Sitting exam shows no reflex, motor or sensory signs in the legs'' and ``Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion''. The ``Drop test positive'' parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The ``Digital interspinous pressure test positive'' had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of

Characteristics of solder joints under fatigue loads using piezomechanical actuation

Science.gov (United States)

Shim, Dong-Jin; Spearing, S. Mark

2003-07-01

Crack initiation and growth characteristics of solder joints under fatigue loads are investigated using piezomechanical actuation. Cracks in solder joints, which can cause failure in microelectronics components, are induced via piezoelectricity in piezo-ceramic bonded joints. Lead-zirconate-titanate ceramic plates and eutectic Sn-Pb solder bonded in a double-lap shear configuration are used in the investigation. Electric field across each piezo-ceramic plate is applied such that shear stresses/strains are induced in the solder joints. The experiments show that cracks initiate in the solder joints around defects such as voids and grow in length until they coalesce with other cracks from adjacent voids. These observations are compared with the similar thermal cycling tests from the literature to show feasibility and validity of the current method in investigating the fatigue characteristics of solder joints. In some specimens, cracks in the piezo-ceramic plates are observed, and failure in the specimens generally occurred due to piezo-ceramic plate fracture. The issues encountered in implementing this methodology such as low actuation and high processing temperatures are further discussed.

Joint Replacement (Finger and Wrist Joints)

Science.gov (United States)

... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Joint Replacement Email to a friend * required fields ...

Joint Operation Planning

National Research Council Canada - National Science Library

2006-01-01

.... It sets forth joint doctrine to govern the joint operation planning activities and performance of the Armed Forces of the United States in joint operations, and provides the joint doctrinal basis...

Jointness for the Rest of Us: Reforming Joint Professional Development

Science.gov (United States)

2016-06-10

transferred to the Joint Staff. 13 DOD’s instinct to “overly centralize planning, organization, and management.”20 The authors contend that this...2. 3 John F. Schank and others, Who is Joint? Reevaluating the Joint Duty Assignment List : A Study Prepared for the Joint Staff, by the RAND...and code those billets as such. Once identified, DOD must expand the Joint Duty Assignment List (JDAL) to include billets that offer enlisted personnel

Joint Force Quarterly. Number 30, Spring 2002

Science.gov (United States)

2002-05-01

Clemmons , USA ■ National War College A. Denis Clift ■ Joint Military Intelligence College RADM David R. Ellison, USN ■ Naval Postgraduate School BG Mark P...to determine the main axis of the German advance [General Maurice ] Gamelin dislocated his strategic reserves by committing the French Seventh Army to

Periprosthetic joint infection: are patients with multiple prosthetic joints at risk?

Science.gov (United States)

Jafari, S Mehdi; Casper, David S; Restrepo, Camilo; Zmistowski, Benjamin; Parvizi, Javad; Sharkey, Peter F

2012-06-01

Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. The type of organism was the same as the first infection in 4 (36%) of 11 patients. The time to developing a second infection averaged 2.0 years (range, 0-6.9 years). Copyright © 2012 Elsevier Inc. All rights reserved.

Joint Probability Distributions for a Class of Non-Markovian Processes

OpenAIRE

Baule, A.; Friedrich, R.

2004-01-01

We consider joint probability distributions for the class of coupled Langevin equations introduced by Fogedby [H.C. Fogedby, Phys. Rev. E 50, 1657 (1994)]. We generalize well-known results for the single time probability distributions to the case of N-time joint probability distributions. It is shown that these probability distribution functions can be obtained by an integral transform from distributions of a Markovian process. The integral kernel obeys a partial differential equation with fr...

The Cost of Jointness: Insights from Environmental Monitoring Systems in Low-Earth Orbit

Energy Technology Data Exchange (ETDEWEB)

Dwyer, Morgan Maeve [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States); Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2014-09-01

This report summarizes the results of doctoral research that explored the cost impact of acquiring complex government systems jointly. The report begins by reviewing recent evidence that suggests that joint programs experience greater cost growth than non-joint programs. It continues by proposing an alternative approach for studying cost growth on government acquisition programs and demonstrates the utility of this approach by applying it to study the cost of jointness on three past programs that developed environmental monitoring systems for low-Earth orbit. Ultimately, the report concludes that joint programs' costs grow when the collaborating government agencies take action to retain or regain their autonomy. The report provides detailed qualitative and quantitative data in support of this conclusion and generalizes its findings to other joint programs that were not explicitly studied here. Finally, it concludes by presenting a quantitative model that assesses the cost impacts of jointness and by demonstrating how government agencies can more effectively architect joint programs in the future.

Coracoclavicular joint

Energy Technology Data Exchange (ETDEWEB)

Kim, Kun Sang; Park, Chan Il; Ahn, Jae Doo; Lim, Chong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1970-10-15

The coracoclvicular joint, a rear abnormality which may be the cause of pain in the shoulder and limitation of motion of the shoulder joint, is discussed. A case of coracoclvicular joint with shoulder pain was observed in 65 yrs old Korean male.

Generalized canonical correlation analysis with missing values

NARCIS (Netherlands)

M. van de Velden (Michel); Y. Takane

2012-01-01

textabstractGeneralized canonical correlation analysis is a versatile technique that allows the joint analysis of several sets of data matrices. The generalized canonical correlation analysis solution can be obtained through an eigenequation and distributional assumptions are not required. When

Temporomandibular joint

International Nuclear Information System (INIS)

Westesson, P.L.; Hatala, M.; Tallents, R.H.; Katzberg, R.W.; Musgrave, M.; Levitt, S.

1990-01-01

This paper determines the frequency of MR signs of abnormal temporomandibular joints (TMJs) in asymptomatic volunteers. Forty-two volunteers with 84 clinically normal TMJs were imaged in the sagittal and coronal planes with surface coil MR imaging. Sagittal closed and open and coronal closed views were obtained bilaterally in all volunteers. The images were classified as normal (superior disk position) or abnormal (disk displacement of degenerative joint disease). Eighteen joints in 11 volunteers were abnormal; 12 had disk displacement with reduction and six had disk displacement without reduction, with associated degenerative joint disease in three of the six. Asymptomatic internal derangement and degenerative joint disease occur in about one-fourth of asymptomatic volunteers

Mechanical model of suture joints with fibrous connective layer

Science.gov (United States)

Miroshnichenko, Kateryna; Liu, Lei; Tsukrov, Igor; Li, Yaning

2018-02-01

A composite model for suture joints with a connective layer of aligned fibers embedded in soft matrix is proposed. Based on the principle of complementary virtual work, composite cylinder assemblage (CCA) approach and generalized self-consistent micro-mechanical models, a hierarchical homogenization methodology is developed to systematically quantify the synergistic effects of suture morphology and fiber orientation on the overall mechanical properties of sutures. Suture joints with regular triangular wave-form serve as an example material system to apply this methodology. Both theoretical and finite element mechanical models are developed and compared to evaluate the overall normal stiffness of sutures as a function of wavy morphology of sutures, fiber orientation, fiber volume fraction, and the mechanical properties of fibers and matrix in the interfacial layer. It is found that generally due to the anisotropy-induced coupling effects between tensile and shear deformation, the effective normal stiffness of sutures is highly dependent on the fiber orientation in the connective layer. Also, the effective shear modulus of the connective layer and the stiffness ratio between the fiber and matrix significantly influence the effects of fiber orientation. In addition, optimal fiber orientations are found to maximize the stiffness of suture joints.

Joint resistance measurements of pancake and terminal joints for JT-60SA EF coils

Energy Technology Data Exchange (ETDEWEB)

Obana, Tetsuhiro, E-mail: obana.tetsuhiro@LHD.nifs.ac.jp [National Institute for Fusion Science, 322-6 Oroshi, Toki, Gifu 509-5292 (Japan); Takahata, Kazuya; Hamaguchi, Shinji; Mito, Toshiyuki; Imagawa, Shinsaku [National Institute for Fusion Science, 322-6 Oroshi, Toki, Gifu 509-5292 (Japan); Kizu, Kaname; Murakami, Haruyuki; Yoshida, Kiyoshi [Japan Atomic Energy Agency, 801-1 Mukoyama, Naka, Ibaraki 311-0193 (Japan)

2013-11-15

Highlights: • To evaluate the joint fabrication technology for the JT-60SA EF coils, joint resistance measurements were conducted with a joint sample. • The joint sample was composed of pancake and terminal joints. • The measurements demonstrated that both joints fulfilled the design requirement. • Considering the measurements, the characteristics of both joints were investigated using an analytical model that represents the joints. -- Abstract: To evaluate the joint fabrication technology for the JT-60SA EF coils, joint resistance measurements were conducted using a sample consisting of pancake and terminal joints. Both joints are shake-hands lap joints composed of cable-in-conduit conductors and a pure copper saddle-shaped spacer. The measurements demonstrated that both joints fulfilled the design requirement. Considering these measurements, the characteristics of both joints were investigated using analytical models that represent the joints. The analyses indicated that the characteristics of the conductors used in the joints affect the characteristics of the joints.

Joint instability and osteoarthritis.

Science.gov (United States)

Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

2015-01-01

Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Joint Force Quarterly. Number 25, Summer 2000

Science.gov (United States)

2000-09-01

and Staff College Brig Gen Richard B. Bundy, USAF ■ The Joint Staff VADM Arthur K. Cebrowski, USN ■ Naval War College MG Reginal G. Clemmons , USA...1930s, General Maurice Gamelin, established the high command as the sole arbiter of doctrine early in his tenure. From that point, all articles, books

The joint essential numerical range, compact perturbations, and the Olsen problem

Czech Academy of Sciences Publication Activity Database

Müller, Vladimír

2010-01-01

Roč. 197, č. 3 (2010), s. 275-290 ISSN 0039-3223 R&D Projects: GA ČR GA201/09/0473; GA AV ČR IAA100190903 Institutional research plan: CEZ:AV0Z10190503 Keywords : joint essential numerical range * joint numerical range * compact perturbation * Olsen's problem Subject RIV: BA - General Mathematics Impact factor: 0.567, year: 2010 http://journals.impan.pl/cgi-bin/doi?sm197-3-5

JOINT ADVISORY APPEALS BOARD

CERN Multimedia

Human Resources Division

2002-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Luc Vos with regard to advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 14 to 28 June 2002. Human Resources Division Tel. 74128

JOINT ADVISORY APPEALS BOARD

CERN Multimedia

Human Resources Division

2001-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Olivier Francis Martin with regard to indefinite contract. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 8 to 25 June 2001.

Joint Advisory Appeals Board

CERN Multimedia

2003-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Aloïs Girardoz with regard to classification and advancement. As the appellant has not objected, the Board's report and the Director-General's decision will be brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 15 to 29 August 2003. Human Resources Division Tel. 74128

Estimation of RC slab-column joints effective strength using neural networks

Directory of Open Access Journals (Sweden)

A. A. Shah

Full Text Available The nominal strength of slab-column joints made of highstrength concrete (HSC columns and normal strength concrete (NSC slabs is of great importance in structural design and construction of concrete buildings. This topic has been intensively studied during the last decades. Different types of column-slab joints have been investigated experimentally providing a basis for developing design provisions. However, available data does not cover all classes of concretes, reinforcements, and possible loading cases for the proper calculation of joint stresses necessary for design purposes. New numerical methods based on modern software seem to be effective and may allow reliable prediction of column-slab joint strength. The current research is focused on analysis of available experimental data on different slab-to-column joints with the aim of predicting the nominal strength of slabcolumn joint. Neural networks technique is proposed herein using MATLAB routines developed to analyze available experimental data. The obtained results allow prediction of the effective strength of column-slab joints with accuracy and good correlation coefficients when compared to regression based models. The proposed method enables the user to predict the effective design of column-slab joints without the need for conservative safety coefficients generally promoted and used by most construction codes.

Joint Instability and Osteoarthritis

Directory of Open Access Journals (Sweden)

Darryl Blalock

2015-01-01

Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

International joint ventures

DEFF Research Database (Denmark)

Sørensen, Karsten Engsig

2001-01-01

The article analysis problems connected with corporate joint ventures. Among others the possible conflicts between the joint venture agreement and the statutes of the companies is examined, as well as certain problems connected to the fact that the joint venture partners have created commen control...... over their joint company....

Joint Chiefs of Staff > About > The Joint Staff > Senior Enlisted Advisor

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Skip to main content (Press Enter). Toggle navigation Joint Chiefs of Staff Joint Chiefs of Staff Joint Chiefs of Staff Facebook Twitter YouTube Flickr Blog Instagram Search JCS: Search Search Search JCS: Search Home Media News Photos Videos Publications About The Joint Staff Chairman Vice Chairman

Estimation of Joint types and Joint Limits from Motion capture data

DEFF Research Database (Denmark)

Engell-Nørregård, Morten Pol; Erleben, Kenny

2009-01-01

It is time-consuming for an animator to explicitly model joint types and joint limits of articulated figures. In this paper we describe a simple and fast approach to automated joint estimation from motion capture data of articulated figures. Our method will make the joint modeling more efficient ...

Effects of changing speed on knee and ankle joint load during walking and running.

Science.gov (United States)

de David, Ana Cristina; Carpes, Felipe Pivetta; Stefanyshyn, Darren

2015-01-01

Joint moments can be used as an indicator of joint loading and have potential application for sports performance and injury prevention. The effects of changing walking and running speeds on joint moments for the different planes of motion still are debatable. Here, we compared knee and ankle moments during walking and running at different speeds. Data were collected from 11 recreational male runners to determine knee and ankle joint moments during different conditions. Conditions include walking at a comfortable speed (self-selected pacing), fast walking (fastest speed possible), slow running (speed corresponding to 30% slower than running) and running (at 4 m · s(-1) ± 10%). A different joint moment pattern was observed between walking and running. We observed a general increase in joint load for sagittal and frontal planes as speed increased, while the effects of speed were not clear in the transverse plane moments. Although differences tend to be more pronounced when gait changed from walking to running, the peak moments, in general, increased when speed increased from comfortable walking to fast walking and from slow running to running mainly in the sagittal and frontal planes. Knee flexion moment was higher in walking than in running due to larger knee extension. Results suggest caution when recommending walking over running in an attempt to reduce knee joint loading. The different effects of speed increments during walking and running should be considered with regard to the prevention of injuries and for rehabilitation purposes.

Recent Advances in Computational Mechanics of the Human Knee Joint

Science.gov (United States)

Kazemi, M.; Dabiri, Y.; Li, L. P.

2013-01-01

Computational mechanics has been advanced in every area of orthopedic biomechanics. The objective of this paper is to provide a general review of the computational models used in the analysis of the mechanical function of the knee joint in different loading and pathological conditions. Major review articles published in related areas are summarized first. The constitutive models for soft tissues of the knee are briefly discussed to facilitate understanding the joint modeling. A detailed review of the tibiofemoral joint models is presented thereafter. The geometry reconstruction procedures as well as some critical issues in finite element modeling are also discussed. Computational modeling can be a reliable and effective method for the study of mechanical behavior of the knee joint, if the model is constructed correctly. Single-phase material models have been used to predict the instantaneous load response for the healthy knees and repaired joints, such as total and partial meniscectomies, ACL and PCL reconstructions, and joint replacements. Recently, poromechanical models accounting for fluid pressurization in soft tissues have been proposed to study the viscoelastic response of the healthy and impaired knee joints. While the constitutive modeling has been considerably advanced at the tissue level, many challenges still exist in applying a good material model to three-dimensional joint simulations. A complete model validation at the joint level seems impossible presently, because only simple data can be obtained experimentally. Therefore, model validation may be concentrated on the constitutive laws using multiple mechanical tests of the tissues. Extensive model verifications at the joint level are still crucial for the accuracy of the modeling. PMID:23509602

A study of fatigue life distribution of butt-welded joints

International Nuclear Information System (INIS)

Sakai, Tatsuo; Fujitani, Keizo; Kikuchi, Toshiro; Tanaka, Takao.

1981-01-01

Various kinds of welded joints are being used in many structures such as ships, bridges and constructions. It is important in reliability analysis of such structures to clarify the statistical fatigue property of the welded joints. In this study, fatigue tests were carried out on the butt-welded joints of SM50A steel and a theoretical interpretation on the fatigue life distribution was attempted, assuming that a butt-welded joint is composed of a number of sliced specimens with different fatigue strengths. Main results obtained are summarized as follows; (1) The median crack initiation life of the butt-welded joint specimens coincided with that of the sliced specimens, when the crack initiation was defined by a 0.2 mm crack in the sliced specimens or the equivalent state of stress intensity factor in the joint specimens. (2) The distribution of crack initiation lives of the butt-welded joints can be theoretically derived by combining the concept of extreme distribution and the distribution model on the number of fatigue cracks. The theoretical distribution of crack initiation lives of the joints is in good agreement with the general trend of the experimental results. (3) If the distribution of crack initiation lives and the crack growth law are given experimentally, one can obtain analytically the distribution of final fatigue lives. The fatigue life distribution of the sliced specimens can be explained by the theory established in this study. (author)

Joint imaging in childhood and adolescence

Energy Technology Data Exchange (ETDEWEB)

Lopes Viana, Sergio [Hospital da Crianca de Brasilia - Jose Alencar Clinica Vila Rica (Brazil); Machado, Ribeiro, Maria Custodia [Hospital da Crianca de Brasilia - Jose Alencar Hospital de Base do Distrito Federal (Brazil); Beber Machado, Bruno [Clinica Radiologica Med Imagem, Unimed Sul Caprixaba, Santa Casa de Misericordia de Cachoeiro de Itapemirim (Brazil)

2013-11-01

First book to be devoted to the imaging of skeletally immature joints since the advent of cross-sectional methods. Covers a wide range of pathologic conditions. Identifies the advantages and weak points of each imaging method. Highlights anatomic and developmental peculiarities of the growing skeleton. Richly illustrated, with up-to-date references and summaries of key points. Since the advent of cross-sectional imaging methods, few works have been devoted to pediatric musculoskeletal imaging, and information is especially limited on the skeletally immature joint. Furthermore, reduced emphasis on pediatric training means that general radiologists are increasingly unfamiliar with normal and abnormal imaging findings in children and adolescents. Knowledge of the imaging appearances of the immature joint is, however, crucial for correct image interpretation. This book covers key selected topics in the imaging evaluation of the skeletally immature joint. The opening chapters consider the current role, advantages, and limitations of each modality in pediatric assessment and present the imaging appearances of anatomic and developmental peculiarities of the growing skeleton. Findings in a wide range of important conditions are then described in a series of richly illustrated chapters that document appearances on diverse imaging studies, from conventional radiography through to modern high-tech modalities. By presenting the essential information on imaging of the immature joint, the authors hope to provide radiologists (musculoskeletal specialists and generalists alike) with a new tool that will assist greatly in overcoming the daily challenges posed by interpretation of pediatric examinations in the twenty-first century. The book will also be of interest to all other specialists involved in the diagnosis and treatment of children and adolescents with articular complaints.

Joint Advisory Appeals Board

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2003-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Poul Frandsen concerning his assimilation into the new career structure. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 13 to 24 January 2003. Human Resources Division Tel. 74128

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Joào Bento with regard to residential category. As the appellant has not objected, the recommendations of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article RÊVIÊ1.20 of the Staff Regulations.The relevant documents will therefore be posted on the notice boards of the Administration Building (N¡ 60) from 29 October to 12 November 1999.Personnel DivisionTel. 74128

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The Joint Advisory Appeals Board was convened to examine an appeal lodged by a member of the personnel with regard to advancement. The person concerned has requested that the report of the Board and the final decision of the Director-General be brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (No. 60) from 24 March to 10 April 2006. Human Resources Department Tel. 74128

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Jack Blanchard with regard to 'non recognition of specific functions'. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 12th to 26th April 2002. Human Resources Division Tel. 74128

Joint Advisory Appeals Board

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mrs Maria DIMOU with regard to a periodic one-step increase. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 30 April to 14 May 2004. Human Resources Department Tel. 74128

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Joël Lahaye with regard to non-resident allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 18 May to 1st June 2001.

JOINT ADVISORY APPEALS BOARD

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Bertrand Nicquevert with regard to the non-resident allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 29 November to 13 December 2002. Human Resources Division Tel. 74128

JOINT ADVISORY APPEALS BOARD

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Antonio Millich with regard to advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 27 September to 11 October 2002. Human Resources Division Tel. 74128

Joint Advisory Appeals Board

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The Joint Advisory Appeals Board was convened to examine an appeal lodged by a member of the personnel with regard to a periodic one-step increase. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 1 to 15 April 2005. Human Resources Department Tel. 74128

JOINT ADVISORY APPEALS BOARD

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Gert Jan Bossen with regard to dependent child allowance. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 1st to 15 March 2002. Human Resources Division Tel. 74128

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The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Serge Peraire with regard to exceptional advancement. As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 17 to 31 May 2002. Human Resources Division Tel. 74128

Biochemical and biomechanical characterisation of equine cervical facet joint cartilage.

Science.gov (United States)

O'Leary, S A; White, J L; Hu, J C; Athanasiou, K A

2018-04-15

The equine cervical facet joint is a site of significant pathology. Located bilaterally on the dorsal spine, these diarthrodial joints work in conjunction with the intervertebral disc to facilitate appropriate spinal motion. Despite the high prevalence of pathology in this joint, the facet joint is understudied and thus lacking in viable treatment options. The goal of this study was to characterise equine facet joint cartilage and provide a comprehensive database describing the morphological, histological, biochemical and biomechanical properties of this tissue. Descriptive cadaver studies. A total of 132 facet joint surfaces were harvested from the cervical spines of six skeletally mature horses (11 surfaces per animal) for compiling biomechanical and biochemical properties of hyaline cartilage of the equine cervical facet joints. Gross morphometric measurements and histological staining were performed on facet joint cartilage. Creep indentation and uniaxial strain-to-failure testing were used to determine the biomechanical compressive and tensile properties. Biochemical assays included quantification of total collagen, sulfated glycosaminoglycan and DNA content. The facet joint surfaces were ovoid in shape with a flat articular surface. Histological analyses highlighted structures akin to articular cartilage of other synovial joints. In general, biomechanical and biochemical properties did not differ significantly between the inferior and superior joint surfaces as well as among spinal levels. Interestingly, compressive and tensile properties of cervical facet articular cartilage were lower than those of articular cartilage from other previously characterised equine joints. Removal of the superficial zone reduced the tissue's tensile strength, suggesting that this zone is important for the tensile integrity of the tissue. Facet surfaces were sampled at a single, central location and do not capture the potential topographic variation in cartilage properties. This

Thermographic Analysis of Stress Distribution in Welded Joints

Directory of Open Access Journals (Sweden)

Domazet Ž.

2010-06-01

Full Text Available The fatigue life prediction of welded joints based on S-N curves in conjunction with nominal stresses generally is not reliable. Stress distribution in welded area affected by geometrical inhomogeneity, irregular welded surface and weld toe radius is quite complex, so the local (structural stress concept is accepted in recent papers. The aim of this paper is to determine the stress distribution in plate type aluminum welded joints, to analyze the reliability of TSA (Thermal Stress Analysis in this kind of investigations, and to obtain numerical values for stress concentration factors for practical use. Stress distribution in aluminum butt and fillet welded joints is determined by using the three different methods: strain gauges measurement, thermal stress analysis and FEM. Obtained results show good agreement - the TSA mutually confirmed the FEM model and stresses measured by strain gauges. According to obtained results, it may be stated that TSA, as a relatively new measurement technique may in the future become a standard tool for the experimental investigation of stress concentration and fatigue in welded joints that can help to develop more accurate numerical tools for fatigue life prediction.

Thermographic Analysis of Stress Distribution in Welded Joints

Science.gov (United States)

Piršić, T.; Krstulović Opara, L.; Domazet, Ž.

2010-06-01

The fatigue life prediction of welded joints based on S-N curves in conjunction with nominal stresses generally is not reliable. Stress distribution in welded area affected by geometrical inhomogeneity, irregular welded surface and weld toe radius is quite complex, so the local (structural) stress concept is accepted in recent papers. The aim of this paper is to determine the stress distribution in plate type aluminum welded joints, to analyze the reliability of TSA (Thermal Stress Analysis) in this kind of investigations, and to obtain numerical values for stress concentration factors for practical use. Stress distribution in aluminum butt and fillet welded joints is determined by using the three different methods: strain gauges measurement, thermal stress analysis and FEM. Obtained results show good agreement - the TSA mutually confirmed the FEM model and stresses measured by strain gauges. According to obtained results, it may be stated that TSA, as a relatively new measurement technique may in the future become a standard tool for the experimental investigation of stress concentration and fatigue in welded joints that can help to develop more accurate numerical tools for fatigue life prediction.

Functional data analysis of generalized regression quantiles

KAUST Repository

Guo, Mengmeng; Zhou, Lan; Huang, Jianhua Z.; Hä rdle, Wolfgang Karl

2013-01-01

Generalized regression quantiles, including the conditional quantiles and expectiles as special cases, are useful alternatives to the conditional means for characterizing a conditional distribution, especially when the interest lies in the tails. We develop a functional data analysis approach to jointly estimate a family of generalized regression quantiles. Our approach assumes that the generalized regression quantiles share some common features that can be summarized by a small number of principal component functions. The principal component functions are modeled as splines and are estimated by minimizing a penalized asymmetric loss measure. An iterative least asymmetrically weighted squares algorithm is developed for computation. While separate estimation of individual generalized regression quantiles usually suffers from large variability due to lack of sufficient data, by borrowing strength across data sets, our joint estimation approach significantly improves the estimation efficiency, which is demonstrated in a simulation study. The proposed method is applied to data from 159 weather stations in China to obtain the generalized quantile curves of the volatility of the temperature at these stations. © 2013 Springer Science+Business Media New York.

Functional data analysis of generalized regression quantiles

KAUST Repository

Guo, Mengmeng

2013-11-05

Generalized regression quantiles, including the conditional quantiles and expectiles as special cases, are useful alternatives to the conditional means for characterizing a conditional distribution, especially when the interest lies in the tails. We develop a functional data analysis approach to jointly estimate a family of generalized regression quantiles. Our approach assumes that the generalized regression quantiles share some common features that can be summarized by a small number of principal component functions. The principal component functions are modeled as splines and are estimated by minimizing a penalized asymmetric loss measure. An iterative least asymmetrically weighted squares algorithm is developed for computation. While separate estimation of individual generalized regression quantiles usually suffers from large variability due to lack of sufficient data, by borrowing strength across data sets, our joint estimation approach significantly improves the estimation efficiency, which is demonstrated in a simulation study. The proposed method is applied to data from 159 weather stations in China to obtain the generalized quantile curves of the volatility of the temperature at these stations. © 2013 Springer Science+Business Media New York.

Joint probability distributions for a class of non-Markovian processes.

Science.gov (United States)

Baule, A; Friedrich, R

2005-02-01

We consider joint probability distributions for the class of coupled Langevin equations introduced by Fogedby [H. C. Fogedby, Phys. Rev. E 50, 1657 (1994)]. We generalize well-known results for the single-time probability distributions to the case of N -time joint probability distributions. It is shown that these probability distribution functions can be obtained by an integral transform from distributions of a Markovian process. The integral kernel obeys a partial differential equation with fractional time derivatives reflecting the non-Markovian character of the process.

Reliability of Tubular Joints

DEFF Research Database (Denmark)

Sørensen, John Dalsgaard; Thoft-Christensen, Palle

In this paper the preliminary results obtained by tests on tubular joints are presented. The joints are T-joints and the loading is static. It is the intention in continuation of these tests to perform tests on other types of joints (e.g. Y-joints) and also with dynamic loading. The purpose...... of the test is partly to obtain empirical data for the ultimate load-carrying capacity of tubular T-joints and partly to obtain some experience in performing tests with tubular joints. It is well known that tubular joints are usually designed in offshore engineering on the basis of empirical formulas obtained...... by experimental test results. Therefore, there is a need for performing experimental tests in this area....

Optimal diagnosis, prevention, and management of periprosthetic joint infection

Directory of Open Access Journals (Sweden)

Tafer N

2015-01-01

Full Text Available Nathalie Tafer,1 Wilson Belaieff,1 Céline Cuérel,1 Matthieu Zingg,1 Pierre Hoffmeyer,1 Ilker Uçkay1,2 1Orthopedic Surgery Department, 2Division of Infectious Diseases, University of Geneva Hospitals and Medical School, Geneva, Switzerland Abstract: The pace of the aging population is steadily rising worldwide with a parallel increase in the demand for joint replacement procedures. With the increasing number of patients undergoing arthroplasty, there is also an increased risk for arthroplasty infection that may lead to severe complications, poorer outcome, and substantial extra costs for health care systems. Current rates of prosthetic joint infection are not dramatically different from the 1960s or 1970s, but some general principles are now better defined, and their management has been studied extensively during the past decades, thus resulting in a change in clinical practice. The purpose of this review is to summarize important principles of prosthetic joint infection to guide the clinician and to contribute to the optimal diagnosis, prevention, and management of periprosthetic joint infections. Keywords: arthroplasty infection, antibiotic therapy, biofilm, surgery, prevention

Proximal tibiofibular joint: Rendezvous with a forgotten articulation

Directory of Open Access Journals (Sweden)

Amitav Sarma

2015-01-01

Full Text Available The proximal tibiofibular joint (PTFJ is a plane type synovial joint. The primary function of the PTFJ is dissipation of torsional stresses applied at the ankle and the lateral tibial bending moments besides a very significant tensile, rather than compressive weight bearing. Though rare, early diagnosis and treatment of the PTFJ dislocation are essential to prevent chronic joint instability and extensive surgical intervention to restore normal PTFJ biomechanics, ankle and knee function, especially in athletes prone to such injuries. PTFJ dislocations often remain undiagnosed in polytrauma scenario with ipsilateral tibial fracture due to the absence of specific signs and symptoms of PTFJ injury. Standard orthopedic textbooks generally describe no specific tests or radiological signs for assessment of the integrity of this joint. The aim of this paper was to review the relevant clinical anatomy, biomechanics and traumatic pathology of PTFJ with its effect on the knee emphasizing the importance of early diagnosis through a high index of suspicion. Dislocation of the joint may have serious implications for the knee joint stability since fibular collateral ligament and posterolateral ligament complex is attached to the upper end of the fibula. Any high energy knee injury with peroneal nerve palsy should immediately raise the suspicion of PTFJ dislocation especially if the mechanism of injury involved knee twisting in flexion beyond 80° and in such cases a comparative radiograph of the contralateral side should be performed. Wider clinical awareness can avoid both embarrassingly extensive surgeries due to diagnostic delays or unnecessary overtreatment due to misinformation on the part of the treating surgeon.

Application value of curved planar reconstruction in sacroiliac joint of ankylosing spondylitis

International Nuclear Information System (INIS)

Wang Tuxing; Huan Xiao; Zhu Xiang; Fang Chun

2008-01-01

Objective: To determine the application value of curved planar reconstruction (CPR) of multislice spiral computed tomography(MSCT) in changes of sacroiliac joint of ankylosing spondylitis(AS). Methods: 33 patients with AS diagnosed clinically were chosen to take MSCT scanning of bilateral sacroiliac joints with the slice thick of 5mm and the slice interval of 5 mm. The primary images were transported to General Electric AW4.0 workstation, and the multiplanar reformatted sagittal images of sacrum were obtained by the reformat software, and further the coronary images of bilateral sacroiliac joints by CPR with the construction curves coincident with sacrums. Results: All coronary images of bilateral sacroiliac joints by CPR were excellent in density and space resolution, and showed complete sacroiliac joints and their changes clearly and directly. Of all 33 cases, 2 were graded as grade 0, 5 grade I, 11 grade II, 10 grade III, 5 glade IV, according to grading standard. Conclusion: The coronary images of sacroiliac joint by CPR are enough clear and eligible for clinical diagnosis, and, in combination with transversal images, are helpful to complete assessment about the grade and scope of changes of sacroiliac joint in AS patients. (authors)

Introducing a European Partnership. First issue of 'European Nuclear Features'. A joint publication of atw, Nuclear Espana, Revue Generale Nucleare (2004)

International Nuclear Information System (INIS)

2004-01-01

'European Nuclear Features' is a joint publication of the three specialized technical journals, Nuclear Espana (Spain), Revue Generale Nucleaire (France), and atw - International Journal for Nuclear Power (Germany), planned for six issues annually. ENF is to further greatly the international European exchange of information and news about energy and nuclear power. News items, comments, and scientific and technical contributions will cover important aspects of the field. The first issue of ENF contains contributions about these topics, among others: - European Nuclear Society and Foratom: Strengthening the Nuclear Network. - Report: EPR - the European Pressurized Water Reactor. - Finland: Starting Construction of the Fifth Nuclear Power Plant. - Czech Republic: Nuclear Power Report for 2003/2004. - The Decommissioning Project of the Bohunice-1 and -2 Units. - FRM-II: TUM Research Neutron Source Generates Its First Neutrons. (orig.)

Elbow joint fatigue and bench-press training.

Science.gov (United States)

Huang, Yen-Po; Chou, You-Li; Chen, Feng-Chun; Wang, Rong-Tyai; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2014-01-01

Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Controlled laboratory study. Motion research laboratory. A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Participants performed bench-press training until fatigued. Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

The Critical Success Factors for School and Community (Joint Use) Libraries in New Zealand

Science.gov (United States)

Matthews, Vivienne Kaye D.; Calvert, Philip J.

2007-01-01

Joint use libraries in New Zealand are generally found in the form of School and Community Libraries, primarily in rural areas, but there is little information available about their effectiveness or success. Research was undertaken by surveying all identified joint use libraries in New Zealand and then following this with detailed Case Studies of…

Learning from Success & Failure: International Joint Ventures in Emerging Markets

DEFF Research Database (Denmark)

Nielsen, Ulrik B.

their expectations. Inter-partner learning has been proposed in the literature as a major cause of IJV instability. However, current research indicates that when IJV partners engage in joint learning to create new IJV-specific knowledge that benefits both partners it stabilizes and sustains the IJV. Yet, joint......, especially when the prime motive of the operation is to capture opportunities in the local markets. However, the performance of IJVs generally turns out to be quite poor whether measured in economic value added, parent organization’s satisfaction or survival. For instance, termination rates of IJVs...

Improving parallel imaging by jointly reconstructing multi-contrast data.

Science.gov (United States)

Bilgic, Berkin; Kim, Tae Hyung; Liao, Congyu; Manhard, Mary Kate; Wald, Lawrence L; Haldar, Justin P; Setsompop, Kawin

2018-08-01

To develop parallel imaging techniques that simultaneously exploit coil sensitivity encoding, image phase prior information, similarities across multiple images, and complementary k-space sampling for highly accelerated data acquisition. We introduce joint virtual coil (JVC)-generalized autocalibrating partially parallel acquisitions (GRAPPA) to jointly reconstruct data acquired with different contrast preparations, and show its application in 2D, 3D, and simultaneous multi-slice (SMS) acquisitions. We extend the joint parallel imaging concept to exploit limited support and smooth phase constraints through Joint (J-) LORAKS formulation. J-LORAKS allows joint parallel imaging from limited autocalibration signal region, as well as permitting partial Fourier sampling and calibrationless reconstruction. We demonstrate highly accelerated 2D balanced steady-state free precession with phase cycling, SMS multi-echo spin echo, 3D multi-echo magnetization-prepared rapid gradient echo, and multi-echo gradient recalled echo acquisitions in vivo. Compared to conventional GRAPPA, proposed joint acquisition/reconstruction techniques provide more than 2-fold reduction in reconstruction error. JVC-GRAPPA takes advantage of additional spatial encoding from phase information and image similarity, and employs different sampling patterns across acquisitions. J-LORAKS achieves a more parsimonious low-rank representation of local k-space by considering multiple images as additional coils. Both approaches provide dramatic improvement in artifact and noise mitigation over conventional single-contrast parallel imaging reconstruction. Magn Reson Med 80:619-632, 2018. © 2018 International Society for Magnetic Resonance in Medicine. © 2018 International Society for Magnetic Resonance in Medicine.

Exploring the Nature of Joint Attention Impairments in Young Children with Autism Spectrum Disorder: Associated Social and Cognitive Skills

Science.gov (United States)

Schietecatte, Inge; Roeyers, Herbert; Warreyn, Petra

2012-01-01

It is generally accepted that joint attention skills are impaired in children with autism spectrum disorder (ASD). In this study, social preference, attention disengagement and intention understanding, assumed to be associated with the development of joint attention, are explored in relation to joint attention skills in children with ASD at the…

[A primary application and evaluation of temporomandibular joint replacement with stock prosthesis].

Science.gov (United States)

Zhang, Xiao-hu; Chen, Min-jie; Qiu, Ya-ting; Yang, Chi

2012-06-01

To evaluate the effect of total joint replacement in treatment of temporomandibular joint(TMJ) osteoarthropathy with stock prostheses. Six female patients involving 10 joints (2 unilateral and 4 bilateral), with an average age of 59 years old, were involved in this study. Three patients (5 joints) were diagnosed as internal derangement in V stage depending on MRI, 3D-CT findings and clinical characteristics. The other 3 patients (5 joints) had histories of failed temporomandibular joint operation using costochondral graft or temporalis fascial flap. The maximal mouth opening was 1.9 cm on average (range, 1.0 to 2.9cm). All the joints were replaced with Biomet standard prosthesis under general anesthesia. The follow-up period was from 7 to 49 months (average, 17.5 months). All the operations were successfully performed. Heterotopic ossification happened in a bilateral case 1 year postoperatively. One patient with bilateral joint disease complained of severe uncomfortable feeling in the region of the ears and the temples, although there was no significant positive signs according to an ENT examination. Pain relief of the joint and mouth opening improvement were significant in 4 patients. No failure was noted secondary to infection or loosening of the prostheses. The occlusal relationship kept stable postoperatively in all cases. Total TMJ joint replacement with standard prosthesis is a good choice for TMJ reconstruction. It can significantly reduce joint pain and the mouth opening limitation resulted from osteoarthritis. Long-term result remains to be evaluated based on a long-term follow-up.

Importance of modeling beam-column joints for seismic safety of reinforced concrete structures

International Nuclear Information System (INIS)

Sharma, Akanshu; Reddy, G.R.; Vaze, K.K.; Eligehausen, R.; Hofmann, J.

2011-01-01

Almost all structures, except the containment building, in a NPP can be classified as reinforced concrete (RC) framed structures. In case of such structures subjected to seismic loads, beam-column joints are recognized as the critical and vulnerable zone. During an earthquake, the global behavior of the structure is highly governed by the behavior of the joints. If the joints behave in a ductile manner, the global behavior generally will be ductile, whereas if the joints behave in a brittle fashion then the structure will display a brittle behavior. The joints of old and non-seismically detailed structures are more vulnerable and behave poorly under the earthquakes compared to the joints of new and seismically detailed structures. Modeling of these joint regions is very important for correct assessment of the seismic performance of the structures. In this paper, it is shown with the help of a recently developed joint model that not modeling the inelastic behavior of the joints can lead to significantly misleading and unsafe results in terms of the performance assessment of the structures under seismic loads. Comparison of analytical and experimental results is shown for two structures, tested under lateral monotonic seismic pushover loads. It is displayed that the model can predict the inelastic seismic response of structures considering joint distortion with high accuracy by little extra effort in modeling. (author)

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2007-01-01

The Joint Advisory Appeals Board was convened to examine an internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has requested that the report of the Board and the final decision of the Director-General be brought to the notice of the members of the personnel, in accordance with Article R VI 1.18 of the Staff Regulations. The relevant documents will therefore be posted on the notice board of the Main building (Bldg. 60) from 24 September to 7 October 2007. Human Resources Department

Joint Advisory Appeals Board

CERN Multimedia

2003-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mrs Judith Igo-Kemenes concerning the application of procedures foreseen by Administrative Circular N§ 26 (Rev. 3). As the appellant has not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 6 to 20 June 2003. Human Resources Division Tel. 74128

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2008-01-01

The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main Building (Bldg. 500) from 26 May to 6 June 2008. Human Resources Department (73911)

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2008-01-01

The Joint Advisory Appeals Board was convened to examine an internal appeal lodged by a member of the personnel with regard to the decision not to grant him an indefinite contract. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel, in accordance with Article R VI 1.18 of the Staff Regulations. These documents will therefore be posted on the notice board of the Main Building (Bldg. 60) from 21 January to 3 February 2008. Human Resources Department (73911)

Identification of Genetic Loci Jointly Influencing Schizophrenia Risk and the Cognitive Traits of Verbal-Numerical Reasoning, Reaction Time, and General Cognitive Function.

Science.gov (United States)

Smeland, Olav B; Frei, Oleksandr; Kauppi, Karolina; Hill, W David; Li, Wen; Wang, Yunpeng; Krull, Florian; Bettella, Francesco; Eriksen, Jon A; Witoelar, Aree; Davies, Gail; Fan, Chun C; Thompson, Wesley K; Lam, Max; Lencz, Todd; Chen, Chi-Hua; Ueland, Torill; Jönsson, Erik G; Djurovic, Srdjan; Deary, Ian J; Dale, Anders M; Andreassen, Ole A

2017-10-01

Schizophrenia is associated with widespread cognitive impairments. Although cognitive deficits are one of the factors most strongly associated with functional outcome in schizophrenia, current treatment strategies largely fail to ameliorate these impairments. To develop more efficient treatment strategies in patients with schizophrenia, a better understanding of the pathogenesis of these cognitive deficits is needed. Accumulating evidence indicates that genetic risk of schizophrenia may contribute to cognitive dysfunction. To identify genomic regions jointly influencing schizophrenia and the cognitive domains of reaction time and verbal-numerical reasoning, as well as general cognitive function, a phenotype that captures the shared variation in performance across cognitive domains. Combining data from genome-wide association studies from multiple phenotypes using conditional false discovery rate analysis provides increased power to discover genetic variants and could elucidate shared molecular genetic mechanisms. Data from the following genome-wide association studies, published from July 24, 2014, to January 17, 2017, were combined: schizophrenia in the Psychiatric Genomics Consortium cohort (n = 79 757 [cases, 34 486; controls, 45 271]); verbal-numerical reasoning (n = 36 035) and reaction time (n = 111 483) in the UK Biobank cohort; and general cognitive function in CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) (n = 53 949) and COGENT (Cognitive Genomics Consortium) (n = 27 888). Genetic loci identified by conditional false discovery rate analysis. Brain messenger RNA expression and brain expression quantitative trait locus functionality were determined. Among the participants in the genome-wide association studies, 21 loci jointly influencing schizophrenia and cognitive traits were identified: 2 loci shared between schizophrenia and verbal-numerical reasoning, 6 loci shared between schizophrenia and

A computational model for three-dimensional jointed media with a single joint set

International Nuclear Information System (INIS)

Koteras, J.R.

1994-02-01

This report describes a three-dimensional model for jointed rock or other media with a single set of joints. The joint set consists of evenly spaced joint planes. The normal joint response is nonlinear elastic and is based on a rational polynomial. Joint shear stress is treated as being linear elastic in the shear stress versus slip displacement before attaining a critical stress level governed by a Mohr-Coulomb faction criterion. The three-dimensional model represents an extension of a two-dimensional, multi-joint model that has been in use for several years. Although most of the concepts in the two-dimensional model translate in a straightforward manner to three dimensions, the concept of slip on the joint planes becomes more complex in three dimensions. While slip in two dimensions can be treated as a scalar quantity, it must be treated as a vector in the joint plane in three dimensions. For the three-dimensional model proposed here, the slip direction is assumed to be the direction of maximum principal strain in the joint plane. Five test problems are presented to verify the correctness of the computational implementation of the model

Optimised robot-based system for the exploration of elastic joint properties.

Science.gov (United States)

Frey, M; Burgkart, R; Regenfelder, F; Riener, R

2004-09-01

Numerous publications provide measured biomechanical data relating to synovial joints. However, in general, they do not reflect the non-linear elastic joint properties in detail or do not consider all degrees of freedom (DOF), or the quantity of data is sparse. To perform more comprehensive, extended measurements of elastic joint properties, an optimised robot-based approach was developed. The basis was an industrial, high-precision robot that was capable of applying loads to the joint and measuring the joint displacement in 6 DOF. The system was equipped with novel, custom-made control hardware. In contrast to the commonly used sampling rates that are below 100 Hz, a rate of 4 kHz was realised for each DOF. This made it possible to implement advanced, highly dynamic, quasi-continuous closed-loop controllers. Thus oscillations of the robot were avoided, and measurements were speeded up. The stiffness of the entire system was greater than 44 kNm(-1) and 22 Nm deg(-1), and the maximum difference between two successive measurements was less than 0.5 deg. A sophisticated CT-based referencing routine facilitated the matching of kinematic data with the individual anatomy of the tested joint. The detailed detection of the elastic varus-valgus properties of a human knee joint is described, and the need for high spatial resolution is demonstrated.

The joint flanker effect and the joint Simon effect: On the comparability of processes underlying joint compatibility effects.

Science.gov (United States)

Dittrich, Kerstin; Bossert, Marie-Luise; Rothe-Wulf, Annelie; Klauer, Karl Christoph

2017-09-01

Previous studies observed compatibility effects in different interference paradigms such as the Simon and flanker task even when the task was distributed across two co-actors. In both Simon and flanker tasks, performance is improved in compatible trials relative to incompatible trials if one actor works on the task alone as well as if two co-actors share the task. These findings have been taken to indicate that actors automatically co-represent their co-actor's task. However, recent research on the joint Simon and joint flanker effect suggests alternative non-social interpretations. To which degree both joint effects are driven by the same underlying processes is the question of the present study, and it was scrutinized by manipulating the visibility of the co-actor. While the joint Simon effect was not affected by the visibility of the co-actor, the joint flanker effect was reduced when participants did not see their co-actors but knew where the co-actors were seated. These findings provide further evidence for a spatial interpretation of the joint Simon effect. In contrast to recent claims, however, we propose a new explanation of the joint flanker effect that attributes the effect to an impairment in the focusing of spatial attention contingent on the visibility of the co-actor.

A Modelling Method of Bolt Joints Based on Basic Characteristic Parameters of Joint Surfaces

Science.gov (United States)

Yuansheng, Li; Guangpeng, Zhang; Zhen, Zhang; Ping, Wang

2018-02-01

Bolt joints are common in machine tools and have a direct impact on the overall performance of the tools. Therefore, the understanding of bolt joint characteristics is essential for improving machine design and assembly. Firstly, According to the experimental data obtained from the experiment, the stiffness curve formula was fitted. Secondly, a finite element model of unit bolt joints such as bolt flange joints, bolt head joints, and thread joints was constructed, and lastly the stiffness parameters of joint surfaces were implemented in the model by the secondary development of ABAQUS. The finite element model of the bolt joint established by this method can simulate the contact state very well.

Report of results of joint research using facilities in Japan Atomic Energy Research Institute in fiscal year 1987

International Nuclear Information System (INIS)

1988-06-01

The total themes of the joint research in fiscal year 1987 were 127. These are shown being classified into the general joint research in Tokai and Takasaki, neutron diffraction research and cooperative research. The general joint research is the standard utilization form using research reactors JRR-2 and JRR-4, Co-60 gamma irradiation facilities in Tokai and Takasaki, an electron beam irradiation facility in Takasaki, an electron beam linear accelator and hot laboratories, which are opened for common utilization by Japan Atomic Energy Research Institute. The cooperative research is carried out by concluding research cooperation contracts between the researchers of universities and JAERI. In the general joint research, radioactivation analysis, radiation chemistry, irradiation effect, neutron diffraction and so on are the main themes, and in the cooperative research, reactor technology, reactor materials, nuclear physics measurement and others are the main themes. The total number of visitors was 2629 man-day, and decreased due to the stop of JRR-2. Also other activities are reported. The abstracts of respective reports are collected in this book. (Kako, I.)

Joint ventures

DEFF Research Database (Denmark)

Sørensen, Karsten Engsig

Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

Preceding trauma in childhood hematogenous bone and joint infections.

Science.gov (United States)

Pääkkönen, Markus; Kallio, Markku J T; Lankinen, Petteri; Peltola, Heikki; Kallio, Pentti E

2014-03-01

Preceding trauma may play a role in the etiology and pathogenesis of hematogenous bone and joint infections. Among 345 children with an acute hematogenous bone and/or joint infection, 20% reported trauma during a 2-week period leading to infection. Blunt impact, bruises, or excoriations were commonly reported. The rate was similar to that in the general pediatric population obtained from the literature. In the study group, patients with and without trauma were similar in age, serum C-reactive protein and erythrocyte sedimentation rate, length of hospitalization, and late sequelae. Preceding minor trauma did not prove to be significant as an etiological or as a prognostic factor.

Gradient material model in analysis of mechanical joints of CFRP laminate

Science.gov (United States)

Puchała, Krzysztof; ElŻbieta, Szymczyk; Jachimowicz, Jerzy; Bogusz, Paweł

2018-01-01

Mechanical joints (e.g. bolted) used for decades are proved to be reliable. They can be assembled and applied in very rough conditions since they are less sensitive to environmental effects than other types of joints (e.g. adhesive). Therefore, they are still employed in aircraft design. High specific stiffness and strength of composite materials (especially CFRP) cause a continuous increase in their usage in aircraft structures. In general, composites are brittle materials and more notch sensitive than metal alloys. Hole making is a necessary stage in manufacturing of a mechanical joint. Holes vicinities are the areas of high stress concentrations and determine load capability of the whole structure. Therefore, mechanical joints of composite parts require a special focus during both a designing and a manufacturing process. The aim of the paper is analysis of potential local material weakness/deterioration caused by a drilling process and its influence on the global response of a mechanical joint. The specimen in the form of a double-shear joint was analyzed. The weakened areas were identified on the basis of NDT ultrasonic analysis. A simple gradient material model was proposed to describe the hole vicinity. Numerical simulations were performed and compared to experimental results.

A New Method for Determination of Joint Roughness Coefficient of Rock Joints

Directory of Open Access Journals (Sweden)

Shigui Du

2015-01-01

Full Text Available The joint roughness coefficient (JRC of rock joints has the characteristic of scale effect. JRC measured on small-size exposed rock joints should be evaluated by JRC scale effect in order to obtain the JRC of actual-scale rock joints, since field rock joints are hardly fully exposed or well saved. Based on the validity analysis of JRC scale effect, concepts of rate of JRC scale effect and effective length of JRC scale effect were proposed. Then, a graphic method for determination of the effective length of JRC scale effect was established. Study results show that the JRC of actual-scale rock joints can be obtained through a fractal model of JRC scale effect according to the statistically measured results of the JRC of small-size partial exposed rock joints and by the selection of fractal dimension of JRC scale effect and the determination of effective length of JRC scale effect.

Distinct element modelling of joint behavior in nearfield rock

International Nuclear Information System (INIS)

Hoekmark, H.; Israelsson, J.

1991-09-01

The investigation reported here concerns numerical simulations of the behaviour of the jointed rock mass in the nearest surroundings Of a portion of a KBS3 type tunnel, including one deposition hole. Results from three-dimensional models are presented and compared to results obtained from previous investigations of two-dimensional models. The three-dimensional models and the previous two-dimensional models relate to conditions prevailing in and around the BMT drift in Stripa mine. In particular are the importance of conditions, implicitly assumed in two-dimensional models, regarding joint orientation and joint persistence, investigated. The evaluation of the results is focused on effects on joint apertures. The implications regarding rock permeability is discussed for a couple of cases. It is found that the real three-dimensional geometry is of great importance, and that the two-dimensional models in some cases tend to overestimate the magnitudes of inelastic joint displacements and associated aperture changes considerably, i.e. the real three-dimensional situation implies locking effects, that generally stabilizes the block assembly. It is recommended that further three-dimensional simulations should be performed to determine relevant ranges of alteration of fracture apertures, caused by excavation and thermal processes, and that fracture geometries, that are typical to virgin granitic rock, should be defined and used as input for these simulations. (au)

Vascular complications (splenic and hepatic artery aneurysms) in the occipital horn syndrome: report of a patient and review of the literature

International Nuclear Information System (INIS)

Mentzel, H.-J.; Seidel, J.; Vogt, L.; Vogt, S.; Kaiser, W.A.

1999-01-01

We report an 18-year-old boy with occipital horn syndrome who developed aneurysms of the splenic and hepatic arteries. Occipital horn syndrome, also called X-linked cutis laxa or Ehlers-Danlos syndrome (EDS) type IX, is characterised by a skeletal dysplasia which includes occipital horns, broad clavicles, deformed radii, ulnae and humeri, narrow rib cage, undercalcified long bones and coxa valga. Distinctive features common to all patients are unusual facial appearance, hypermobility of finger joints, limitation of extension of elbows, chronic diarrhoea and genitourinary abnormalities. In this case report we describe the difficulties encountered in the diagnostic management of patients with EDS-related vascular lesions. (orig.)

Unassailable Advantage: The British Use of Principles of Joint Operations from 1758-1762

Science.gov (United States)

2017-05-25

victory at First Battle of Cape Finisterre in 1747. Nicholas A.M. Rodger highlights Anson’s circumvention of standing policy during the Seven Years War to...history. An important point because at the time there was no doctrine on joint service planning. 16 Nicholas A.M. Rodger, The Command of the Ocean...General 136 JP 3-0, Joint Operations, A-2. 137 Michelle Tan , “Army unveils new plan to

The practical problems of applying cost-effectiveness analysis to joint finance programmes

OpenAIRE

Karen Gerard; Ken Wright

1990-01-01

Joint finance is money allocated by the Department of Health to NHS authorities to promote policies of inter-agency collaboration which prevent people being admitted to hospital or facilitate earlier discharge from hospital or save on NHS resources generally. Worries have been expressed that joint finance has not been used as effectively or efficiency as it might have been. This paper is concerned with the practical application of cost-effectiveness analysis to policies or schemes which typic...

A new peak shear strength criterion for rock joints which includes spectral parameters as roughness measures

International Nuclear Information System (INIS)

Kulatilake, P.H.S.W.; Shou, G.; Huang, T.H.

1996-01-01

Most of the natural rock joint surface profiles do not belong to the self similar fractal category. In general, roughness profiles of rock joints consist of non-stationary and stationary components. At the simplest level, only one parameter is sufficient to quantify non-stationary joint roughness. The average inclination angle I, along with the direction considered for the joint surface, is suggested to capture the non-stationary roughness. It is shown that even though the fractal dimension D is a useful parameter, it alone is insufficient to quantify the stationary roughness of non-self similar profiles

Research on Deep Joints and Lode Extension Based on Digital Borehole Camera Technology

Directory of Open Access Journals (Sweden)

Han Zengqiang

2015-09-01

Full Text Available Structure characteristics of rock and orebody in deep borehole are obtained by borehole camera technology. By investigating on the joints and fissures in Shapinggou molybdenum mine, the dominant orientation of joint fissure in surrounding rock and orebody were statistically analyzed. Applying the theory of metallogeny and geostatistics, the relationship between joint fissure and lode’s extension direction is explored. The results indicate that joints in the orebody of ZK61borehole have only one dominant orientation SE126° ∠68°, however, the dominant orientations of joints in surrounding rock were SE118° ∠73°, SW225° ∠70° and SE122° ∠65°, NE79° ∠63°. Then a preliminary conclusion showed that the lode’s extension direction is specific and it is influenced by joints of surrounding rock. Results of other boreholes are generally agree well with the ZK61, suggesting the analysis reliably reflects the lode’s extension properties and the conclusion presents important references for deep ore prospecting.

Sonography for hip joint effusion in adults with hip pain

NARCIS (Netherlands)

S.M. Bierma-Zeinstra (Sita); A.M. Bohnen (Arthur); J.A.N. Verhaar (Jan); A. Prins (Ad); J.S. Lameris; A.Z. Ginai (Abida)

2000-01-01

textabstractOBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general

Laboratory characterization of rock joints

International Nuclear Information System (INIS)

Hsiung, S.M.; Kana, D.D.; Ahola, M.P.; Chowdhury, A.H.; Ghosh, A.

1994-05-01

A laboratory characterization of the Apache Leap tuff joints under cyclic pseudostatic and dynamic loads has been undertaken to obtain a better understanding of dynamic joint shear behavior and to generate a complete data set that can be used for validation of existing rock-joint models. Study has indicated that available methods for determining joint roughness coefficient (JRC) significantly underestimate the roughness coefficient of the Apache Leap tuff joints, that will lead to an underestimation of the joint shear strength. The results of the direct shear tests have indicated that both under cyclic pseudostatic and dynamic loadings the joint resistance upon reverse shearing is smaller than that of forward shearing and the joint dilation resulting from forward shearing recovers during reverse shearing. Within the range of variation of shearing velocity used in these tests, the shearing velocity effect on rock-joint behavior seems to be minor, and no noticeable effect on the peak joint shear strength and the joint shear strength for the reverse shearing is observed

Road network safety evaluation using Bayesian hierarchical joint model.

Science.gov (United States)

Wang, Jie; Huang, Helai

2016-05-01

Safety and efficiency are commonly regarded as two significant performance indicators of transportation systems. In practice, road network planning has focused on road capacity and transport efficiency whereas the safety level of a road network has received little attention in the planning stage. This study develops a Bayesian hierarchical joint model for road network safety evaluation to help planners take traffic safety into account when planning a road network. The proposed model establishes relationships between road network risk and micro-level variables related to road entities and traffic volume, as well as socioeconomic, trip generation and network density variables at macro level which are generally used for long term transportation plans. In addition, network spatial correlation between intersections and their connected road segments is also considered in the model. A road network is elaborately selected in order to compare the proposed hierarchical joint model with a previous joint model and a negative binomial model. According to the results of the model comparison, the hierarchical joint model outperforms the joint model and negative binomial model in terms of the goodness-of-fit and predictive performance, which indicates the reasonableness of considering the hierarchical data structure in crash prediction and analysis. Moreover, both random effects at the TAZ level and the spatial correlation between intersections and their adjacent segments are found to be significant, supporting the employment of the hierarchical joint model as an alternative in road-network-level safety modeling as well. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dual joint space arthrography in temporomandibular joint disorders: Comparison with single inferior joint space arthrography

Energy Technology Data Exchange (ETDEWEB)

Choi, Hyung Sik; Chang, Duk Soo; Lee, Kyung Soo; Kim, Woo Sun; Sung, Jung Ho; Jun, Young Hwan [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

1989-02-15

The temporomandibular joint(TMJ) is really a complex of two synovial space separated by fibrocartilaginous disc. Single inferior joint space arthrography is commonly performed for evaluation of TMJ disorders, which is known to be superior in demonstrating joint dynamics. But it reveals only the inferior surface of the disc. Therefore, dual space arthrography is superior to demonstrate the soft tissue anatomic feature of the joint such as disc position and shape. Authors performed 83 TMJ arthrograms in TMJ problems. Initially, the inferior joint space was done and then the superior space was sequentially contrasted. The follow results were noted: 1. In all cases, dual space arthrography revealed accurate disc shape and positions. 2. Concordant findings between the two techniques: 68 cases (82%). Discordance between the two techniques: 15 cases (18%) 3. Possible causes of discordance between inferior and dual space arthrography. a) Normal varians of anterior recess: 3 cases b) Posterior disc displacement: 4 cases c) Influence of the patient's head position change :4 cases d) False perforation: 2 cases e) Reduction change: 2 cases 4. In 5 cases with anterior displacement, dual space arthrography gave additional findings such as adhesion within the superior space, which could not be evaluated by single inferior space.

Inverse dynamic analysis of general n-link robot manipulators

International Nuclear Information System (INIS)

Yih, T.C.; Wang, T.Y.; Burks, B.L.; Babcock, S.M.

1996-01-01

In this paper, a generalized matrix approach is derived to analyze the dynamic forces and moments (torques) required by the joint actuators. This method is general enough to solve the problems of any n-link open-chain robot manipulators with joint combinations of R(revolute), P(prismatic), and S(spherical). On the other hand, the proposed matrix solution is applicable to both nonredundant and redundant robotic systems. The matrix notation is formulated based on the Newton-Euler equations under the condition of quasi-static equilibrium. The 4 x 4 homogeneous cylindrical coordinates-Bryant angles (C-B) notation is applied to model the robotic systems. Displacements, velocities, and accelerations of each joint and link center of gravity (CG) are calculated through kinematic analysis. The resultant external forces and moments exerted on the CG of each link are considered as known inputs. Subsequently, a 6n x 6n displacement coefficient matrix and a 6n x 1 external force/moment vector can be established. At last, the joint forces and moments needed for the joint actuators to control the robotic system are determined through matrix inversion. Numerical examples will be illustrated for the nonredundant industrial robots: Bendix AA/CNC (RRP/RRR) and Unimate 2000 spherical (SP/RRR) robots; and the redundant light duty utility arm (LDUA), modified LDUA, and tank waste retrieval manipulator system

Joint Electromagnetic Spectrum Management Operations

Science.gov (United States)

2012-03-20

promulgate command-specific policy and guidance for EMS use, the joint restricted frequency list (JRFL) process, the joint communications–electronics...joint communications–electronics operating instructions (JCEOI) and joint restricted frequency list (JRFL). Examples of FM include providing the...joint restricted frequency list Figure III-4. Joint Frequency Management Office Spectrum Management Process Chapter III III-10 JP 6-01 assignments

Pathophysiological Significance of Dermatan Sulfate Proteoglycans Revealed by Human Genetic Disorders

Directory of Open Access Journals (Sweden)

Shuji Mizumoto

2017-03-01

Full Text Available The indispensable roles of dermatan sulfate-proteoglycans (DS-PGs have been demonstrated in various biological events including construction of the extracellular matrix and cell signaling through interactions with collagen and transforming growth factor-β, respectively. Defects in the core proteins of DS-PGs such as decorin and biglycan cause congenital stromal dystrophy of the cornea, spondyloepimetaphyseal dysplasia, and Meester-Loeys syndrome. Furthermore, mutations in human genes encoding the glycosyltransferases, epimerases, and sulfotransferases responsible for the biosynthesis of DS chains cause connective tissue disorders including Ehlers-Danlos syndrome and spondyloepimetaphyseal dysplasia with joint laxity characterized by skin hyperextensibility, joint hypermobility, and tissue fragility, and by severe skeletal disorders such as kyphoscoliosis, short trunk, dislocation, and joint laxity. Glycobiological approaches revealed that mutations in DS-biosynthetic enzymes cause reductions in enzymatic activities and in the amount of synthesized DS and also disrupt the formation of collagen bundles. This review focused on the growing number of glycobiological studies on recently reported genetic diseases caused by defects in the biosynthesis of DS and DS-PGs.

Joint reconstruction via coupled Bregman iterations with applications to PET-MR imaging

Science.gov (United States)

Rasch, Julian; Brinkmann, Eva-Maria; Burger, Martin

2018-01-01

Joint reconstruction has recently attracted a lot of attention, especially in the field of medical multi-modality imaging such as PET-MRI. Most of the developed methods rely on the comparison of image gradients, or more precisely their location, direction and magnitude, to make use of structural similarities between the images. A challenge and still an open issue for most of the methods is to handle images in entirely different scales, i.e. different magnitudes of gradients that cannot be dealt with by a global scaling of the data. We propose the use of generalized Bregman distances and infimal convolutions thereof with regard to the well-known total variation functional. The use of a total variation subgradient respectively the involved vector field rather than an image gradient naturally excludes the magnitudes of gradients, which in particular solves the scaling behavior. Additionally, the presented method features a weighting that allows to control the amount of interaction between channels. We give insights into the general behavior of the method, before we further tailor it to a particular application, namely PET-MRI joint reconstruction. To do so, we compute joint reconstruction results from blurry Poisson data for PET and undersampled Fourier data from MRI and show that we can gain a mutual benefit for both modalities. In particular, the results are superior to the respective separate reconstructions and other joint reconstruction methods.

Joint diseases

International Nuclear Information System (INIS)

Weissman, S.D.

1989-01-01

The authors discuss how x-ray examination is essential in the diagnosis and evaluation of the arthritides. Most arthritides are first suspected by the clinician, and x-ray evaluation of these entities along with laboratory testing is important for confirmation of the clinical diagnosis and in staging of the disease process. Several arthritides are often diagnosed first by the podiatrist on x-ray evaluation, including pseudogout, ankylosing spondylitis, early rheumatoid arthritis, degenerative joint disease, and tuberculosis of bone. The joint responds to insult in only a limited number of ways that become apparent on x-ray. The soft tissues surrounding the joint, the articulating bones, and alignment of the joint space may all be involved by the arthritic process. On roentgenographic examination, the soft tissues must be examined for edema, masses, calcifications, and atrophy. The articulating bones must be examined for demineralization, erosions, osteophytes, periosteal reaction, cysts and sclerosis

Experimental knee joint pain during strength training and muscle strength gain in healthy subjects

DEFF Research Database (Denmark)

Sørensen, T J; Langberg, Henning; Hodges, P W

2012-01-01

Knee joint pain and reduced quadriceps strength are cardinal symptoms in many knee pathologies. In people with painful knee pathologies, quadriceps exercise reduces pain, improves physical function, and increases muscle strength. A general assumption is that pain compromises muscle function...... and thus may prevent effective rehabilitation. This study evaluated the effects of experimental knee joint pain during quadriceps strength training on muscle strength gain in healthy individuals....

Sonography for hip joint effusion in adults with hip pain

NARCIS (Netherlands)

Bierma-Zeinstra, S. M.; Bohnen, A. M.; Verhaar, J. A.; Prins, A.; Ginai-Karamat, A. Z.; Laméris, J. S.

2000-01-01

To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a

Kinematic analysis of subtalar eversion during gait in women with fibromyalgia.

Science.gov (United States)

Silva, Ana Paula; Chagas, Daniel das Virgens; Cavaliere, Maria Lúcia; Pinto, Sérgio; de Oliveira Barbosa, José Silvio; Batista, Luiz Alberto

2016-08-01

To analyse the subtalar eversion range of motion during walking in women with fibromyalgia. Twenty women diagnosed with fibromyalgia were directed to walk barefoot at comfortable and self-paced speed on a 7m walkway. Subtalar eversion range of motion was measured using the difference between the maximum and minimum values of subtalar eversion in stance phase. A range of motion between 4°-6° was considered as reference values for subtalar eversion during gait. Descriptive statistics were performed. In both right and left lower limb analysis of subtalar eversion range of motion, five women showed joint hypomobility, and twelve showed hypermobility. Only one patient performed unaltered subtalar eversion range of motion in both lower limbs. Both joints expressed high variability, and there were no significant differences between the right and left sides. The findings suggest that biomechanical function of the subtalar joint eversion during the loading response phase of gait in women with fibromyalgia, by excessive rigidity or complacency joint, tends to be impaired. This finding suggests that the indication of walking as an auxiliary strategy in the treatment of women with fibromyalgia should be preceded by thorough examination of the mechanical conditions of the subtalar joint of the patient. Copyright © 2016 Elsevier Ltd. All rights reserved.

Imaging findings of charcot joint

International Nuclear Information System (INIS)

Meng Quanfei; Zhou Chunxiang; Chen Yingming; Jiang Bo

2003-01-01

Objective: To analyze the MRI characters of Charcot joint, and to evaluate the diagnostic value of X-ray, CT, and MRI on Charcot joint. Methods: Eight patients with 8 Charcot joints underwent X-ray, CT, and MR examinations. 6 of them had syringomyelia, 1 patient had injury of the spinal cord, and 1 case had diabetes. All 8 patients had sensory reduction or deficit in the sick extremities. Results: There were two types of Charcot joint, hypertrophic and atrophic. Radiographic and CT features of hypertrophic joint (n=3) showed hyperostotic osteosclerosis and mammoth osteophytes in the sick bones, periarticular ossification, and articular disorganization. Radiographic and CT features of atrophic joint (n=5) showed extensive bone resorption (destruction), periarticular debris, and articular disorganization. Main MRI features of Charcot joint included hydrarthrosis within joint capsule, thickened, loose, and elongated joint capsule with para-joint, peri-diaphysis, and inter-muscular extension in a pseudopodia pattern. The irregular joint capsule wall was presented as mild hypointensity on T 1 WI, slight hyper-intensity on T 2 WI, and was markedly enhanced after Gd-DTPA was administrated, which was considered as a characteristic manifestation of the lesion. Soft tissue mass containing hypo-intense stripes on both T 1 WI and T 2 WI was commonly noted adjacent to the involved joint. Conclusion: X-rays plain film is the first choice for the diagnosis of Charcot joint, and MRI is pretty useful in the diagnosis of Charcot joint

The Joint Capabilities Integration and Development System: Its Impact on Air Force Acquisition Thirteen Years Later

Science.gov (United States)

2016-08-01

PAROCHIALISM : OPERATIONAL REQUIREMENTS AND THE REQUIREMENTS GENERATION SYSTEM (RGS) ........................................................ 15 2003...SERVICE STOVEPIPES AND PAROCHIALISM : OPERATIONAL REQUIREMENTS AND THE REQUIREMENTS GENERATION SYSTEM (RGS) According to a 1974 General Accounting...The time had come to put aside service parochialism and self-interest and begin the march to joint capability development, joint concepts and

Annual Report of the United Nations Joint Staff Pension Board. The Report Made In 1974

Energy Technology Data Exchange (ETDEWEB)

NONE

1974-11-06

Pursuant to the requirement in Article 14(a) of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1974 as Supplement No. 9 to the Official Records of the General Assembly: Twenty-Ninth Session (A/9609). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them.

Annual Report of the United Nations Joint Staff Pension Board. The Report made in 1975

Energy Technology Data Exchange (ETDEWEB)

NONE

1975-11-27

Pursuant to the requirement in Article 14(a) of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1975 as Supplement No. 9 to the Official Records of the General Assembly: Thirtieth Session (A/10009). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them.

Annual Report of the United Nations Joint Staff Pension Board. The Report made in 1972

International Nuclear Information System (INIS)

1972-01-01

Pursuant to the requirement in Article 14 of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1972 as Supplement No. 9 to the Official Records of the General Assembly: Twenty-Seventh Session (A/8709). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them

Annual Report of the United Nations Joint Staff Pension Board. The Report Made In 1974

International Nuclear Information System (INIS)

1974-01-01

Pursuant to the requirement in Article 14(a) of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1974 as Supplement No. 9 to the Official Records of the General Assembly: Twenty-Ninth Session (A/9609). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them

Annual Report of the United Nations Joint Staff Pension Board. The Report made in 1975

International Nuclear Information System (INIS)

1975-01-01

Pursuant to the requirement in Article 14(a) of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1975 as Supplement No. 9 to the Official Records of the General Assembly: Thirtieth Session (A/10009). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them

Annual Report of the United Nations Joint Staff Pension Board. The Report made in 1972

Energy Technology Data Exchange (ETDEWEB)

NONE

1972-11-28

Pursuant to the requirement in Article 14 of the Regulations of the United Nations Joint Staff Pension Fund that the United Nations Joint Staff Pension Board present an annual report to the General Assembly of the United Nations and to the member organizations of the Fund, the United Nations has published the report presented by the Board in 1972 as Supplement No. 9 to the Official Records of the General Assembly: Twenty-Seventh Session (A/8709). The report has thus already been communicated to Governments. However, if any Member should require additional copies, the Secretariat is ready to obtain them.

Joint Advisory Appeals Board

CERN Multimedia

2013-01-01

The Joint Advisory Appeals Board has examined the internal appeal lodged by a former member of the personnel, a beneficiary of the CERN Pension Fund, against the calculation of his pension in the framework of the Progressive Retirement Programme.   The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be available from 26 July to 11 August 2013 at the following link. HR Department Head Office

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2008-01-01

The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel against the decision to grant him only a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main building (bldg. 500) from 1 September to 14 September 2008. Human Resources Department (73911)

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2008-01-01

The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel with regard to the decision not to award him a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the notice of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main building (Bldg. 500) from 17 March to 30 March 2008. Human Resources Department Tel. 73911

Joint Advisory Appeals Board

CERN Multimedia

HR Department

2008-01-01

The Joint Advisory Appeals Board has examined the internal appeal lodged by a member of the personnel against the decision to grant him only a periodic one-step advancement for the 2006 reference year. The person concerned has not objected to the report of the Board and the final decision of the Director-General being brought to the attention of the members of the personnel. In application of Article R VI 1.18 of the Staff Regulations, these documents will therefore be posted on the notice board of the Main Building (Bldg. 500) from 1 September to 14 September 2008. Human Resources Department (73911)

The relationship between target joints and direct resource use in severe haemophilia.

Science.gov (United States)

O'Hara, Jamie; Walsh, Shaun; Camp, Charlotte; Mazza, Giuseppe; Carroll, Liz; Hoxer, Christina; Wilkinson, Lars

2018-01-16

Target joints are a common complication of severe haemophilia. While factor replacement therapy constitutes the majority of costs in haemophilia, the relationship between target joints and non drug-related direct costs (NDDCs) has not been studied. Data on haemophilia patients without inhibitors was drawn from the 'Cost of Haemophilia across Europe - a Socioeconomic Survey' (CHESS) study, a cost assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the United Kingdom) in which 139 haemophilia specialists provided demographic and clinical information for 1285 adult patients. NDDCs were calculated using publicly available cost data, including 12-month ambulatory and secondary care activity: haematologist and other specialist consultant consultations, medical tests and examinations, bleed-related hospital admissions, and payments to professional care providers. A generalized linear model was developed to investigate the relationship between NDDCs and target joints (areas of chronic synovitis), adjusted for patient covariates. Five hundred and thirteen patients (42% of the sample) had no diagnosed target joints; a total of 1376 target joints (range 1-10) were recorded in the remaining 714 patients. Mean adjusted NDDCs for persons with no target joints were EUR 3134 (standard error (SE) EUR 158); for persons with one or more target joints, mean adjusted NDDCs were EUR 3913 (SE EUR 157; average mean effect EUR 779; p target joints has a significant impact on NDDCs for patients with severe haemophilia, ceteris paribus. Prevention and management of target joints should be an important consideration of managing haemophilia patients.

Formation of tough composite joints

International Nuclear Information System (INIS)

Brun, M.K.

1997-05-01

Joints which exhibit tough fracture behavior were formed in a composite with a Si/SiC matrix reinforced with Textron SCS-6 fibers with either boron nitride or silicon nitride fiber coatings. In composites with BN coatings fibers were aligned uniaxially, while composites with Si 3 N 4 -coated fibers had a 0/90 degree architecture. Lapped joints (joints with overlapping fingers) were necessary to obtain tough behavior. Geometrical requirements necessary to avoid brittle joint failure have been proposed. Joints with a simple overlap geometry (only a few fingers) would have to be very long in order to prevent brittle failure. Typical failure in these joints is caused by a crack propagating along the interfaces between the joint fingers. Joints of the same overall length, but with geometry changed to be symmetric about the joint centerline and with an extra shear surface exhibited tough fractures accompanied with extensive fiber pullout. The initial matrix cracking of these joints was relatively low because cracks propagated easily through the ends of the fingers. Joints with an optimized stepped sawtooth geometry produced composite-like failures with the stress/strain curves containing an elastic region followed by a region of rising stress with an increase of strain. Increasing the fiber/matrix interfacial strength from 9 to 25 MPa, by changing the fiber coating, increased matrix cracking and ultimate strength of the composite significantly. The best joints had matrix cracking stress and ultimate strength of 138 and 240 MPa, respectively. Joint failure was preceded by multiple matrix cracking in the entire composite. The high strength of the joints will permit building of structures containing joints with only a minor reduction of design stresses

Simulation of Seismic Response of Reinforced Concrete Beam-Column Joints with Nurbs Surface Fitting

Directory of Open Access Journals (Sweden)

Mirhosseini R. Tabatabaei

2017-09-01

Full Text Available This paper presents an approach based on NURBS (non-uniform rational B-splines to achieve a seismic response surface (SRS from a group of points obtained by using an analytical model of RC joints. NURBS based on the genetic algorithm is an important mathematical tool and consists of generalizations of Bezier curves and surfaces and B-splines. Generally, the accuracy of the design process of joints depends on the number of control points that are captured in the results of experimental research on real specimens. The values obtained from the specimens are the best tools to use in seismic analysis, though more expensive when compared to values simulated by SRSs. The SRS proposed in this paper can be applied to obtain surfaces that show site effect results on destructions of beam-column joint, taking into account different site conditions for a specific earthquake. The efficiency of this approach is demonstrated by the retrieval of simulated-versus-analytical results.

Determination of ductile tearing resistance J-R curves in welded joints; Determination de courbes de resistance a la dechirure ductile dans les joints soudes

Energy Technology Data Exchange (ETDEWEB)

Gilles, Ph.; Ould, P. [AREVA NP, Tour AREVA, 92086 Paris La Defense (France); Marie, St. [CEA Saclay, DM2S, 91191 Gif sur Yvette Cedex (France)

2010-05-15

The ductile tearing resistance of steels is generally characterized in terms of resistance curves giving the increase of a resistance parameter such as the crack driving force J or a crack opening displacement as a function of the crack extension {Delta}a. Welded joints are often the weakest part of structures because of greater risk of defects, heterogeneity of the microstructure of the weld, strain concentration along mismatched interfaces. This paper recalls the transferability issues common to all integrity assessments based on tearing resistance curves and points out the difficulties of characterization specific to welds. Several recommendations are proposed for the experimental determination of tearing resistance of welded joints. (authors)

Revised analysis of the Transition Joint Life Test

Energy Technology Data Exchange (ETDEWEB)

Sartory, W K

1984-07-01

The Transition Joint Life Test was performed by General Electric and the Energy Technology Engineering Center and was analyzed earlier by General Electric. Because of later developments in analysis techniques and in our understanding of the stress behavior near a dissimilar metal weldment, agreement was reached between General Electric and Oak Ridge National Laboratory`s High-Temperature Structural Design program that a more up-to-date analysis was needed. This report presents results of a new analysis incorporating modified mechanical properties, revised constitutive equations, and a more refined finite element grid. The structural life prediction of the present report is quite conservative (approximately 3 cycles of predicted life compared to 12 to 25 cycles of measured life), whereas the earlier General Electric analysis was underconservative by a similar factor.

Study on the corrosion assessment of overpack welds-III (Joint research)

International Nuclear Information System (INIS)

Mitsui, Hiroyuki; Takahashi, Rieko; Otsuki, Akiyoshi; Asano, Hidekazu; Taniguchi, Naoki; Yui, Mikazu

2006-12-01

There is some possibility that the corrosion resistance of overpack welds is different from that of base metal due to the differences of material properties. In this study, corrosion behavior of welded joint for carbon steel was compared with base metal using the specimens taken from welded joint model fabricated by TIG, MAG and EBW respectively. The corrosion tests were performed for following four items. Passivation behavior and corrosion type. Propagation of general corrosion, pitting corrosion and crevice corrosion under aerobic condition. Stress corrosion cracking susceptibility. Propagation of general corrosion and hydrogen embrittlement under anaerobic condition. The results of these corrosion tests indicated that the corrosion resistance of welded metal by TIG and MAG was inferior to base metal for general corrosion, pitting corrosion and crevice corrosion. It was implied that the filler materials used for welding affected the corrosion resistance. No deterioration of corrosion resistance was observed in any corrosion modes for EBW, which does not need filler material. The susceptibility to stress corrosion cracking of welded metal and heat affected zone was lower than that of base metal. (author)

Joint evolution of predator body size and prey-size preference.

NARCIS (Netherlands)

Troost, T.A.; Kooi, B.W.; Dieckmann, U.

2007-01-01

We studied the joint evolution of predator body size and prey-size preference based on dynamic energy budget theory. The predators' demography and their functional response are based on general eco-physiological principles involving the size of both predator and prey. While our model can account for

Joint evolution of predator body size and prey-size preference

NARCIS (Netherlands)

Troost, Tineke; Kooi, Bob; Dieckmann, Ulf

2007-01-01

We studied the joint evolution of predator body size and prey-size preference based on dynamic energy budget theory. The predators’ demography and their functional response are based on general eco-physiological principles involving the size of both predator and prey. While our model can account

Weilby-Burton arthroplasty of the trapeziometacarpal joint of the thumb

DEFF Research Database (Denmark)

Thomsen, N O; Jensen, Claus Hjorth; Nygaard, H

2000-01-01

. Activities of daily living were generally easier. Mobility and strength of the thumb were satisfactory. One patient had signs of instability during a stress test. We conclude that our technique produces a stable and pain-free thumb joint. However, careful selection of the patients for this procedure...

Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

Science.gov (United States)

Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

2016-01-01

Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

SYNOVIAL CHONDROMATOSIS OF THE TEMPORO-MANDIBULAR JOINT. A CASE REPORT

Directory of Open Access Journals (Sweden)

V. MALANCHUK

2015-09-01

Full Text Available The study describes a rare clinical case of synovial chondromatosis of the temporo-mandibular joint, in a 53 year-old patient. In the prehospital stage, the patient was examined by additional diagnostic methods – 3D CT and subsequent computer simulation, in view of subsequent surgery. In January 2015, partial synovektomy of the right temporo-mandibular joint with removal of cartilaginous impurities was performed under general anesthesia. After histopathological confirmation of the clinical diagnosis, the patient was discharged in satisfactory condition, with recommendations for further examination and radiological control. Synovial chondromatosis of the temporo-mandibular joint is a disease characterized by impaired formation of cartilage or of intraarticular, cartilaginous, and relatively rare bone impurities. An important role in the diagnosis of joints’ synovial chondromatosis is played by the instrumental research methods, especially X-ray. Surgical treatment is recommended as a function of the prevalence of lesions.

Generalizing smooth transition autoregressions

DEFF Research Database (Denmark)

Chini, Emilio Zanetti

We introduce a variant of the smooth transition autoregression - the GSTAR model - capable to parametrize the asymmetry in the tails of the transition equation by using a particular generalization of the logistic function. A General-to-Specific modelling strategy is discussed in detail, with part......We introduce a variant of the smooth transition autoregression - the GSTAR model - capable to parametrize the asymmetry in the tails of the transition equation by using a particular generalization of the logistic function. A General-to-Specific modelling strategy is discussed in detail......, with particular emphasis on two different LM-type tests for the null of symmetric adjustment towards a new regime and three diagnostic tests, whose power properties are explored via Monte Carlo experiments. Four classical real datasets illustrate the empirical properties of the GSTAR, jointly to a rolling...

Experimental joint immobilization in guinea pigs. Effects on the knee joint

Science.gov (United States)

Marcondesdesouza, J. P.; Machado, F. F.; Sesso, A.; Valeri, V.

1980-01-01

In young and adult guinea pigs, the aftermath experimentally induced by the immobilization of the knee joint in hyperextended forced position was studied. Joint immobilization which varied from one to nine weeks was attained by plaster. Eighty knee joints were examined macro and microscopically. Findings included: (1) muscular hypotrophy and joint stiffness in all animals, directly proportional to the length of immobilization; (2) haemoarthrosis in the first week; (3) intra-articular fibrous tissue proliferation ending up with fibrous ankylosis; (4) hyaline articular cartilage erosions; (5) various degrees of destructive menisci changes. A tentative explanation of the fibrous tissue proliferation and of the cartilage changes is offered.

Prosthesis of the wrist-joint

Energy Technology Data Exchange (ETDEWEB)

Feldmeier, C.

1983-02-25

Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

Evaluation of new composite rigid joint under cyclic loading and its effect on one-floor composite frame

Directory of Open Access Journals (Sweden)

Azadeh Haghighat

2017-08-01

Full Text Available In order to improve the performance of structure against lateral and gravity loads, new systems known as composite systems consisting of the reinforced concrete columns and steel beams (RCS can be used and thereby the advantages of concrete beside steel are acquired. RCS joints can be implemented as either through-beam-type joint or through-column-type joint. In this paper, a concrete joint as standard reference joint and a proposed composite joint through-column‎ with new details were built and tested under cyclic loading. Then, using numerical analysis by finite element method, the behavior of composite joint under cyclic loading has been studied and the behavior and performance of proposed composite joint has been studied by comparing the results with that of concrete joint. The results showed that the joint composition in this way resulted in decreasing of the compressive and tensile damages of concrete and increasing in loading capacity, ductility, stiffness and energy absorption. General results of application of composite joint at the one floor-one span composite frame indicating that lateral loading capacity of frame was increased and the performance of frame was improved.

The impact of elbow and knee joint lesions on abnormal gait and posture of sows

Directory of Open Access Journals (Sweden)

Jørgensen Bente

2008-02-01

Full Text Available Abstract Background Joint lesions occur widespread in the Danish sow population and they are the most frequent cause for euthanasia. Clinically, it is generally impossible to differentiate between various types of non-inflammatory joint lesions. Consequently, it is often necessary to perform a post mortem examination in order to diagnose these lesions. A study was performed in order to examine the relation of abnormal gait and posture in sows with specific joint lesions, and thereby obtaining a clinical diagnostic tool, to be used by farmers and veterinarians for the evaluation of sows with joint problems. Methods The gait, posture and lesions in elbow- and knee joints of 60 randomly selected sows from one herd were scored clinically and pathologically. Associations between the scorings were estimated. Results The variables 'fore- and hind legs turned out' and 'stiff in front and rear' were associated with lesions in the elbow joint, and the variables 'hind legs turned out' and 'stiff in rear' were associated with lesions in the knee joint. Conclusion It was shown that specified gait and posture variables reflected certain joint lesions. However, further studies are needed to strengthen and optimize the diagnostic tool.

[Short-term effectiveness of Swanson artificial joint replacement in treating posttraumatic metacarpophalangeal joint stiffness].

Science.gov (United States)

Lu, Hui; Shen, Xiangqian; Xu, Jihua; Huang, Xin; Ye, Po; Wu, Shoucheng

2011-11-01

To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 +/- 28.96) degrees. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 +/- 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 +/- 28.86) degrees, showing significant difference when compared with preoperative value (t = 25.214, P = 0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 +/- 8.20 postoperatively, showing significant difference when compared with the preoperative score (t = -10.470, P = 0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Swanson artificial joint replacement can be applied to treat post-traumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short

Joint ownership of spouses and good faith acquisition of immovables by relying in the real estate cadastre

Directory of Open Access Journals (Sweden)

Cvetić Radenka M.

2016-01-01

Full Text Available The paper examines the rules on transferring of immovables in the matrimonial ownership regime against the backdrop of general notion of joint ownership and joint ownership (property of spouses. It explores whether the party who invokes the principle of reliance in the real estate cadastre shall be protected in the absence of an explicit rule guaranteeing the protection of a good faith acquirer in case of an unauthoriesd transfer done by one of the spouses. In other words, should for the sake of protection of confidence in legal transactions, acquisition of ownership and other rights in rem exceptionally be allowed by the good faith acquirer, provided that general presumptions under which confidence in accuracy and completeness of public registry of rights on immovables are fulfilled, in case where ownership was not inscribed as a joint ownership. The answer has been given in the absence of general rules on joint ownership, taking into account existing rules in the neighbouring countries, principle of reliance in the real estate cadastre and with due regard to the stance taken by the highest judicial body in the Republic of Serbia. The conclusion is that a spouse who is not inscribed in the public registry should not benefit from the protection against the good faith acquirer.

Evaluation of the magnitude of hip joint deformation in subjects with avascular necrosis of the hip joint during walking with and without Scottish Rite orthosis.

Science.gov (United States)

Karimi, Mohammad Taghi; Mohammadi, Ali; Ebrahimi, Mohammad Hossein; McGarry, Anthony

2017-02-01

The femoral head in subjects with leg calve perthes disease (LCPD) is generally considerably deformed. It is debatable whether this deformation is due to an increase in applied loads, a decrease in bone mineral density or a change in containment of articular surfaces. The aim of this study was to determine the influence of these factors on deformation of the femoral head. Two subjects with LCPD participated in this study. Subject motion and the forces applied on the affected leg were recorded using a motion analysis system (Qualsis TM ) and a Kistler force plate. OpenSim software was used to determine joint contact force of the hip joint whilst walking with and without a Scottish Rite orthosis. 3D Models of hip joints of both subjects were produced by Mimics software. The deformation of femoral bone was determined by Abaqus. Mean values of the force applied on the leg increased while walking with the orthosis. There was no difference between bone mineral density (BMD) of the femoral bone of normal and LCPD sides (p-value>0.05) and no difference between hip joint contact force of normal and LCPD sides. Hip joint containment appeared to decrease follow the use of the orthosis. It can be concluded that the deformation of femoral head in LCPD may not be due to change in BMD or applied load. Although the Scottish Rite orthosis is used mostly to increase hip joint containment, it appears to reduce hip joint contact area. It is recommended that a similar study is conducted using a higher number of subjects. Copyright © 2016 IPEM. All rights reserved.

A Review of Natural Joint Systems and Numerical Investigation of Bio-Inspired GFRP-to-Steel Joints

Directory of Open Access Journals (Sweden)

Evangelos I. Avgoulas

2016-07-01

Full Text Available There are a great variety of joint types used in nature which can inspire engineering joints. In order to design such biomimetic joints, it is at first important to understand how biological joints work. A comprehensive literature review, considering natural joints from a mechanical point of view, was undertaken. This was used to develop a taxonomy based on the different methods/functions that nature successfully uses to attach dissimilar tissues. One of the key methods that nature uses to join dissimilar materials is a transitional zone of stiffness at the insertion site. This method was used to propose bio-inspired solutions with a transitional zone of stiffness at the joint site for several glass fibre reinforced plastic (GFRP to steel adhesively bonded joint configurations. The transition zone was used to reduce the material stiffness mismatch of the joint parts. A numerical finite element model was used to identify the optimum variation in material stiffness that minimises potential failure of the joint. The best bio-inspired joints showed a 118% increase of joint strength compared to the standard joints.

Joint pain and Doppler-detectable bubbles in altitude (Hypobaric) decompression

Science.gov (United States)

Powell, Michael R.

1993-01-01

The observation that altitude decompression sickness (DCS) is associated with pain in the lower extremities is not new, although it is not a consistent finding. DCS in divers is generally in the upper body, an effect often attributed to non-loading of the body while immersed. In caisson workers, DCS is reported more in the lower extremities. Surprisingly, many researchers do not mention the location of DCS joint pain, apparently considering it to be random. This is not the case for the tissue ratios encountered in studying decompression associated with simulated EVA. In NASA/JSC tests, altitude DCS generally presented first in either the ankle, knee, or hip (83 percent = 73/88). There was a definite statistical relation between the maximum Spencer precordial Doppler Grade and the incidence of DCS in the extremity, although this is not meant to imply a casual relation between circulating gas bubbles and joint pain. The risk of DCS with Grade 4 was considerably higher than that of Grades 0 to 3. The DCS risk was independent of the 'tissue ratio.' There was a predominance of lower extremity DCS even when exercise was performed with the upper body. The reason for these locations we hypothesize to be attributed to the formation of tissue gas micronuclei from kinetic and tensile forces (stress-assisted nucleation) and are the result of the individuals ambulating in a 1g environment. Additionally, since these showers of Doppler bubbles can persist for hours, it is difficult to imagine that they are emanating solely from tendons and ligaments, the supposed site of joint pain. This follows from Henry's law linking the volume of joint tissue (the solvent) and the solubility coefficient of inert gas; there is volumetrically insufficient connective tissue to produce the prolonged release of gas bubbles. If gas bubbles are spawned and released from connective tissue, their volume is increased by those from muscle tissue. Therefore, the nexus between Doppler-detectable gas

Prosthesis of the wrist-joint

International Nuclear Information System (INIS)

Feldmeier, C.

1983-01-01

Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated. (orig.) [de

Design of mechanical joints

CERN Document Server

Blake, Alexander

2018-01-01

A cornerstone publication that covers the basic principles and practical considerations of design methodology for joints held by rivets, bolts, weld seams, and adhesive materials, Design of Mechanical Joints gives engineers the practical results and formulas they need for the preliminary design of mechanical joints, combining the essential topics of joint mechanics...strength of materials...and fracture control to provide a complete treatment of problems pertinent to the field of mechanical connections.

Teaching Joint-Level Robot Programming with a New Robotics Software Tool

Directory of Open Access Journals (Sweden)

Fernando Gonzalez

2017-12-01

Full Text Available With the rising popularity of robotics in our modern world there is an increase in the number of engineering programs that offer the basic Introduction to Robotics course. This common introductory robotics course generally covers the fundamental theory of robotics including robot kinematics, dynamics, differential movements, trajectory planning and basic computer vision algorithms commonly used in the field of robotics. Joint programming, the task of writing a program that directly controls the robot’s joint motors, is an activity that involves robot kinematics, dynamics, and trajectory planning. In this paper, we introduce a new educational robotics tool developed for teaching joint programming. The tool allows the student to write a program in a modified C language that controls the movement of the arm by controlling the velocity of each joint motor. This is a very important activity in the robotics course and leads the student to gain knowledge of how to build a robotic arm controller. Sample assignments are presented for different levels of difficulty.

Effect of Strain Rate on Joint Strength and Failure Mode of Lead-Free Solder Joints

Science.gov (United States)

Lin, Jian; Lei, Yongping; Fu, Hanguang; Guo, Fu

2018-03-01

In surface mount technology, the Sn-3.0Ag-0.5Cu solder joint has a shorter impact lifetime than a traditional lead-tin solder joint. In order to improve the impact property of SnAgCu lead-free solder joints and identify the effect of silver content on tensile strength and impact property, impact experiments were conducted at various strain rates on three selected SnAgCu based solder joints. It was found that joint failure mainly occurred in the solder material with large plastic deformation under low strain rate, while joint failure occurred at the brittle intermetallic compound layer without any plastic deformation at a high strain rate. Joint strength increased with the silver content in SnAgCu alloys in static tensile tests, while the impact property of the solder joint decreased with increasing silver content. When the strain rate was low, plastic deformation occurred with failure and the tensile strength of the Sn-3.0Ag-0.5Cu solder joint was higher than that of Sn-0.3Ag-0.7Cu; when the strain rate was high, joint failure mainly occurred at the brittle interface layer and the Sn-0.3Ag-0.7Cu solder joint had a better impact resistance with a thinner intermetallic compound layer.

Forming a multinational joint venture

International Nuclear Information System (INIS)

Bhatia, N.K.; Garb, R.H.; Statton, T.D.

1990-01-01

This paper discusses the basis and mechanics for forming a multinational joint venture. The topics of the paper include the motivations for a joint venture, selection of the appropriate co-venturer, management of the multinational joint venture, and the joint venture agreement. The authors state that a joint venture is not applicable or desirable in all instances and to be successful, must be carefully planned

Instantaneous Metabolic Cost of Walking: Joint-Space Dynamic Model with Subject-Specific Heat Rate.

Directory of Open Access Journals (Sweden)

Dustyn Roberts

Full Text Available A subject-specific model of instantaneous cost of transport (ICOT is introduced from the joint-space formulation of metabolic energy expenditure using the laws of thermodynamics and the principles of multibody system dynamics. Work and heat are formulated in generalized coordinates as functions of joint kinematic and dynamic variables. Generalized heat rates mapped from muscle energetics are estimated from experimental walking metabolic data for the whole body, including upper-body and bilateral data synchronization. Identified subject-specific energetic parameters-mass, height, (estimated maximum oxygen uptake, and (estimated maximum joint torques-are incorporated into the heat rate, as opposed to the traditional in vitro and subject-invariant muscle parameters. The total model metabolic energy expenditure values are within 5.7 ± 4.6% error of the measured values with strong (R2 > 0.90 inter- and intra-subject correlations. The model reliably predicts the characteristic convexity and magnitudes (0.326-0.348 of the experimental total COT (0.311-0.358 across different subjects and speeds. The ICOT as a function of time provides insights into gait energetic causes and effects (e.g., normalized comparison and sensitivity with respect to walking speed and phase-specific COT, which are unavailable from conventional metabolic measurements or muscle models. Using the joint-space variables from commonly measured or simulated data, the models enable real-time and phase-specific evaluations of transient or non-periodic general tasks that use a range of (aerobic energy pathway similar to that of steady-state walking.

Joint imaging

International Nuclear Information System (INIS)

Hengst, W.

1984-01-01

Joint imaging is a proven diagnostic procedure which has become indispensable to the detection and treatment of different joint diseases in almost all disciplines. The method is suited for early diagnosis of joint affections both in soft tissue and bone which cannot be detected by X-ray or other procedures. The local activity accumulation depends on the rate of metabolism and is visualized in the scan, which in turn enables the extension and floridity of focal lesions to be evaluated and followed-up. Although joint scans may often give hints to probabilities relevant to differential diagnosis, the method is non-specific and only useful if based on the underlying clinical picture and X-ray finding, if possible. The radiation exposure is very low and does not represent a hazard in cases of adequate assessment of indication. In pregnant women and children the assessment of indication has to be based on very strict principles. The method is suited for out-patient diagnosis and can be applied in all installations equipped with a gamma camera and a technetium generator. (orig.) [de

Managing Joint Production Motivation

DEFF Research Database (Denmark)

Lindenberg, Siegwart; Foss, Nicolai Juul

2011-01-01

We contribute to the microfoundations of organizational performance by proffering the construct of joint production motivation. Under such motivational conditions individuals see themselves as part of a joint endeavor, each with his or her own roles and responsibilities; generate shared...... representations of actions and tasks; cognitively coordinate cooperation; and choose their own behaviors in terms of joint goals. Using goal-framing theory, we explain how motivation for joint production can be managed by cognitive/symbolic management and organizational design....

Mechanics of Suture Joints

Science.gov (United States)

Li, Yaning; Song, Juha; Ortiz, Christine; Boyce, Mary; Ortiz Group/DMSE/MIT Team; Boyce Group/ME/MIT Team

2011-03-01

Biological sutures are joints which connect two stiff skeletal or skeletal-like components. These joints possess a wavy geometry with a thin organic layer providing adhesion. Examples of biological sutures include mammalian skulls, the pelvic assembly of the armored fish Gasterosteus aculeatus (the three-spined stickleback), and the suture joints in the shell of the red-eared slider turtle. Biological sutures allow for movement and compliance, control stress concentrations, transmit loads, reduce fatigue stress and absorb energy. In this investigation, the mechanics of the role of suture geometry in providing a naturally optimized joint is explored. In particular, analytical and numerical micromechanical models of the suture joint are constructed. The anisotropic mechanical stiffness and strength are studied as a function of suture wavelength, amplitude and the material properties of the skeletal and organic components, revealing key insights into the optimized nature of these ubiquitous natural joints.

Joint Intentionality

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Koreň Ladislav

2016-03-01

Full Text Available According to the shared intentionality hypothesis proposed by Michael Tomasello, two cognitive upgrades – joint and collective intentionality, respectively – make human thinking unique. Joint intentionality, in particular, is a mindset supposed to account for our early, species-specific capacity to participate in collaborative activities involving two (or a few agents. In order to elucidate such activities and their proximate cognitive-motivational mechanism, Tomasello draws on philosophical accounts of shared intentionality. I argue that his deference to such cognitively demanding accounts of shared intentional activities is problematic if his theoretical ambition is in part to show that and how early (prelinguistic and precultural capacities for joint action contribute to the development of higher cognitive capacities.

Uniqueness of the joint measurement and the structure of the set of compatible quantum measurements

Science.gov (United States)

Guerini, Leonardo; Terra Cunha, Marcelo

2018-04-01

We address the problem of characterising the compatible tuples of measurements that admit a unique joint measurement. We derive a uniqueness criterion based on the method of perturbations and apply it to show that extremal points of the set of compatible tuples admit a unique joint measurement, while all tuples that admit a unique joint measurement lie in the boundary of such a set. We also provide counter-examples showing that none of these properties are both necessary and sufficient, thus completely describing the relation between the joint measurement uniqueness and the structure of the compatible set. As a by-product of our investigations, we completely characterise the extremal and boundary points of the set of general tuples of measurements and of the subset of compatible tuples.

Joint Coal Board. Thirty-eighth annual report 1984/1985. [New South Wales

Energy Technology Data Exchange (ETDEWEB)

1986-01-01

The thirty-eighth annual report of the Joint Coal Board is presented. Included are the major activities of the Board, general statistics of the New South Wales coal industry, an industry review and the Board's financial statements.

The joint probability distribution of structure factors incorporating anomalous-scattering and isomorphous-replacement data

International Nuclear Information System (INIS)

Peschar, R.; Schenk, H.

1991-01-01

A method to derive joint probability distributions of structure factors is presented which incorporates anomalous-scattering and isomorphous-replacement data in a unified procedure. The structure factors F H and F -H , whose magnitudes are different due to anomalous scattering, are shown to be isomorphously related. This leads to a definition of isomorphism by means of which isomorphous-replacement and anomalous-scattering data can be handled simultaneously. The definition and calculation of the general term of the joint probability distribution for isomorphous structure factors turns out to be crucial. Its analytical form leads to an algorithm by means of which any particular joint probability distribution of structure factors can be constructed. The calculation of the general term is discussed for the case of four isomorphous structure factors in P1, assuming the atoms to be independently and uniformly distributed. A main result is the construction of the probability distribution of the 64 triplet phase sums present in space group P1 amongst four isomorphous structure factors F H , four isomorphous F K and four isomorphous F -H-K . The procedure is readily generalized in the case where an arbitrary number of isomorphous structure factors are available for F H , F K and F -H-K . (orig.)

JOINT ADVISORY APPEALS BOARD

CERN Multimedia

Human Resources Division

2001-01-01

The Joint Advisory Appeals Board was convened to examine the appeal lodged by Mr Neil Calder, Mrs Sudeshna Datta Cockerill, Mrs Andrée Fontbonne, Mrs Moniek Laurent and Mr Ulrich Liptow with regard to membership in the Pension Fund under the period with a Paid Associate contract, appeals dealt with on a collective basis. As the appellants have not objected, the report of the Board and the final decision of the Director-General are brought to the notice of the personnel in accordance with Article R VI 1.20 of the Staff Regulations. The relevant documents will therefore be posted on the notice boards of the Administration Building (N° 60) from 10 to 31 August 2001.

HEREDITARY CONNECTIVE TISSUE DISORDERS: NOMENCLATURE AND DIAGNOSTIC ALGORITHM

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A. V. Klemenov

2015-01-01

Full Text Available Hereditary connective tissue disorders (HCTDs are a genetically and clinically diverse group of diseases, which encompasses common congenital disorders of fibrous connective tissue structures. Out of the whole variety of the clinical manifestations of NCTDs, only differentiated monogenic syndromes with the agreed guidelines for their diagnosis have been long the focus of the medical community’s attention. Many unclassified forms of the pathology (dysplasia phenotypes have been disregarded while assessing a person’s prognosis and defining treatment policy. With no clear definition of NCTDs or their approved diagnostic algorithm, it is difficult to study their real prevalence in the population, to compare literature data, and to constructively discuss various scientific and practical aspects of this disease. Efforts to systematize individual clinical types of NCTD and to formulate their diagnostic criteria are set forth in the All-Russian Research Society Expert Committee national guidelines approved in 2009 and revised in 2012. The paper gives current views on the nomenclature of NCTDs, considers diagnostic criteria for both classified monogenic syndromes (Marfan's syndrome, Ehlers–Danlos' syndrome, MASS phenotype, primary mitral valve prolapse, joint hypermobility syndrome and unclassified dysplasia phenotypes (MASS-like phenotype, marfanoid appearance, Ehlers–Danlos-like phenotype, benign joint hypermobility syndrome, unclassified phenotype. The above abnormalities are presented as a continuous list drawn up in the decreasing order of the degree of their clinical manifestations and prognostic value (the phenotypic continuum described by M.J. Glesby and R.E. Pyentz: from monogenic syndromes through dysplasia phenotypes to an unclassified phenotype. Emphasis is laid on the clinical NCTD identification difficulties associated with the lack of specificity of external and visceral markers of connective tissue asthenia and with the certain

Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.

Science.gov (United States)

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2016-07-01

To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings. Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE). A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both. The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

A One-Step-Ahead Smoothing-Based Joint Ensemble Kalman Filter for State-Parameter Estimation of Hydrological Models

KAUST Repository

El Gharamti, Mohamad

2015-11-26

The ensemble Kalman filter (EnKF) recursively integrates field data into simulation models to obtain a better characterization of the model’s state and parameters. These are generally estimated following a state-parameters joint augmentation strategy. In this study, we introduce a new smoothing-based joint EnKF scheme, in which we introduce a one-step-ahead smoothing of the state before updating the parameters. Numerical experiments are performed with a two-dimensional synthetic subsurface contaminant transport model. The improved performance of the proposed joint EnKF scheme compared to the standard joint EnKF compensates for the modest increase in the computational cost.

Information Entropy Measures for Stand Structural Diversity:Joint Entropy

Institute of Scientific and Technical Information of China (English)

Lei Xiangdong; Lu Yuanchang

2004-01-01

Structural diversity is the key attribute of a stand. A set of biodiversity measures in ecology was introduced in forest management for describing stand structure, of which Shannon information entropy (Shannon index) has been the most widely used measure of species diversity. It is generally thought that tree size diversity could serve as a good proxy for height diversity. However, tree size diversity and height diversity for stand structure is not completely consistent. Stand diameter cannot reflect height information completely. Either tree size diversity or height diversity is one-dimensional information entropy measure. This paper discussed the method of multiple-dimensional information entropy measure with the concept of joint entropy. It is suggested that joint entropy is a good measure for describing overall stand structural diversity.

Analysis on Adhesively-Bonded Joints of FRP-steel Composite Bridge under Combined Loading : Arcan Test Study and Numerical Modeling

NARCIS (Netherlands)

Jiang, X.; Qiang, X.; Kolstein, M.H.; Bijlaard, F.S.K.

2016-01-01

The research presented in this paper is an experimental study and numerical analysis on mechanical behavior of the adhesively-bonded joint between FRP sandwich bridge deck and steel girder. Generally, there are three typical stress states in the adhesively-bonded joint: shear stress, tensile stress,

Sacroiliac joint dysfunction.

Science.gov (United States)

Ilaslan, Hakan; Arslan, Ahmet; Koç, Omer Nadir; Dalkiliç, Turker; Naderi, Sait

2010-07-01

Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome. Four cases with sacroiliac dysfunction are presented. The clinical and radiological signs supported the evidence of sacroiliac dysfunction, and exact diagnosis was made after positive response to sacroiliac joint block. A percutaneous sacroiliac fixation provided pain relief in all cases. The mean VAS scores reduced from 8.2 to 2.2. It is concluded that sacroiliac joint dysfunction diagnosis requires a careful physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases.

Metallic joints for very high vacuum; Joints metalliques pour ultra-vide

Energy Technology Data Exchange (ETDEWEB)

Paigne, J [Commissariat a l' Energie Atomique, Saclay (France).Centre d' Etudes Nucleaires

1961-07-01

After defining three main types of joint; three types of distribution of the tightening force in the clamps are demonstrated; the distribution of stresses, distortion and displacements in these clamps is then calculated by means of the theory of elasticity. This is followed by experimental results on a particular means of tightening (i.e. screw-clamps). From a brief discussion on the behaviour of the clamps it is possible finally to define other types of joint deriving from the main types originally foreseen. (author) [French] Apres avoir defini trois principaux types de joints, on met en evidence trois types de distribution des forces de serrage des brides; puis on calcule a l'aide de la theorie de l'elasticite la distribution des contraintes, deformations et deplacements dans ces brides. On donne ensuite des resultats experimentaux sur un mode de serrage particulier (cas des serres-joints). Une discussion sommaire sur le comportement des brides permet de definir finalement d'autres types de joints derivant des types principaux envisages initialement. (auteur)

Acromioclavicular joint separation

Directory of Open Access Journals (Sweden)

Devan Pandya, BS

2018-04-01

Full Text Available History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs were stable and his only complaint was pain around his left shoulder. On exam, the patient had a prominent left clavicle without skin compromise. He had adequate range of motion in the left shoulder with moderate pain, and his left upper extremity was neurovascularly intact. Significant findings: Plain films of the left shoulder showed elevation of the left clavicle above the acromion. There was an increase in the acromioclavicular (AC and coracoclavicular (CC distances (increased joint distances marked with red and blue arrows, respectively. A normal AC joint measures 1-3 mm whereas a normal CC distance measures 11-13 mm.1 The injury was classified as a Rockwood type III AC joint separation. Discussion: The AC joint is a synovial joint between an oval facet on the acromion and a similar facet on the distal end of the clavicle. Horizontal stability is provided by the AC joint while axial stability is provided by the CC joint.2,3 AC joint injuries account for about 9%-12% of shoulder girdle injuries, and the most common mechanism is direct trauma.4,5 Initial evaluation with imaging includes plain films with three views: the anterior-posterior (AP view with the shoulder in internal and external rotation as well as an axillary, or scapula-Y view (sensitivity 40%, specificity 90% for all films.6,7 AC joint injuries are classified by the Rockwood system.8 Type I involves a sprain or incomplete tear of the AC ligaments with an intact CC ligament. The AC joint appears normal on X-ray, but can become widened with stress, achieved by having the patient hold a 10-15 pound weight from each

Hip joint injection

Science.gov (United States)

... medicine into the joint. The provider uses a real-time x-ray (fluoroscopy) to see where to place ... Wakefield RJ. Arthrocentesis and injection of joints and soft tissue. In: Firestein GS, Budd RC, Gabriel SE, ...

Evaluation of Radiographic Instability of the Trapeziometacarpal Joint in Women With Carpal Tunnel Syndrome.

Science.gov (United States)

Kim, Jeong Hwan; Gong, Hyun Sik; Kim, Youn Ho; Rhee, Seung Hwan; Kim, Jihyoung; Baek, Goo Hyun

2015-07-01

To determine whether median nerve dysfunction measured by electrophysiologic studies in carpal tunnel syndrome (CTS) is associated with thumb trapeziometacarpal (TMC) joint instability. We evaluated 71 women with CTS and 31 asymptomatic control women. Patients with generalized laxity or TMC joint osteoarthritis were excluded. We classified the electrophysiologic severity of CTS based on nerve conduction time and amplitude and assessed radiographic instability of the TMC joint based on TMC joint stress radiographs. We compared subluxation ratio between patients with CTS and controls and performed correlation analysis of the relationship between the electrophysiologic grade and subluxation ratio. Thirty-one patients were categorized into the mild CTS subgroup and 41 into the severe CTS subgroup. There was no significant difference in subluxation ratio between the control group and CTS patients or between the control group and CTS subgroup patients. Furthermore, there was no significant correlation between electrophysiologic grade and subluxation ratio. This study demonstrated that patients with CTS did not have greater radiographic TMC joint instability compared with controls, and suggests that TMC joint stability is not affected by impaired median nerve function. Further studies could investigate how to better evaluate proprioceptive function of TMC joint and whether other nerves have effects on TMC joint motor/proprioceptive function, to elucidate the relationship between neuromuscular control of the TMC joint, its stability, and its progression to osteoarthritis. Diagnostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Generalized spectral radius and its max algebra version

Czech Academy of Sciences Publication Activity Database

Müller, Vladimír; Peperko, A.

2013-01-01

Roč. 439, č. 4 (2013), s. 1006-1016 ISSN 0024-3795 R&D Projects: GA ČR GA201/09/0473; GA AV ČR IAA100190903 Institutional support: RVO:67985840 Keywords : generalized spectral radius * joint spectral radius * Berger-Wang formula Subject RIV: BA - General Mathematics Impact factor: 0.983, year: 2013 http://www.sciencedirect.com/science/article/pii/S0024379512007380

Computed tomography of sacro-iliac joints

International Nuclear Information System (INIS)

Miquel, A.; Laredo, J.D.

1995-01-01

Actual technologies to explore sacro-iliac joints are conventional radiography, computed tomography , scintigraphy and nuclear magnetic resonance imaging. Standards films are sufficient, except in beginning sacro-iliac septic inflammations where the computed tomography is superior. Two problems are generally posed for the radiologist, to differentiate a septic arthritis from a rheumatic pathology An other problem in diagnosis is to make the difference between a degenerative arthropathy (which does not need a further investigation) and an infectious rheumatic pathology where more exploration is necessary. 28 refs., 3 tabs., 13 figs

Small fiber neuropathy is a common feature of Ehlers-Danlos syndromes

Science.gov (United States)

Cazzato, Daniele; Castori, Marco; Lombardi, Raffaella; Caravello, Francesca; Bella, Eleonora Dalla; Petrucci, Antonio; Grammatico, Paola; Dordoni, Chiara; Colombi, Marina

2016-01-01

Objective: To investigate the involvement of small nerve fibers in Ehlers-Danlos syndrome (EDS). Methods: Patients diagnosed with EDS underwent clinical, neurophysiologic, and skin biopsy assessment. We recorded sensory symptoms and signs and evaluated presence and severity of neuropathic pain according to the Douleur Neuropathique 4 (DN4) and ID Pain questionnaires and the Numeric Rating Scale (NRS). Sensory action potential amplitude and conduction velocity of sural nerve was recorded. Skin biopsy was performed at distal leg and intraepidermal nerve fiber density (IENFD) obtained and referred to published sex- and age-adjusted normative reference values. Results: Our cohort included 20 adults with joint hypermobility syndrome/hypermobility EDS, 3 patients with vascular EDS, and 1 patient with classic EDS. All except one patient had neuropathic pain according to DN4 and ID Pain questionnaires and reported 7 or more symptoms at the Small Fiber Neuropathy Symptoms Inventory Questionnaire. Pain intensity was moderate (NRS ≥4 and <7) in 8 patients and severe (NRS ≥7) in 11 patients. Sural nerve conduction study was normal in all patients. All patients showed a decrease of IENFD consistent with the diagnosis of small fiber neuropathy (SFN), regardless of the EDS type. Conclusions: SFN is a common feature in adults with EDS. Skin biopsy could be considered an additional diagnostic tool to investigate pain manifestations in EDS. PMID:27306637

Vascular complications (splenic and hepatic artery aneurysms) in the occipital horn syndrome: report of a patient and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Mentzel, H.-J. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)]|[Institute of Diagnostic and Interventional Radiology, Bachstrasse 18, D-07 740 Jena (Germany); Seidel, J.; Vogt, L. [Department of Paediatrics, University of Jena, Friedrich-Schiller-Universitaet Jena, Jena/Thueringen (Germany); Vogt, S.; Kaiser, W.A. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)

1999-01-01

We report an 18-year-old boy with occipital horn syndrome who developed aneurysms of the splenic and hepatic arteries. Occipital horn syndrome, also called X-linked cutis laxa or Ehlers-Danlos syndrome (EDS) type IX, is characterised by a skeletal dysplasia which includes occipital horns, broad clavicles, deformed radii, ulnae and humeri, narrow rib cage, undercalcified long bones and coxa valga. Distinctive features common to all patients are unusual facial appearance, hypermobility of finger joints, limitation of extension of elbows, chronic diarrhoea and genitourinary abnormalities. In this case report we describe the difficulties encountered in the diagnostic management of patients with EDS-related vascular lesions. (orig.) With 5 figs., 2 tabs., 12 refs.

Bayesian analysis of factors associated with fibromyalgia syndrome subjects

Science.gov (United States)

Jayawardana, Veroni; Mondal, Sumona; Russek, Leslie

2015-01-01

Factors contributing to movement-related fear were assessed by Russek, et al. 2014 for subjects with Fibromyalgia (FM) based on the collected data by a national internet survey of community-based individuals. The study focused on the variables, Activities-Specific Balance Confidence scale (ABC), Primary Care Post-Traumatic Stress Disorder screen (PC-PTSD), Tampa Scale of Kinesiophobia (TSK), a Joint Hypermobility Syndrome screen (JHS), Vertigo Symptom Scale (VSS-SF), Obsessive-Compulsive Personality Disorder (OCPD), Pain, work status and physical activity dependent from the "Revised Fibromyalgia Impact Questionnaire" (FIQR). The study presented in this paper revisits same data with a Bayesian analysis where appropriate priors were introduced for variables selected in the Russek's paper.

Development of Non-Conservative Joints in Beam Networks for Vibration Energy Flow Analysis

Directory of Open Access Journals (Sweden)

Jee-Hun Song

2007-01-01

Full Text Available Our work aims to find a general solution for the vibrational energy flow through a plane network of beams on the basis of an energy flow analysis. A joint between two semi-infinite beams are modeled by three sets of springs and dashpots. Thus, the results can incorporate the case of complaint and non-conservative in all the three degrees of freedom. In the cases of finite coupled structures connected at a certain angle, the derived non-conservative joints and developed wave energy equation were applied. The joint properties, the frequency, the coupling angle, and the internal loss factor were changed to evaluate the proposed methods for predicting medium-to-high frequency vibrational energy and intensity distributions.

Probing neutrino oscillations jointly in long and very long baseline experiments

International Nuclear Information System (INIS)

Wang, Y.F.; Whisnant, K.; Young Binglin; Xiong Zhaohua; Yang Jinmin

2002-01-01

We examine the prospects of making a joint analysis of neutrino oscillations at two baselines with neutrino superbeams. Assuming narrow band superbeams and a 100 kiloton water Cherenkov calorimeter, we calculate the event rates and sensitivities to the matter effect, the signs of the neutrino mass differences, the CP phase, and the mixing angle θ 13 . Taking into account all possible experimental errors under general consideration, we explore the optimum cases of a narrow band beam to measure the matter effect and the CP violation effect at all baselines up to 3000 km. We then focus on two specific baselines, a long baseline of 300 km and a very long baseline of 2100 km, and analyze their joint capabilities. We find that the joint analysis can offer extra leverage to resolve some of the ambiguities that are associated with the measurement at a single baseline

Parameter identification for joint elements in a revolute-joint detector manipulator

International Nuclear Information System (INIS)

Preissner, C.; Shu, D.; Royston, T.

2005-01-01

A revolute-joint robot is being developed for the spatial positioning of an x-ray detector at the Advanced Photon Source. Commercially available revolute-joint manipulators do not meet our size, positioning, or payload specifications. One idea being considered is the modification of a commercially available robot, with the goal of improving the repeatability and trajectory accuracy. Theoretical, computational, and experimental procedures are being used to (1) identify, (2) simulate the dynamics of an existing robot system using a multibody approach, and eventually (3) design an improved version, with low dynamic positioning uncertainty. A key aspect of the modeling and performance prediction is accurate stiffness and damping values for the robot joints. This paper discusses the experimental identification of the stiffness and damping parameters for one robot harmonic drive joint

Brachygnathia superior and degenerative joint disease: a new lethal syndrome in Angus calves.

Science.gov (United States)

Jayo, M; Leipold, H W; Dennis, S M; Eldridge, F E

1987-03-01

Brachygnathia superior and generalized diarthrodial degenerative joint disease were seen in 17 related, purebred Angus calves ranging in age from 2 days to 4 months. Craniometrical studies revealed decreased maxillary and palatine bone lengths and increased cranial, skull, and facial indices. Radiological evaluation of major appendicular joints demonstrated lipping of the joint margins with osteophyte formation, sclerosis of subchondral bone, and narrowing of joint spaces. Synovial fluid evaluation indicated joint degeneration but no etiologic agent. Rheumatoid factor analysis of plasma was negative. Grossly, all major appendicular joints were defective including the atlanto-occipital articulation. Lesions ranged from loss of surface luster to erosions and deep ulcers with eburnation of the subchondral bone and secondary proliferative synovitis. Histological changes were degeneration of the articular cartilage matrix, chondrocyte necrosis, flaking and fibrillation, chondrone formation, erosions and ulcers of the articular cartilage with subchondral bone sclerosis, vascular invasion with fibrosis, and chronic, nonsuppurative, proliferative synovitis. Growth plates had defective chondrocyte proliferation and hypertrophy with aberrant ossification of calcified cartilaginous matrix. Histochemical analysis of cartilage and bone failed to incriminate which component was defective, glycosaminoglycan or collagen, but indicated different distribution or absence of one or the other. Genealogic studies revealed a genetic basis for the new defect.

Theories on the beginnings and structure of joint-families ("zadruga"

Directory of Open Access Journals (Sweden)

Novaković Nada

2005-01-01

Full Text Available In this paper the author has a critical standpoint toward the most known theories on joint family communities. The works of the up-to-now called Yugoslav authors were put in the foreground. The works of foreign authors were placed after. They were classified by a general criterion, by how the authors saw the origins of this form of family. The comprehension of the basic characteristics depends, as a rule, on that, as well as the elements structure, changing processes, adjustment to new conditions and extinction of the joint family community. The first part of this article is devoted to theories about family communities as an institution of the Slavs. In this way its origin is connected with elements of a certain ethnic community. The range and consequences of such beliefs are suggested. The second part is reserved to explaining the family community as an institution which appeared in feudalism. It is a consequence of the tax system role. With its termination, the communities fell apart. This kind of social development determination and this type of family is proven to be ahistorical. It is predominantly stressed that the authors neglected that feudalism was a class society and overemphasized the force factor significance. The third part deals with theories which believe joint-family communities as an institution which arose in the transition from tribal to class society. These researchers stress that it is a general, historically determined conditioned form, which originated before class society and terminated with its development. Elements of its structure are especially important, as well as methods of its transformation in new conditions and termination processes. The essence of this belief is the following: a joint-family is a general historical form of family organization which arose in the transition from tribal to class society. The most important characteristics are: 1 blood relationship among men members; 2 common property; 3

A Joint Less Ordinary: Intriguing Roles for Hedgehog Signalling in the Development of the Temporomandibular Synovial Joint

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Malgorzata Kubiak

2016-08-01

Full Text Available This review highlights the essential role of Hedgehog (Hh signalling in the developmental steps of temporomandibular joint (TMJ formation. We review evidence for intra- and potentially inter-tissue Hh signaling as well as Glioma-Associated Oncogene Homolog (GLI dependent and independent functions. Morphogenesis and maturation of the TMJ’s individual components and the general landscape of Hh signalling is also covered. Comparison of the appendicular knee and axial TMJ also reveals interesting differences and similarities in their mechanisms of development, chondrogenesis and reliance on Hh signalling.

A Joint Less Ordinary: Intriguing Roles for Hedgehog Signalling in the Development of the Temporomandibular Synovial Joint

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Kubiak, Malgorzata; Ditzel, Mark

2016-01-01

This review highlights the essential role of Hedgehog (Hh) signalling in the developmental steps of temporomandibular joint (TMJ) formation. We review evidence for intra- and potentially inter-tissue Hh signaling as well as Glioma-Associated Oncogene Homolog (GLI) dependent and independent functions. Morphogenesis and maturation of the TMJ’s individual components and the general landscape of Hh signalling is also covered. Comparison of the appendicular knee and axial TMJ also reveals interesting differences and similarities in their mechanisms of development, chondrogenesis and reliance on Hh signalling. PMID:29615589

Determination of Ductile Tearing Resistance Curve in Weld Joints

International Nuclear Information System (INIS)

Marie, S.; Gilles, P.; Ould, P.

2010-01-01

Steels present in the ductile domain a tearing resistance which increase with the crack propagation up to the failure. This ductile tearing resistance is in general characterised with curves giving the variation of a global parameter (opening displacement at the crack tip delta, integral J) versus the crack extension Delta a. These global approaches depend more or less on the specimen geometry and on the type of the imposed loading. Local approaches based on the description of the ductile tearing mechanisms provide reliable solution to the transferability problem (from the lab specimen to the component) but are complex and costly to use and are not codified. These problems get worse in the case of a weld joint where no standard is available for the measurement of their ductile tearing resistance. But the welded joints are often the weak point of the structure because of greater risk of defects, the heterogeneity of the microstructure of the weld, deformation along the interface between two materials with different yield stress (mismatch).... After briefly recalling the problems of transferability of the ductile tearing resistance curves obtained on lab specimen to the case of components, this article identifies the factors complicating the determination of the toughness in the welded joints and gives recommendations for the experimental determination of ductile tearing resistance curves of welded joints

A modeling of sliding joint on one-dimensional flexible medium

International Nuclear Information System (INIS)

Hong Difeng; Ren Gexue

2011-01-01

The dynamic modeling of a sliding joint on a one-dimensional medium, such as a cable or a beam, is studied in this paper. The sliding joint is implemented by positioning it at a moving node on the one-dimensional medium, which is realized by variable-length elements at either side of the joint. The variable-length element is established with an absolute nodal coordinate formulation (ANCF) in the framework of the Arbitrary Lagrange–Euler (ALE) description. The sliding of the joint is described by the increasing of the length on one side of the one-dimensional medium and a corresponding decreasing of the other side. In order to capture the discontinuity of the slopes at the position of the sliding joint, the moving node has two slopes as generalized coordinates which are equal to each other in the case of a beam but not in the case of a cable, and in order to avoid the addition–deletion constraint, the node adjacent to the moving node is added or deleted if the element is too long or too short. The governing equations for the coupled system are derived in terms of D’Alembert’s principle and the resulting equations of motion are formulated in the standard form of differential algebraic equations of multibody systems. Numerical examples are presented to validate the method proposed by comparing with analytical results which are available or are made possible by simplifying the model.

Dynamic modeling method of the bolted joint with uneven distribution of joint surface pressure

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Li, Shichao; Gao, Hongli; Liu, Qi; Liu, Bokai

2018-03-01

The dynamic characteristics of the bolted joints have a significant influence on the dynamic characteristics of the machine tool. Therefore, establishing a reasonable bolted joint dynamics model is helpful to improve the accuracy of machine tool dynamics model. Because the pressure distribution on the joint surface is uneven under the concentrated force of bolts, a dynamic modeling method based on the uneven pressure distribution of the joint surface is presented in this paper to improve the dynamic modeling accuracy of the machine tool. The analytic formulas between the normal, tangential stiffness per unit area and the surface pressure on the joint surface can be deduced based on the Hertz contact theory, and the pressure distribution on the joint surface can be obtained by the finite element software. Futhermore, the normal and tangential stiffness distribution on the joint surface can be obtained by the analytic formula and the pressure distribution on the joint surface, and assigning it into the finite element model of the joint. Qualitatively compared the theoretical mode shapes and the experimental mode shapes, as well as quantitatively compared the theoretical modal frequencies and the experimental modal frequencies. The comparison results show that the relative error between the first four-order theoretical modal frequencies and the first four-order experimental modal frequencies is 0.2% to 4.2%. Besides, the first four-order theoretical mode shapes and the first four-order experimental mode shapes are similar and one-to-one correspondence. Therefore, the validity of the theoretical model is verified. The dynamic modeling method proposed in this paper can provide a theoretical basis for the accurate dynamic modeling of the bolted joint in machine tools.

Quantifying the impact of transient joint symptoms, chronic joint symptoms, and arthritis: a population-based approach.

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Busija, Lucy; Buchbinder, Rachelle; Osborne, Richard H

2009-10-15

To estimate the prevalence and co-occurrence of self-reported doctor-diagnosed arthritis, chronic joint symptoms (pain, aching, stiffness, or swelling on most days for a month), and transient joint symptoms (pain, aching, stiffness, or swelling but not on most days for a month), and to compare the sociodemographic characteristics, activity limitations, and health-related quality of life (HRQOL) of people with joint conditions with those who have no self-reported doctor-diagnosed arthritis and no joint symptoms. Data from the 2004 population-based South Australian Health Omnibus Survey (n = 2,840, ages 18-96 years) were used in the study. Activity limitations were assessed using 10 activity limitations questions from the Short Form 36 health survey. HRQOL was assessed using the Assessment of Quality of Life scale. Half of all respondents reported having joint problems, with 26%, 11%, and 13% reporting self-reported doctor-diagnosed arthritis, chronic joint symptoms, and transient joint symptoms, respectively. Chronic joint conditions (self-reported doctor-diagnosed arthritis and chronic joint symptoms) accounted for 74% of all joint problems and were associated with higher odds of activity limitations and poorer HRQOL. The frequency of transient and chronic joint symptoms was highest among middle-aged participants (ages 45-54 years for transient and 45-64 years for chronic joint symptoms) and those who had a body mass index in the obese range. Prevalence of self-reported doctor-diagnosed arthritis increased with age and was higher among women and those who were overweight or obese. This study documented the high prevalence and impact of joint conditions in the community. Chronic joint conditions affect daily life and are substantial barriers for effective public health interventions aimed at reducing obesity and inactivity.

Tinnitus in Temporomandibular Joint Disorders: Is it a Specific Somatosensory Tinnitus Subtype?

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Algieri, Giuseppe Maria Antonio; Leonardi, Alessandra; Arangio, Paolo; Vellone, Valentino; Paolo, Carlo Di; Cascone, Piero

2017-04-19

The most significant otologic symptoms, consisting of ear pain, tinnitus, dizziness, hearing loss and auricolar "fullness", generally arise within the auditory system, often are associated with extra auricolar disorders, particularly disorder of the temporo-mandibular joint. In our study we examined a sample of 200 consecutive patients who had experienced severe disabling symptom. The patiens came to maxillofacial specialist assessment for temporomandibular disorder. Each patient was assessed by a detailed anamnestic and clinical temporomandibular joint examination and they are divided into five main groups according classification criteria established by Wilkes; tinnitus and subjective indicators of pain are evaluated. The results of this study provide a close correlation between the joint pathology and otologic symptoms, particularly regarding tinnitus and balance disorders, and that this relationship is greater the more advanced is the stage of joint pathology. Moreover, this study shows that TMD-related tinnitus principally affects a younger population (average fifth decade of life) and mainly women (more than 2/3 of the cases). Such evidence suggests the existence of a specific tinnitus subtype that may be defined as "TMD-related somatosensory tinnitus".

Moving dynamic loads caused by bridge deck joint unevenness - a case study

CSIR Research Space (South Africa)

Steyn, WJV

2004-11-01

Full Text Available This paper focus on the general guidelines regarding maximum unevenness from bridge deck joints for typical South African heavy vehicles, in order to minimize the generation of moving variable loads. In a recent investigation it was found that areas...

Bone mineral density in patients with destructive arthrosis of the hip joint.

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Okano, Kunihiko; Aoyagi, Kiyoshi; Enomoto, Hiroshi; Osaki, Makoto; Chiba, Ko; Yamaguchi, Kazumasa

2014-05-01

Recent reports have shown the existence of subchondral insufficiency fracture in rapidly destructive arthrosis of the hip joint (RDA), and the findings suggest that osteopenia is related to the pathogenesis of the rapid progression of this disease. Therefore, we measured bone mineral density (BMD) in RDA patients. We measured BMD of the lumbar spine, radius, and calcaneus using dual-energy X-ray absorptiometry in 19 patients with RDA and 75 with osteoarthritis of the hip (OA) and compared BMD at different skeletal sites between RDA and OA patients. No significant differences were observed in BMD of the lumbar spine, ultradistal radius, mid-radius, and calcaneous between the RDA and OA groups. Our data suggest that RDA is not accompanied by generalized osteoporosis. Factors other than generalized bone status, for example, BMD around the affected hip joint before destruction, need to be analyzed to elucidate the pathophysiological mechanism of RDA.

Can symptomatic acromioclavicular joints be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging?

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Choo, Hye Jung; Lee, Sun Joo; Kim, Jung Han; Cha, Seong Sook; Park, Young Mi; Park, Ji Sung; Lee, Jun Woo; Oh, Minkyung

2013-04-01

To evaluate retrospectively whether symptomatic acromioclavicular joints can be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging. This study included 146 patients who underwent physical examination of acromioclavicular joints and 3-T MR imaging of the shoulder. Among them, 67 patients showing positive results on physical examination were assigned to the symptomatic group, whereas 79 showing negative results were assigned to the asymptomatic group. The following MR findings were compared between the symptomatic and asymptomatic groups: presence of osteophytes, articular surface irregularity, subchondral cysts, acromioclavicular joint fluid, subacromial fluid, subacromial bony spurs, joint capsular distension, bone edema, intraarticular enhancement, periarticular enhancement, superior and inferior joint capsular distension degree, and joint capsular thickness. The patients were subsequently divided into groups based on age (younger, older) and the method of MR arthrography (direct MR arthrography, indirect MR arthrography), and all the MR findings in each subgroup were reanalyzed. The meaningful cutoff value of each significant continuous variable was calculated using receiver operating characteristic analysis. The degree of superior capsular distension was the only significant MR finding of symptomatic acromioclavicular joints and its meaningful cutoff value was 2.1mm. After subgroup analyses, this variable was significant in the older age group and indirect MR arthrography group. On 3-T MR imaging, the degree of superior joint capsular distension might be a predictable MR finding in the diagnosis of symptomatic acromioclavicular joints. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

MP Joint Arthritis

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