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Sample records for rapid limb protraction

  1. Dentoskeletal effects of maxillary protraction in cleft patients with repetitive weekly protocol of alternate rapid maxillary expansions and constrictions.

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    da Luz Vieira, Gustavo; de Menezes, Luciane Macedo; de Lima, Eduardo Martinelli S; Rizzatto, Susana

    2009-07-01

    To evaluate the amount of maxillary protraction with face mask in complete unilateral cleft lip and palate patients submitted to two distinct rapid maxillary expansion (RME) protocols. The sample consisted of 20 individuals (nine boys and 11 girls; mean age of 10.4 +/- 2.62 years) with unilateral complete cleft lip and palate who had a constricted maxilla in the vertical and transverse dimensions. Ten patients underwent 1 week of RME with screw activation of one complete turn per day, followed by 23 weeks of maxillary protraction (group 1). The other 10 patients underwent 7 weeks of alternate rapid maxillary expansion and constriction, with one complete turn per day, followed by 17 weeks of maxillary protraction (group 2); both groups underwent a total of 6 months of treatment. Cephalometric measurements were taken at different times: pretreatment (T1), soon after RME (T2), and after 6 months of treatment (T3). Each measurement was analyzed with mixed models for repeated measures, and the covariance structure chosen was compound symmetry. The maxilla displaced slightly forward and downward with a counterclockwise rotation; the mandible rotated downward and backward, resulting in an increase in anterior facial height; the sagittal maxillomandibular relationship was improved; the maxillary molars and incisors were protruded and extruded; and the mandibular incisors were retroclined. There was no significant difference between the groups in evaluation time.

  2. [Effect of maxillary protraction with or without rapid palatal expansion in treating early skeletal Class III malocclusion].

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    Ma, Wen-Sheng; Lu, Hai-Yan; Dong, Fu-Sheng; Hu, Xiao-Ying; Li, Xing-Chao

    2009-04-01

    To evaluate the effectiveness of treatment with maxillary protraction with or without rapid palatal expansion (RPE) for skeletal Class III malocclusion in mixed dentition. A total of 31 children with Class III malocclusion in mixed dentition were selected, and 15 (group A) received maxillary protraction treatment with RPE, the other 16 (group B) received maxillary protraction without RPE. Cephalometric films were taken before and after treatment, and traditional and Pancherz analysis were used. The average duration of treatment was 10.14 months in group A and 9.77 months in group B respectively (P>0.05). According to Pancherz analysis, maxillary basal bone moved forwards by 2.99 mm in group A and 3.33 mm in group B respectively (P>0.05), mandibular basal bone moved backwards by 0.07 mm in group A, while forwards by 0.80 mm in group B (P>0.05), the overjet increased by 4.51 mm in group A and 6.37 mm in group B respectively (P0.05). The effects were clinically satisfactory in the both groups. Lower molar moved forwards by 1.18 mm in basal bone in group A, while backwards by 1.20 mm in group B (PClass III malocclusion.

  3. Validity of palatal superimposition of 3-dimensional digital models in cases treated with rapid maxillary expansion and maxillary protraction headgear.

    Science.gov (United States)

    Choi, Jin-Il; Cha, Bong-Kuen; Jost-Brinkmann, Paul-Georg; Choi, Dong-Soon; Jang, In-San

    2012-10-01

    The purpose of this study was to evaluate the validity of the 3-dimensional (3D) superimposition method of digital models in patients who received treatment with rapid maxillary expansion (RME) and maxillary protraction headgear. The material consisted of pre- and post-treatment maxillary dental casts and lateral cephalograms of 30 patients, who underwent RME and maxillary protraction headgear treatment. Digital models were superimposed using the palate as a reference area. The movement of the maxillary central incisor and the first molar was measured on superimposed cephalograms and 3D digital models. To determine whether any difference existed between the 2 measuring techniques, intra-class correlation (ICC) and Bland-Altman plots were analyzed. The measurements on the 3D digital models and cephalograms showed a very high correlation in the antero-posterior direction (ICC, 0.956 for central incisor and 0.941 for first molar) and a moderate correlation in the vertical direction (ICC, 0.748 for central incisor and 0.717 for first molar). The 3D model superimposition method using the palate as a reference area is as clinically reliable for assessing antero-posterior tooth movement as cephalometric superimposition, even in cases treated with orthopedic appliances, such as RME and maxillary protraction headgear.

  4. Limb-effect of rapidly rotating stars

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    A.B. Morcos

    2013-06-01

    Full Text Available Kerr metric is used to study the limb-effect phenomenon for axially rotating massive stars. The limb-effect phenomenon is concerned by the variation of the red-shift from the center to the limb of star. This phenomenon has been studied before for the sun. The solar gravitational field is assumed to be given by Schwarzschild and Lense-Thirring fields. In this trial, a study of the limb-effect for a massive axially symmetric rotating star is done. The line of site of inclination and the motion of the observer are taken into consideration to interpret a formula for this phenomenon using a general relativistic red-shift formula. A comparison between the obtained formula and previous formulae is given.

  5. Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction.

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    Hino, Claudia Toyama; Cevidanes, Lucia H S; Nguyen, Tung T; De Clerck, Hugo J; Franchi, Lorenzo; McNamara, James A

    2013-11-01

    Our objectives in this study were to evaluate in 3 dimensions the growth and treatment effects on the midface and the maxillary dentition produced by facemask therapy in association with rapid maxillary expansion (RME/FM) compared with bone-anchored maxillary protraction (BAMP). Forty-six patients with Class III malocclusion were treated with either RME/FM (n = 21) or BAMP (n = 25). Three-dimensional models generated from cone-beam computed tomographic scans, taken before and after approximately 1 year of treatment, were registered on the anterior cranial base and measured using color-coded maps and semitransparent overlays. The skeletal changes in the maxilla and the right and left zygomas were on average 2.6 mm in the RME/FM group and 3.7 mm in the BAMP group; these were different statistically. Seven RME/FM patients and 4 BAMP patients had a predominantly vertical displacement of the maxilla. The dental changes at the maxillary incisors were on average 3.2 mm in the RME/FM group and 4.3 mm in the BAMP group. Ten RME/FM patients had greater dental compensations than skeletal changes. This 3-dimensional study shows that orthopedic changes can be obtained with both RME/FM and BAMP treatments, with protraction of the maxilla and the zygomas. Approximately half of the RME/FM patients had greater dental than skeletal changes, and a third of the RME/FM compared with 17% of the BAMP patients had a predominantly vertical maxillary displacement. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  6. Performance of the efferent limb of a rapid response system

    DEFF Research Database (Denmark)

    Sørensen, Emilie M; Petersen, Asger

    2015-01-01

    AIM: To determine the distribution of outcomes following a medical emergency team (MET) call using a modified version of the multidisciplinary audit and evaluation of outcomes of rapid response (MAELOR) tool, and to evaluate its usefulness in monitoring the performance of the efferent limb...

  7. [The effect of two different methods of rapid maxillary expansion on treatment results of skeletal Class III malocclusion patients with maxillary protraction in early permanent dentition].

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    Chen, Xi-hua; Xie, Xing-qian

    2012-10-01

    To evaluate and compare the effect of single rapid maxillary expansion and repetitive rapid expansion and constriction with maxillary protraction in treating early permanent skeletal Class III patients. Twenty children with skeletal Class III malocclusion were randomly divided into two groups.Ten patients received 1 week of rapid expansion,followed by maxillary protraction(group A) and the other ten patients received 5 weeks of repetitive rapid expansion and constriction followed by maxillary protraction (group B).Cephalometric analysis was performed before and after treatment. The data was analyzed with SPSS 13.0 software package for paired t test. Significant changes in cranio-maxillofacial structures were observed in both groups after 6 months of treatment.Point A moved forward. SNA, ANB, UL-EP, U1-PP, SN-MP, ANS-Me/N-Me, Wit's value increased. L1-MP, LL-EP decreased. Significant differences were found in SNA,ANB,UL-EP between the two groups(PClass III malocclusion patients.

  8. Displacements prediction from 3D finite element model of maxillary protraction with and without rapid maxillary expansion in a patient with unilateral cleft palate and alveolus.

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    Zhang, Dan; Zheng, Li; Wang, Qiang; Lu, Li; Ma, Jia

    2015-08-19

    Both maxillary protraction and rapid expansion are recommended for patients with cleft palate and alveolus. The aim of the study is to establish a three-dimensional finite element model of the craniomaxillary complex with unilateral cleft palate and alveolus to simulate maxillary protraction with and without rapid maxillary expansion. The study also investigates the deformation of the craniomaxillary complex after applied orthopaedic forces in different directions. A three dimensional finite element model of 1,277,568 hexahedral elements (C3D8) and 1,801,945 nodes was established based upon CT scan of a patient with unilateral cleft palate and alveolus on the right side in this study. A force of 4.9 N per side was directed on the anatomic height of contour on the buccal side of the first molar. The angles between the force vector and occlusal plane were -30°, -20°, -10°, 0°, 10°, 20°, and 30°. A force of 2.45 N on each loading point was directed on the anatomic height of contour on the lingual side of the first premolar and the first molar to simulate the expansion of the palate. The craniomaxillary complex displaced forward under any of the loading conditions. The sagittal and vertical displacement of the craniomaxillary complex reached their peak at the protraction degree of -10° forward and downward to the occlusal plane. There were larger sagittal displacements when the maxilla was protracted forward with maxillary expansion. The palatal plane rotated counterclockwise under any of the loading conditions. Being protracted without expansion, the dental arch was constricted. When supplemented with maxillary expansion, the width of the dental arch increased. Transverse deformation of the dental arch on affected side was different from that on unaffected side. Protraction force alone led the craniomaxillary complex moved forward and counterclockwise, accompanied with lateral constrain on the dental arch. Additional rapid maxillary expansion resulted in a

  9. Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: a single-center, randomized controlled trial.

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    Liu, Weitao; Zhou, Yanheng; Wang, Xuedong; Liu, Dawei; Zhou, Shaonan

    2015-10-01

    The objective of this randomized controlled trial was to investigate the effects of facemask protraction combined with alternating rapid palatal expansion and constriction (RPE/C) vs rapid palatal expansion (RPE) alone in the early treatment of maxillary retrusive patients. Patients with a midface deficiency were recruited and randomly allocated into either the control group (RPE) or the intervention group (RPE/C). Eligibility criteria included the following: age 7 to 13 years old, Class III malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, A-Np less than 0 mm, and no cleft of lip or palate. The primary outcome was the degree of maxillary forward movement after treatment. The secondary outcomes were the changes of the other cephalometric variables after treatment and the treatment time. Simple randomization was carried out using a random number table at the beginning of the study. Envelopes containing the grouping information were used to ensure allocation concealment from the researchers. Blinding was applicable for cephalometric analysis only. Hyrax palatal expanders and facemask maxillary protraction were used in all patients. Patients in the RPE group were treated with rapid palatal expansion for 1 week. Patients in the RPE/C group were treated with RPE/C for 7 weeks. The expansion or constriction rate was 1 mm per day. Cephalometric analysis with traditional cephalometric measurements and an x-y coordinate system were used to compare the pretreatment and posttreatment cephalometric radiographs. Independent t tests were used to compare the data between the 2 groups. A total of 44 patients were randomized to either the RPE group or the RPE/C group in a 1:1 ratio. One subject in the RPE group was lost to follow-up during the treatment. Per-protocol analysis was used. All the other 43 patients reached the treatment completion criteria and were analyzed (RPE group: n = 21; RPE/C group: n = 22). The average protraction time was 10

  10. The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis

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    Zhang, Wei; Qu, Hong-Chen; Yu, Mo; Zhang, Yang

    2015-01-01

    We conducted a comprehensive meta-analysis of 12 studies to examine whether maxillary protraction face mask associated with rapid maxillary expansion (FM/RME) could be an effective treatment for Class III malocclusion and to evaluate the effect of timing on treatment response. Patients with a maxillary deficiency who were treated with FM with or without RME were compared with those who had an untreated Class III malocclusion. In both treatment groups, forward displacement of the maxilla and skeletal changes were found to be statistically significant. In addition, posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the control group. However, no significant differences were observed between the early treatment groups and late treatment groups. The results indicated that both FM/RME and FM therapy produced favorable skeletal changes for correcting anterior crossbite, and the curative time was not affected by the presence of deciduous teeth, early mixed dentition or late mixed dentition in the patient. PMID:26068221

  11. The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    Full Text Available We conducted a comprehensive meta-analysis of 12 studies to examine whether maxillary protraction face mask associated with rapid maxillary expansion (FM/RME could be an effective treatment for Class III malocclusion and to evaluate the effect of timing on treatment response. Patients with a maxillary deficiency who were treated with FM with or without RME were compared with those who had an untreated Class III malocclusion. In both treatment groups, forward displacement of the maxilla and skeletal changes were found to be statistically significant. In addition, posterior rotation of the mandible and increased facial height were more evident in the FM group compared with the control group. However, no significant differences were observed between the early treatment groups and late treatment groups. The results indicated that both FM/RME and FM therapy produced favorable skeletal changes for correcting anterior crossbite, and the curative time was not affected by the presence of deciduous teeth, early mixed dentition or late mixed dentition in the patient.

  12. Rapid and repeated limb loss in a clade of scincid lizards

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    Lee Michael SY

    2008-11-01

    Full Text Available Abstract Background The Australian scincid clade Lerista provides perhaps the best available model for studying limb reduction in squamates (lizards and snakes, comprising more than 75 species displaying a remarkable variety of digit configurations, from pentadactyl to entirely limbless conditions. We investigated the pattern and rate of limb reduction and loss in Lerista, employing a comprehensive phylogeny inferred from nucleotide sequences for a nuclear intron and six mitochondrial genes. Results The inferred phylogeny reveals extraordinary evolutionary mutability of limb morphology in Lerista. Ancestral state reconstructions indicate at least ten independent reductions in the number of digits from a pentadactyl condition, with a further seven reductions proceeding independently from a tetradactyl condition derived from one of these reductions. Four independent losses of all digits are inferred, three from pentadactyl or tetradactyl conditions. These conclusions are not substantially affected by uncertainty in assumed rates of character state transition or the phylogeny. An estimated age of 13.4 million years for Lerista entails that limb reduction has occurred not only repeatedly, but also very rapidly. At the highest rate, complete loss of digits from a pentadactyl condition is estimated to have occurred within 3.6 million years. Conclusion The exceptionally high frequency and rate of limb reduction inferred for Lerista emphasise the potential for rapid and substantial alteration of body form in squamates. An absence of compelling evidence for reversals of digit loss contrasts with a recent proposal that digits have been regained in some species of the gymnophthalmid clade Bachia, possibly reflecting an influence of differing environmental and genetic contexts on the evolution of limb morphology in these clades. Future study of the genetic, developmental, and ecological bases of limb reduction and loss in Lerista promises the elucidation of

  13. Using multimodal imaging techniques to monitor limb ischemia: a rapid noninvasive method for assessing extremity wounds

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    Luthra, Rajiv; Caruso, Joseph D.; Radowsky, Jason S.; Rodriguez, Maricela; Forsberg, Jonathan; Elster, Eric A.; Crane, Nicole J.

    2013-03-01

    Over 70% of military casualties resulting from the current conflicts sustain major extremity injuries. Of these the majority are caused by blasts from improvised explosive devices. The resulting injuries include traumatic amputations, open fractures, crush injuries, and acute vascular disruption. Critical tissue ischemia—the point at which ischemic tissues lose the capacity to recover—is therefore a major concern, as lack of blood flow to tissues rapidly leads to tissue deoxygenation and necrosis. If left undetected or unaddressed, a potentially salvageable limb may require more extensive debridement or, more commonly, amputation. Predicting wound outcome during the initial management of blast wounds remains a significant challenge, as wounds continue to "evolve" during the debridement process and our ability to assess wound viability remains subjectively based. Better means of identifying critical ischemia are needed. We developed a swine limb ischemia model in which two imaging modalities were combined to produce an objective and quantitative assessment of wound perfusion and tissue viability. By using 3 Charge-Coupled Device (3CCD) and Infrared (IR) cameras, both surface tissue oxygenation as well as overall limb perfusion could be depicted. We observed a change in mean 3CCD and IR values at peak ischemia and during reperfusion correlate well with clinically observed indicators for limb function and vitality. After correcting for baseline mean R-B values, the 3CCD values correlate with surface tissue oxygenation and the IR values with changes in perfusion. This study aims to not only increase fundamental understanding of the processes involved with limb ischemia and reperfusion, but also to develop tools to monitor overall limb perfusion and tissue oxygenation in a clinical setting. A rapid and objective diagnostic for extent of ischemic damage and overall limb viability could provide surgeons with a more accurate indication of tissue viability. This may

  14. Maxillary protraction after surgically assisted maxillary expansion

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    Laurindo Zanco Furquim

    2010-06-01

    Full Text Available This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME followed by orthopedic protraction (Sky Hook and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

  15. Three-Dimensional Evaluation of the Upper Airway Morphological Changes in Growing Patients with Skeletal Class III Malocclusion Treated by Protraction Headgear and Rapid Palatal Expansion: A Comparative Research.

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    Xueling Chen

    Full Text Available The aim of this study was to evaluate the morphological changes of upper airway after protraction headgear and rapid maxillary expansion (PE treatment in growing patients with Class III malocclusion and maxillary skeletal deficiency compared with untreated Class III patients by cone-beam computed tomography (CBCT.Thirty growing patients who have completed PE therapy were included in PE group. The control group (n = 30 was selected from the growing untreated patients with the same diagnosis. The CBCT scans of the pre-treatment (T1 and post-treatment (T2 of PE group and the control group were collected. Reconstruction and registration of the 3D models of T1 and T2 were completed. By comparing the data obtained from T1, T2 and control group, the morphological changes of the upper airway during the PE treatment were evaluated.Comparing with the data from T1 group, the subspinale (A of maxilla and the upper incisor (UI of the T2 group were moved in the anterior direction. The gnathion (Gn of mandible was moved in the posterior-inferior direction. The displacement of the hyoid bone as well as the length and width of dental arch showed significant difference. The volume and mean cross-sectional area of nasopharynx, velopharynx and glossopharynx region showed significant difference. The largest anteroposterior/the largest lateral (AP/LR ratios of the velopharynx and glossopharynx were increased, but the AP/LR ratio of the hypopharynx was decreased. In addition, the length and width of the maxillary dental arch, the displacement of the hyoid bone, the volume of nasopharynx and velopharynx, and the AP/LR ratio of the hypopharynx and velopharynx showed significant difference between the data from control and T2 group.The PE treatment of Class III malocclusion with maxillary skeletal hypoplasia leads to a significant increase in the volume of nasopharynx and velopharynx.

  16. Three-Dimensional Evaluation of the Upper Airway Morphological Changes in Growing Patients with Skeletal Class III Malocclusion Treated by Protraction Headgear and Rapid Palatal Expansion: A Comparative Research.

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    Chen, Xueling; Liu, Dongxu; Liu, Ju; Wu, Zizhong; Xie, Yongtao; Li, Liang; Liu, Hong; Guo, Tiantian; Chen, Chen; Zhang, Shijie

    2015-01-01

    The aim of this study was to evaluate the morphological changes of upper airway after protraction headgear and rapid maxillary expansion (PE) treatment in growing patients with Class III malocclusion and maxillary skeletal deficiency compared with untreated Class III patients by cone-beam computed tomography (CBCT). Thirty growing patients who have completed PE therapy were included in PE group. The control group (n = 30) was selected from the growing untreated patients with the same diagnosis. The CBCT scans of the pre-treatment (T1) and post-treatment (T2) of PE group and the control group were collected. Reconstruction and registration of the 3D models of T1 and T2 were completed. By comparing the data obtained from T1, T2 and control group, the morphological changes of the upper airway during the PE treatment were evaluated. Comparing with the data from T1 group, the subspinale (A) of maxilla and the upper incisor (UI) of the T2 group were moved in the anterior direction. The gnathion (Gn) of mandible was moved in the posterior-inferior direction. The displacement of the hyoid bone as well as the length and width of dental arch showed significant difference. The volume and mean cross-sectional area of nasopharynx, velopharynx and glossopharynx region showed significant difference. The largest anteroposterior/the largest lateral (AP/LR) ratios of the velopharynx and glossopharynx were increased, but the AP/LR ratio of the hypopharynx was decreased. In addition, the length and width of the maxillary dental arch, the displacement of the hyoid bone, the volume of nasopharynx and velopharynx, and the AP/LR ratio of the hypopharynx and velopharynx showed significant difference between the data from control and T2 group. The PE treatment of Class III malocclusion with maxillary skeletal hypoplasia leads to a significant increase in the volume of nasopharynx and velopharynx.

  17. Protocols for Late Maxillary Protraction in Cleft Lip and Palate Patients at Childrens Hospital Los Angeles

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    Yen, Stephen L-K

    2011-01-01

    This paper describes the protocols used at Childrens Hospital Los Angeles (CHLA) to protract the maxilla during early adolescence. It is a modification of techniques introduced by Eric Liou with his Alternate Rapid Maxillary Expansion and Constriction (ALT-RAMEC) technique. The main differences between the CHLA protocol and previous maxillary protraction protocols are the age the protraction is attempted, the sutural loosening by alternating weekly expansion with constriction and the use of Class III elastics to support and redirect the protraction by nightly facemask wear. The CHLA protocol entirely depends on patient compliance and must be carefully taught and monitored. In a cooperative patient, the technique can correct a Class III malocclusion that previously would have been treated with LeFort 1 maxillary advancement surgery. Thus, it is not appropriate for patients requiring 2 jaw surgeries to correct mandibular prognathism, occlusal cants or facial asymmetry. The maxillary protraction appears to work by a combination of skeletal advancement, dental compensation and rotation of the occlusal planes. Microscrew/microimplant/temporary anchorage devices have been used with these maxillary protraction protocols to assist in expanding the maxilla, increasing skeletal anchorage during protraction, limiting dental compensations and reducing skeletal relapse. PMID:21765629

  18. Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI).

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    Valentim, Daniela Pereira; Sato, Tatiana de Oliveira; Comper, Maria Luiza Caíres; Silva, Anderson Martins da; Boas, Cristiana Villas; Padula, Rosimeire Simprini

    2017-11-26

    There are very few observational methods for analysis of biomechanical exposure available in Brazilian-Portuguese. This study aimed to cross-culturally adapt and test the measurement properties of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). The cross-cultural adaptation and measurement properties test were established according to Beaton et al. and COSMIN guidelines, respectively. Several tasks that required static posture and/or repetitive motion of upper limbs were evaluated (n>100). The intra-raters' reliability for the RULA ranged from poor to almost perfect (k: 0.00-0.93), and SI from poor to excellent (ICC2.1: 0.05-0.99). The inter-raters' reliability was very poor for RULA (k: -0.12 to 0.13) and ranged from very poor to moderate for SI (ICC2.1: 0.00-0.53). The agreement was good for RULA (75-100% intra-raters, and 42.24-100% inter-raters) and to SI (EPM: -1.03% to 1.97%; intra-raters, and -0.17% to 1.51% inter-raters). The internal consistency was appropriate for RULA (α=0.88), and low for SI (α=0.65). Moderate construct validity were observed between RULA and SI, in wrist/hand-wrist posture (rho: 0.61) and strength/intensity of exertion (rho: 0.39). The adapted versions of the RULA and SI presented semantic and cultural equivalence for the Brazilian Portuguese. The RULA and SI had reliability estimates ranged from very poor to almost perfect. The internal consistency for RULA was better than the SI. The correlation between methods was moderate only of muscle request/movement repetition. Previous training is mandatory to use of observations methods for biomechanical exposure assessment, although it does not guarantee good reproducibility of these measures. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. Chronic Protracted Dislocation of the Temporomandibular Joint ...

    African Journals Online (AJOL)

    Background: Chronic protracted dislocation worsens with time due to continuing spasms and progressive fibrosis and consolidation. The aim of this report was to document our experience in the management of two different cases of longstanding dislocation in our centre. Method: First case was treated with traction method ...

  20. Seeking Sustainable Solutions in Protracted Refugee Situations ...

    African Journals Online (AJOL)

    Refugees in Africa are forced to fl ee their homelands because of ongoing conflicts, persecution and humanitarian crises in their countries. Refugees constitute one of Africa's most complex challenges, and in many regions protracted refugee situations (PRSs) have developed. This means that refugees have lived in host ...

  1. Federal Mineral Lease Blocks Protractions from MMS source data, Geographic NAD83, LOSCO (2004) [offshore_blocks_protraction_MMS_2004

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    Louisiana Geographic Information Center — Federal lease blocks protractions for the Gulf of Mexico (GOM) Outer Continental Shelf (OCS) Region. Based on the OCS Marine Survey Group Official Protraction...

  2. Safety and Effectiveness of Bone Marrow Cell Concentrate in the Treatment of Chronic Critical Limb Ischemia Utilizing a Rapid Point-of-Care System

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    Venkatesh Ponemone

    2017-01-01

    Full Text Available Critical limb ischemia (CLI is the end stage of lower extremity peripheral vascular disease (PVD in which severe obstruction of blood flow results in ischemic rest pain, ulcers and/or gangrene, and a significant risk of limb loss. This open-label, single-arm feasibility study evaluated the safety and therapeutic effectiveness of autologous bone marrow cell (aBMC concentrate in revascularization of CLI patients utilizing a rapid point-of-care device. Seventeen (17 no-option CLI patients with ischemic rest pain were enrolled in the study. Single dose of aBMC, prepared utilizing an intraoperative point-of-care device, the Res-Q™ 60 BMC system, was injected intramuscularly into the afflicted limb and patients were followed up at regular intervals for 12 months. A statistically significant improvement in Ankle Brachial Index (ABI, Transcutaneous Oxygen Pressure (TcPO2, mean rest pain and intermittent claudication pain scores, wound/ ulcer healing, and 6-minute walking distance was observed following aBMC treatment. Major amputation-free survival (mAFS rate and amputation-free rates (AFR at 12 months were 70.6% and 82.3%, respectively. In conclusion, aBMC injections were well tolerated with improved tissue perfusion, confirming the safety, feasibility, and preliminary effectiveness of aBMC treatment in CLI patients.

  3. Protracted bacterial bronchitis: reinventing an old disease.

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    Craven, Vanessa; Everard, Mark L

    2013-01-01

    Chronic cough is common in the paediatric population, yet the true prevalence of this condition remains difficult to define. Protracted bacterial bronchitis (PBB) is a disease caused by the chronic infection of the conducting airways. In many children the condition appears to be secondary to impaired mucociliary clearance that creates a niche for bacteria to become established, probably in the form of biofilms. In others, immunodeficiencies, which may be subtle, appear to be a factor. PBB causes persistent coughing and disturbed sleep, and affects exercise tolerance, causing significant levels of morbidity. PBB has remained largely unrecognised and is often misdiagnosed as asthma.

  4. Stresses in the midpalatal suture in the maxillary protraction therapy: a 3D finite element analysis

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    Orlando M. Tanaka

    2016-03-01

    Full Text Available Abstract Background The aim of the present work was to evaluate the stress magnitudes and directions along the midpalatal suture in the maxillary protraction therapy. Methods The geometry of the maxilla and teeth were digitally reconstructed based on computer tomography images obtained from the skull of a girl in a mixed dentition stage with skeletal and dental class III malocclusion. An appliance commonly used for rapid palatal expansion (RPE was also digitally modeled for anchorage of the protraction force and meshed for finite element analysis. The maxillary protraction was simulated applying 600 cN (300 cN for each side directed 30° forward and downward to the maxillary occlusal plane. Results The principal stresses, through the force application, exhibited similar distribution patterns. A higher stress area was observed in the region of the midpalatal suture located in front of the incisive canal. All the sections showed vectors of compressive nature. Conclusions Because of the compressive nature of the stresses distributed along the midpalatal suture in the maxillary protraction therapy simulation, which is opposite to the natural growth transversal tendency, maxillary expansion is advisable in clinical cases.

  5. Impact of experience when using the Rapid Upper Limb Assessment to assess postural risk in children using information and communication technologies.

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    Chen, Janice D; Falkmer, Torbjörn; Parsons, Richard; Buzzard, Jennifer; Ciccarelli, Marina

    2014-05-01

    The Rapid Upper Limb Assessment (RULA) is an observation-based screening tool that has been used to assess postural risks of children in school settings. Studies using eye-tracking technology suggest that visual search strategies are influenced by experience in the task performed. This study investigated if experience in postural risk assessments contributed to differences in outcome scores on the RULA and the visual search strategies utilized. While wearing an eye-tracker, 16 student occupational therapists and 16 experienced occupational therapists used the RULA to assess 11 video scenarios of a child using different mobile information and communication technologies (ICT) in the home environment. No significant differences in RULA outcome scores, and no conclusive differences in visual search strategies between groups were found. RULA can be used as a screening tool for postural risks following a short training session regardless of the assessor's experience in postural risk assessments. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  6. "Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

    DEFF Research Database (Denmark)

    Devita, M.A.; Smith, G.B.; Adam, S.K.

    2010-01-01

    Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patie...

  7. "Identifying the hospitalised patient in crisis"--a consensus conference on the afferent limb of rapid response systems

    DEFF Research Database (Denmark)

    DeVita, Michael A; Smith, Gary B; Adam, Sheila K

    2010-01-01

    Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deteriora...

  8. Limb regeneration.

    Science.gov (United States)

    Simon, András; Tanaka, Elly M

    2013-01-01

    Limb regeneration is observed in certain members of the animal phyla. Some animals keep this ability during their entire life while others lose it at some time during development. How do animals regenerate limbs? Is it possible to find unifying, conserved mechanisms of limb regeneration or have different species evolved distinct means of replacing a lost limb? How is limb regeneration similar or different to limb development? Studies on many organisms, including echinoderms, arthropods, and chordates have provided significant knowledge about limb regeneration. In this focus article, we concentrate on tetrapod limb regeneration as studied in three model amphibians: newts, axolotls, and frogs. We review recent progress on tissue interactions during limb regeneration, and place those findings into an evolutionary context. Copyright © 2012 Wiley Periodicals, Inc.

  9. Artificial Limbs

    Science.gov (United States)

    ... you are missing an arm or leg, an artificial limb can sometimes replace it. The device, which ... activities such as walking, eating, or dressing. Some artificial limbs let you function nearly as well as ...

  10. The Effects of Protracted War on Representative Government

    National Research Council Canada - National Science Library

    Wiersema, Richard E

    2005-01-01

    ... war against transnational terrorism. The paper presents a theory that posits the mechanisms by which protracted war may have demonstrated its corrosive effect on representative government, examines 3 historical case studies, then posits...

  11. Atlantic NAD 83 Protraction Limits (non-clipped)

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI shapefile format. Atlantic Region OPDs are approximately 2 degrees wide by one degree...

  12. Alaska NAD 83 Official Protraction Diagram (OPD) Outlines

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI shapefile format. At lower latitudes (0-48 degrees) OPDs are 1 degree in latitude by 2...

  13. Pacific NAD 83 Official Protraction Diagram (OPD) Images

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagrams (OPDs) in Adobe PDF format. Pacific Region OPDs are approximately 2 degrees wide by one degree high. OPDs are...

  14. Official Protraction Diagram and Leasing Map Boundaries - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows official protraction diagram (OPD) and leasing map boundaries covering areas of the Outer Continental Shelf (OCS) within Federal jurisdiction....

  15. Outer Continental Shelf Official Protraction Diagrams - Atlantic Region NAD 83

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI shapefile format. Atlantic Region OPDs are approximately 2 degrees wide by one degree...

  16. Outer Continental Shelf Official Protraction Diagrams - Alaska Region NAD 83

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI shapefile format. At lower latitudes (0-48 degrees) OPDs are 1 degree in latitude by 2...

  17. Atlantic NAD 83 Official Protraction Diagram (OPD) Images

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagrams (OPDs) in Adobe PDF format. Atlantic Region OPDs are approximately 2 degrees wide by one degree high. OPDs are...

  18. Effect of dual tasking on postural responses to rapid lower limb movement while seated on an exercise ball.

    Science.gov (United States)

    Jones, P; Sorinola, I; Strutton, P H

    2014-06-01

    Postural adjustments are used by the central nervous system to pre-empt and correct perturbations in balance during voluntary body movements. Alteration in these responses is associated with a number of neuromuscular/musculoskeletal conditions. Attention has been identified as important in this system; performing a concurrent cognitive task has been suggested to reduce the efficacy of this postural control. The aim of this study was to examine the effect of concurrent cognitive tasking on anticipatory postural adjustments while sitting on an exercise ball with a view to help inform future rehabilitation programmes. Bilateral EMG activity was recorded from the external and internal obliques, rectus abdominis, erector spinae and the right rectus femoris of 20 healthy subjects (9 males) with mean (SD) age of 21.88 (0.86) years (range 21-24 years). A rapid hip flexion protocol was carried out under three conditions: no concurrent task, counting out loud up from one and completing a serial sevens task. The addition of the cognitive task delayed and reduced the EMG in the prime mover muscle but had little impact on the responses of the trunk muscles within the time frame of the anticipatory responses; suggestive of a decoupling of voluntary and postural control mechanisms. The results of this study suggest that perhaps the clinical effects of dual task may not be largely due to changes in anticipatory postural adjustments. However, it would be important to compare these results to those seen in older and functionally impaired individuals as this would be more representative of the typical population undertaking such rehabilitation programmes. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Recent data on rapid eye movement sleep behavior disorder in patients with Parkinson disease: analysis of behaviors, movements, and periodic limb movements.

    Science.gov (United States)

    Cochen De Cock, Valérie

    2013-08-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a fascinating parasomnia in which patients are able to enact their dreams because of a lack of muscle atonia during REM sleep. RBD represents a unique window into the dream world. Frequently associated with Parkinson's disease (PD), RBD raises various issues about dream modifications in this pathology and about aggressiveness during RBD episodes in placid patients during wakefulness. Studies on these behaviors have underlined their non-stereotyped, action-filled and violent characteristics but also their isomorphism with dream content. Complex, learnt behaviors may reflect the cortical involvement in this parasomnia but the more frequent elementary movements and the associated periodic limb movements during sleep also implicate the brainstem. Surprisingly, patients with PD have an improvement of their movements during their RBD as if they were disease-free. Also not yet understood, this improvement of movement during REM sleep raises issues about the pathways involved in RBD and about the possibility of using this pathway to improve movement in PD during the day. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Resolving a protracted refugee situation through a regional process

    Directory of Open Access Journals (Sweden)

    Olga Mitrovic

    2015-09-01

    Full Text Available Protracted refugee situations are usually a result of political deadlock, and their resolution demands the involvement of a range of actors and a multifaceted approach focused on leveraging political will. Despite its shortcomings, the Regional Process in the Western Balkans offers a number of lessons for resolving such situations.

  1. Stable bipedal walking with a swing-leg protraction strategy.

    Science.gov (United States)

    Bhounsule, Pranav A; Zamani, Ali

    2017-01-25

    In bipedal locomotion, swing-leg protraction and retraction refer to the forward and backward motion, respectively, of the swing-leg before touchdown. Past studies have shown that swing-leg retraction strategy can lead to stable walking. We show that swing-leg protraction can also lead to stable walking. We use a simple 2D model of passive dynamic walking but with the addition of an actuator between the legs. We use the actuator to do full correction of the disturbance in a single step (a one-step dead-beat control). Specifically, for a given limit cycle we perturb the velocity at mid-stance. Then, we determine the foot placement strategy that allows the walker to return to the limit cycle in a single step. For a given limit cycle, we find that there is swing-leg protraction at shallow slopes and swing-leg retraction at steep slopes. As the limit cycle speed increases, the swing-leg protraction region increases. On close examination, we observe that the choice of swing-leg strategy is based on two opposing effects that determine the time from mid-stance to touchdown: the walker speed at mid-stance and the adjustment in the step length for one-step dead-beat control. When the walker speed dominates, the swing-leg retracts but when the step length dominates, the swing-leg protracts. This result suggests that swing-leg strategy for stable walking depends on the model parameters, the terrain, and the stability measure used for control. This novel finding has a clear implication in the development of controllers for robots, exoskeletons, and prosthetics and to understand stability in human gaits. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Robustness of the Approximate Likelihood of the Protracted Speciation Model.

    Science.gov (United States)

    Simonet, Camille Anna; Scherrer, Raphaël; Rego-Costa, Artur; Etienne, Rampal S

    2017-12-22

    The protracted speciation model presents a realistic and parsimonious explanation for the observed slowdown in lineage accumulation through time, by accounting for the fact that speciation takes time. A method to compute the likelihood for this model given a phylogeny is available and allows estimation of its parameters (rate of initiation of speciation, rate of completion of speciation, and extinction rate) and statistical comparison of this model to other proposed models of diversification. However this likelihood computation method makes an approximation of the protracted speciation model to be mathematically tractable: it sometimes counts fewer species than one would do from a biological perspective. This approximation may have large consequences for likelihood-based inferences: it may render any conclusions based on this method completely irrelevant. Here we study to what extent this approximation affects parameter estimations. We simulated phylogenies from which we reconstructed the tree of extant species according to the original, biologically meaningful protracted speciation model and according to the approximation. We then compared the resulting parameter estimates. We found that the differences were larger for high values of extinction rates and small values of speciation-completion rates. Indeed, a long speciation-completion time and a high extinction rate promote the appearance of cases to which the approximation applies. However, surprisingly, the deviation introduced is largely negligible over the parameter space explored, suggesting that this approximate likelihood can be applied reliably in practice to estimate biologically relevant parameters under the original protracted speciation model. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  3. Limb myokymia

    Energy Technology Data Exchange (ETDEWEB)

    Albers, J.W.; Allen, A.A.; Bastron, J.A.; Daube, J.R.

    Thirty-eight patients with myokymic discharges localized to limb muscles on needle electromyography had various neurologic lesions, both acute and chronic. Of the 38 patients, 27 had had previous radiation therapy and the clinical diagnosis of radiation-induced plexopathy, myelopathy, or both. For the remaining 11 patients, the diagnoses included multiple sclerosis, inflammatory polyradiculoneuropathy, ischemic neuropathy, inflammatory myopathy, and chronic disorders of the spinal cord and peripheral nerves. The clinical presentations and results of local ischemia, peripheral nerve block, and percutaneous stimulation suggest that most limb myokymic discharges arise focally at the site of a chronic peripheral nerve lesion.

  4. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances

    OpenAIRE

    Forghani, Ali; Milner, Theodore E.

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the h...

  5. Effective Maxillary Protraction with Tandem Traction Bow Appliance

    Directory of Open Access Journals (Sweden)

    Pravin Kumar S Marure

    2014-01-01

    Full Text Available Tandem traction bow appliance (TTBA promotes patient compliance, because it is more esthetic and comfortable than extraoral appliances. TTBA should be used only in case where maxillary deficiency and normal mandible is present. Advantages of it includes good oral hygiene, early treatment of any Class III malocclusion, optimal retention, distribution of the forces for protraction to all maxillary teeth, free mandibular movement. It can be used in conjunction with fixed appliances if necessary. This paper includes two case reports. The treatment results in both the cases demonstrated significant skeletal and dental response to TTBA therapy. Skeletal change was primarily a result of anterior movement of the maxilla.

  6. Reduction of residual limb volume in people with transtibial amputation

    NARCIS (Netherlands)

    Tantua, Audrey T.; Geertzen, Jan H. B.; van den Dungen, Jan J. A. M.; Breek, Jan-Kees C.; Dijkstra, Pieter U.

    2014-01-01

    The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study was to analyze the reduction of residual limb volume in people

  7. Low marine sulphate and protracted oxygenation of the Proterozoic biosphere.

    Science.gov (United States)

    Kah, Linda C; Lyons, Timothy W; Frank, Tracy D

    2004-10-14

    Progressive oxygenation of the Earth's early biosphere is thought to have resulted in increased sulphide oxidation during continental weathering, leading to a corresponding increase in marine sulphate concentration. Accurate reconstruction of marine sulphate reservoir size is therefore important for interpreting the oxygenation history of early Earth environments. Few data, however, specifically constrain how sulphate concentrations may have changed during the Proterozoic era (2.5-0.54 Gyr ago). Prior to 2.2 Gyr ago, when oxygen began to accumulate in the Earth's atmosphere, sulphate concentrations are inferred to have been Proterozoic. Our calculations indicate sulphate levels between 1.5 and 4.5 mM, or 5-15 per cent of modern values, for more than 1 Gyr after initial oxygenation of the Earth's biosphere. Persistence of low oceanic sulphate demonstrates the protracted nature of Earth's oxygenation. It links biospheric evolution to temporal patterns in the depositional behaviour of marine iron- and sulphur-bearing minerals, biological cycling of redox-sensitive elements and availability of trace metals essential to eukaryotic development.

  8. Accent detection and social cognition: evidence of protracted learning.

    Science.gov (United States)

    Creel, Sarah C

    2017-07-03

    How and when do children become aware that speakers have different accents? While adults readily make a variety of subtle social inferences based on speakers' accents, findings from children are more mixed: while one line of research suggests that even infants may be acutely sensitive to accent unfamiliarity, other studies suggest that 5-year-olds have difficulty identifying accents as different from their own. In an attempt to resolve this paradox, the current study assesses American children's sensitivity to American vs. Dutch accents in two situations. First, in an eye-tracked sentence processing paradigm where children have previously shown sensitivity to a salient social distinction (gender) from voice cues, 3-5-year-old children showed no sensitivity to accent differences. Second, in a social decision-making task where accent sensitivity has been found in 5-year-olds, an age gradient appeared, suggesting that familiar accent preferences emerge slowly between 3 and 7 years. Counter to claims that accent is an early, salient signal of social group, results are more consistent with a protracted learning hypothesis that children need extended exposure to native-language sound patterns in order to detect that an accent deviates from their own. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=BQAgy3IFYXA. © 2017 John Wiley & Sons Ltd.

  9. Arenavirus Glycan Shield Promotes Neutralizing Antibody Evasion and Protracted Infection.

    Directory of Open Access Journals (Sweden)

    Rami Sommerstein

    2015-11-01

    Full Text Available Arenaviruses such as Lassa virus (LASV can cause severe hemorrhagic fever in humans. As a major impediment to vaccine development, delayed and weak neutralizing antibody (nAb responses represent a unifying characteristic of both natural infection and all vaccine candidates tested to date. To investigate the mechanisms underlying arenavirus nAb evasion we engineered several arenavirus envelope-chimeric viruses and glycan-deficient variants thereof. We performed neutralization tests with sera from experimentally infected mice and from LASV-convalescent human patients. NAb response kinetics in mice correlated inversely with the N-linked glycan density in the arenavirus envelope protein's globular head. Additionally and most intriguingly, infection with fully glycosylated viruses elicited antibodies, which neutralized predominantly their glycan-deficient variants, both in mice and humans. Binding studies with monoclonal antibodies indicated that envelope glycans reduced nAb on-rate, occupancy and thereby counteracted virus neutralization. In infected mice, the envelope glycan shield promoted protracted viral infection by preventing its timely elimination by the ensuing antibody response. Thus, arenavirus envelope glycosylation impairs the protective efficacy rather than the induction of nAbs, and thereby prevents efficient antibody-mediated virus control. This immune evasion mechanism imposes limitations on antibody-based vaccination and convalescent serum therapy.

  10. ERS statement on protracted bacterial bronchitis in children.

    Science.gov (United States)

    Kantar, Ahmad; Chang, Anne B; Shields, Mike D; Marchant, Julie M; Grimwood, Keith; Grigg, Jonathan; Priftis, Kostas N; Cutrera, Renato; Midulla, Fabio; Brand, Paul L P; Everard, Mark L

    2017-08-01

    This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care. Copyright ©ERS 2017.

  11. Extracorporeal membrane oxygenation after protracted ventricular fibrillation cardiac arrest: case report and discussion.

    Science.gov (United States)

    Abu-Laban, Riyad B; Migneault, David; Grant, Meghan R; Dhingra, Vinay; Fung, Anthony; Cook, Richard C; Sweet, David

    2015-03-01

    Extracorporeal membrane oxygenation (ECMO) is a method to provide temporary cardiac and respiratory support to critically ill patients. In recent years, the role of ECMO in emergency departments (EDs) for select adults has increased. We present the dramatic case of a 29-year-old man who was placed on venoarterial ECMO for cardiogenic shock and respiratory failure following collapse and protracted ventricular fibrillation cardiac arrest in our ED. Resuscitation efforts prior to ECMO commencement included 49 minutes of virtually continuous cardiopulmonary resuscitation (CPR), 11 defibrillations, administration of numerous medications, including a thrombolytic agent, while CPR was ongoing, percutaneous coronary intervention and stenting for a mid-left anterior descending coronary artery dissection and thrombotic occlusion, inotropic support, and intra-aortic balloon pump counterpulsation. Over the next 48 hours following ECMO commencement, the patient's cardiorespiratory function rapidly improved, and he was discharged home 9 days after admission with no neurologic sequelae. The history, indications, and increasing role of ECMO in a range of conditions, including cardiac arrest, are reviewed.

  12. Bone growth marks reveal protracted growth in New Zealand kiwi (Aves, Apterygidae)

    Science.gov (United States)

    Bourdon, Estelle; Castanet, Jacques; de Ricqlès, Armand; Scofield, Paul; Tennyson, Alan; Lamrous, Hayat; Cubo, Jorge

    2009-01-01

    The presence of bone growth marks reflecting annual rhythms in the cortical bone of non-avian tetrapods is now established as a general phenomenon. In contrast, ornithurines (the theropod group including modern birds and their closest relatives) usually grow rapidly in less than a year, such that no annual rhythms are expressed in bone cortices, except scarce growth marks restricted to the outer cortical layer. So far, cyclical growth in modern birds has been restricted to the Eocene Diatryma, the extant parrot Amazona amazonica and the extinct New Zealand (NZ) moa (Dinornithidae). Here we show the presence of lines of arrested growth in the long bones of the living NZ kiwi (Apteryx spp., Apterygidae). Kiwis take 5–6 years to reach full adult body size, which indicates a delayed maturity and a slow reproductive cycle. Protracted growth probably evolved convergently in moa and kiwi sometime since the Middle Miocene, owing to the severe climatic cooling in the southwest Pacific and the absence of mammalian predators. PMID:19515655

  13. USGS Small-scale Dataset - Official Protraction Diagram and Leasing Map Boundaries 200105 Shapefile

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows official protraction diagram (OPD) and leasing map boundaries covering areas of the Outer Continental Shelf (OCS) within Federal jurisdiction....

  14. Digital Offshore Cadastre (DOC) - Pacific83 - Official Protraction Diagram (OPD) Outlines

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI Arc/Info export and Arc/View shape file formats for the BOEM Pacific Region. The use of...

  15. Outer Continental Shelf Official Protraction Diagrams and Lease Maps - Gulf of Mexico Region NAD27

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file is based on the Mapping and Boundary Branch's Official Protraction Diagram (OPD)and Leasing Maps (LM). Each offshore area is defined by an API Number...

  16. Outer Continental Shelf Official Protraction Diagrams - Pacific Region - West Coast NAD 83

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Official Protraction Diagram (OPD) outlines in ESRI Arc/Info export and Arc/View shape file formats for the BOEM Pacific Region. The use of...

  17. Outer Continental Shelf Official Protraction Diagrams and Lease Maps - Gulf of Mexico Region NAD27-Unclipped

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file is based on the Mapping and Boundary Branch's Official Protraction Diagram (OPD)and Leasing Maps (LM). Each offshore area is defined by an API Number...

  18. Life with an unwelcome guest - caring in a context of protracted bodily pain.

    Science.gov (United States)

    Koskinen, Camilla; Aho, Sonja; Nyholm, Linda

    2016-12-01

    Protracted bodily pain is a phenomenon that often affects a human being's whole life. Care of human beings with protracted pain is challenging because pain is not always measureable, and the experiences of pain are subjective, unique and shapeshifting. Therefore, the aim is to highlight what protracted bodily pain signifies for the human being, and human beings' experiences of what is caring in a context of protracted bodily pain. Four informants with protracted bodily pain took part in a focus group interview. The interview was analysed by using a qualitative content analysis with a hermeneutic approach. The findings show that protracted pain renders human beings speechless, limits and robs them of their lives. The pain is described as a domineering, unpleasant and unwelcome guest. The pain can change the human being's personality and creates feelings of guilt. Uncertainty about the origin of the pain as well as a nonchalant treatment or not being believed intensifies the pain. Human being experience mastering the pain, encounters with caregivers who can ease the burden, community with others and finding that little something extra in everyday life is experienced as caring. From a caring science perspective, the relation between protracted pain and suffering is obvious. Suffering emerges as illness suffering, as life suffering and as suffering caused by care. Professional as well as natural caring is important in a context of protracted bodily pain. The human being longs to encounter caregivers who are courageous enough to lay themselves on the line. Community with people who are prepared to share the burden eases the heavy burden that pain brings to life, it brings hope and relief. © 2016 Nordic College of Caring Science.

  19. Usefulness of milnacipran in treating phantom limb pain.

    Science.gov (United States)

    Nagoshi, Yasuhide; Watanabe, Akira; Inoue, Saiko; Kuroda, Tomoki; Nakamura, Mitsuo; Matsumoto, Yoshitake; Fukui, Kenji

    2012-01-01

    Amputation of an extremity often results in the sensation of a "phantom limb" where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by "phantom limb pain". We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients. The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly. These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment.

  20. Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed.

    Directory of Open Access Journals (Sweden)

    Brian K Barber

    included in assessments of the full impact of protracted political conflict on functioning.

  1. Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed.

    Science.gov (United States)

    Barber, Brian K; McNeely, Clea A; El Sarraj, Eyad; Daher, Mahmoud; Giacaman, Rita; Arafat, Cairo; Barnes, William; Abu Mallouh, Mohammed

    2016-01-01

    assessments of the full impact of protracted political conflict on functioning.

  2. Gene expression in Catla catla (Hamilton) subjected to acute and protracted doses of gamma radiation

    Energy Technology Data Exchange (ETDEWEB)

    Anbumani, S., E-mail: aquatox1982@gmail.com; Mohankumar, Mary N., E-mail: marynmk@gmail.com

    2016-09-15

    Highlights: • Gamma radiation induced up- and down- regulation of cell cycle genes. • Protracted dose-rate induced gene up-regulation to facilitate cell survival. • bcl-2 gene facilitates repair at protracted dose and cell death at acute exposures. • gadd45α, cdk1 and bcl-2 genes work in concert to promote ‘repair’ and ‘death’ circuitries in fish blood cells. - Abstract: Studies on transcriptional modulation after gamma radiation exposure in fish are limited. Cell cycle perturbations and expression of apoptotic genes were investigated in the fish, Catla catla after acute and protracted exposures to gamma radiation over a 90 day period. Significant changes in gene expression were observed between day 1 and 90 post-exposure. Gamma radiation induced a significant down-regulation of target genes gadd45α, cdk1 and bcl-2 from day 1 to day 3 after protracted exposure, whereas it persists till day 6 upon acute exposure. From day 12 onwards, Gadd45α, cdk1 and bcl-2 genes were up-regulated following protracted exposure, indicating DNA repair, cell-cycle arrest and apoptosis. There exists a linear correlation between these genes (gadd45α – r = 0.85, p = 0.0073; cdk1 – r = 0.86, p = 0.0053; bcl-2 – r = 0.89, p = 0.0026) at protracted exposures. This is the first report on the dual role of bcl-2 gene in fish exposed to acute and protracted radiation and correlation among the aforementioned genes that work in concert to promote ‘repair’ and ‘death’ circuitries in fish blood cells.

  3. EFFICIENCY OF IMMUNOCORRECTION WITH MEDICAL OZONE IN PROTRACTED PURULENT INFLAMMATORY DISEASES AFFECTING SOFT TISSUES IN THE PATIENTS OF SENIOR AGE GROUP

    Directory of Open Access Journals (Sweden)

    T. I. Vitkina

    2008-01-01

    Full Text Available Abstract. We performed a clinical and immunological study of patients from senior age group suffering with protracted purulent inflammation of soft tissues in maxillo-facial area. The patients underwent either common medication, or combined treatment including ozone therapy. Application of medicinal ozone, along with basic treatment schedule, resulted into more marked and rapid normalization of non-specific resistance markers, Т-cell immunity. This approach allows of reducing the terms of inpatient care and variety of possible complications. (Med. Immunol., 2008, vol. 10, N 2-3, pp 277-282.

  4. Usefulness of milnacipran in treating phantom limb pain

    Science.gov (United States)

    Nagoshi, Yasuhide; Watanabe, Akira; Inoue, Saiko; Kuroda, Tomoki; Nakamura, Mitsuo; Matsumoto, Yoshitake; Fukui, Kenji

    2012-01-01

    Background Amputation of an extremity often results in the sensation of a “phantom limb” where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by “phantom limb pain”. We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients. Methods and results The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly. Conclusion These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment. PMID:23185119

  5. The alien limb phenomenon.

    Science.gov (United States)

    Graff-Radford, Jonathan; Rubin, Mark N; Jones, David T; Aksamit, Allen J; Ahlskog, J Eric; Knopman, David S; Petersen, Ronald C; Boeve, Bradley F; Josephs, Keith A

    2013-07-01

    Alien limb phenomenon refers to involuntary motor activity of a limb in conjunction with the feeling of estrangement from that limb. Alien limb serves as a diagnostic feature of corticobasal syndrome. Our objective was to determine the differential diagnoses of alien limb and to determine the features in a large group of patients with the alien limb with different underlying etiologies. We searched the Mayo Clinic Medical Records Linkage system to identify patients with the diagnosis of alien limb seen between January 1, 1996, and July 11, 2011. One hundred and fifty patients with alien limb were identified. Twenty-two were followed in the Alzheimer's Disease Research Center. Etiologies of alien limb included corticobasal syndrome (n = 108), stroke (n = 14), Creutzfeldt Jakob disease (n = 9), hereditary diffuse leukoencephalopathy with spheroids (n = 5), tumor (n = 4), progressive multifocal leukoencephalopathy(n = 2), demyelinating disease (n = 2), progressive dementia not otherwise specified (n = 2), posterior reversible encephalopathy syndrome (n = 1), corpus callosotomy (n = 1), intracerebral hemorrhage (n = 1) and thalamic dementia (n = 1). Ten of 14 cerebrovascular cases were right hemisphere in origin. All cases involved the parietal lobe. Of the 44 patients with corticobasal syndrome from the Alzheimer's Disease Research Center cohort, 22 had alien limb, and 73 % had the alien limb affecting the left extremities. Left sided corticobasal syndrome was significantly associated with the presence of alien limb (p = 0.004). These findings support the notion that the alien limb phenomenon is partially related to damage underlying the parietal cortex, especially right parietal, disconnecting it from other cortical areas.

  6. The Mechanism of Protracted Wound Healing on Oral Mucosa in Diabetes. Review

    Directory of Open Access Journals (Sweden)

    Yoshihiro Abiko

    2010-08-01

    Full Text Available Diabetic patients increase their body’s susceptibility to infection and diabetes is a risk factor for periodontal diseases and oral infection. Although many studies showed the mechanism of impaired wound healing in diabetes, there are still arguments to shed light on what kind of factors, including local and systemic factors are involved in the protracted wound healing. This review article summarizes reports on the wound healing in diabetes and discusses the mechanism of the protracted wound healing of the oral mucosa in diabetes. Delayed vascularization, reduction in blood flow, decline in innate immunity, decreases in growth factor production, and psychological stresses may be involved in the protracted wound healing of the oral mucosa in diabetics.

  7. The mechanism of protracted wound healing on oral mucosa in diabetes. Review.

    Science.gov (United States)

    Abiko, Yoshihiro; Selimovic, Denis

    2010-08-01

    Diabetic patients increase their body's susceptibility to infection and diabetes is a risk factor for periodontal diseases and oral infection. Although many studies showed the mechanism of impaired wound healing in diabetes, there are still arguments to shed light on what kind of factors, including local and systemic factors are involved in the protracted wound healing. This review article summarizes reports on the wound healing in diabetes and discusses the mechanism of the protracted wound healing of the oral mucosa in diabetes. Delayed vascularization, reduction in blood flow, decline in innate immunity, decreases in growth factor production, and psychological stresses may be involved in the protracted wound healing of the oral mucosa in diabetics.

  8. Reduction of residual limb volume in people with transtibial amputation.

    Science.gov (United States)

    Tantua, Audrey T; Geertzen, Jan H B; van den Dungen, Jan J A M; Breek, Jan-Kees C; Dijkstra, Pieter U

    2014-01-01

    The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study is to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference. In a longitudinal cohort study of 21 people who had a transtibial amputation, residual limb volume was measured using a laser scanner and circumference was measured using a tape measure 1 wk postamputation and every 3 wk thereafter until 24 wk postamputation. A linear mixed model analysis was performed with weeks postamputation transformed according to the natural logarithm as predictor. Residual limb volume decreased significantly over time, with a large variation between patients. Residual limb volume does not correlate well with circumference. On average, residual limb volume decreased 200.5 mL (9.7% of the initial volume) per natural logarithm of the weeks postamputation. The decrease in residual limb volume following a transtibial amputation is substantial in the early postamputation phase, followed by a leveling off. It was not possible to determine a specific moment when the residual limb volume had stabilized.

  9. Upper Limb Exoskeleton

    NARCIS (Netherlands)

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace

  10. The effectiveness of protraction face mask therapy: a meta-analysis.

    Science.gov (United States)

    Kim, J H; Viana, M A; Graber, T M; Omerza, F F; BeGole, E A

    1999-06-01

    This study examined the effectiveness of maxillary protraction with orthopedic appliances in Class III patients. A meta-analysis of relevant literature was performed to determine whether a consensus exists regarding controversial issues such as the timing of treatment and the use of adjunctive intraoral appliances. An initial search identified 440 articles relating to Class III malocclusion. Among those articles, 11 studies in English and 3 studies in foreign languages met the previously established selection criteria. Data from the selected studies were categorized by age and appliance groups for the meta-analysis. The sample sizes were comparable between the groups. The statistical synthesis of changes before and after treatment in selected cephalometric landmarks showed no distinct difference between the palatal expansion group and nonexpansion group except for 1 variable, upper incisor angulation, which increased to a greater degree in the nonexpansion group. This finding implies that more skeletal effect and less dental change are produced in the expansion appliance group. Examination of the effects of age revealed greater treatment changes in the younger group. Results indicate that protraction face mask therapy is effective in patients who are growing, but to a lesser degree in patients who are older than 10 years of age, and that protraction in combination with an initial period of expansion may provide more significant skeletal effects. Overall mean values and corresponding standard deviations for the studies selected can also be used to estimate mean treatment effects expected from the use of protraction face mask.

  11. Governing humanitarian emergencies, protracted crises, and (in)security through resilience

    NARCIS (Netherlands)

    Anholt, Rosanne

    2017-01-01

    ‘Resilience’ occupies a prominent place in contemporary discussions around the governance of humanitarian emergencies, protracted crises and insecurity more broadly. The aim of this study was to further our understanding of resilience as a governance rationality and a policy discourse, in particular

  12. Isolated limb perfusion

    Directory of Open Access Journals (Sweden)

    Sandra Kuhar

    2016-02-01

    Full Text Available Isolated limb perfusion is a surgical procedure that can be used to treat an advanced malignant melanoma and soft tissue sarcomas, it is also effective in treating in-transit metastases of melanoma and local metastases of soft tissue sarcomas. With perfusion of the affected limb with cytostatic agents it is possible to avoid amputation and mutilating operations that significantly reduced the function of the limb. Since the procedure is isolated on a limb, it can be perfused with much higher doses of cytotoxic drugs, systemic toxicity is thus reduced or prevented. The most common side effects are erythema and edema.Cytotoxic drugs, that are manly used, are melphalan and tumor necrosis factor alpha. Efficient also proved to be simultaneous hyperthermia of the affected limb.

  13. LIMB Demonstration Project Extension

    Energy Technology Data Exchange (ETDEWEB)

    1988-09-15

    The basic goal of the Limestone Injection Multistage Burner (LIMB) demonstration is to extend LIMB technology development to a full-scale application on a representative wall-fired utility boiler. The successful retrofit of LIMB to an existing boiler is expected to demonstrate that (a) reductions of 50 percent or greater in SO and NO emissions can be achieved at a fraction of the cost of add-on FGD systems, (b) boiler reliability, operability, and steam production can be maintained at levels existing prior to LIMB retrofit, and (c) technical difficulties attributable to LIMB operation, such as additional slagging and fouling, changes in ash disposal requirements, and an increased particulate load, can be resolved in a cost-effective manner. The primary fuel to be used will be an Ohio bituminous coal having a nominal sulfur content of 3 percent or greater.

  14. Upper Limb Exoskeleton

    OpenAIRE

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace relative to the first fixed frame. In an example the present invention is for use in post-stroke therapy.

  15. Protracted dendritic growth in the typically developing human amygdala and increased spine density in young ASD brains.

    Science.gov (United States)

    Weir, R K; Bauman, M D; Jacobs, B; Schumann, C M

    2018-02-01

    The amygdala is a medial temporal lobe structure implicated in social and emotional regulation. In typical development (TD), the amygdala continues to increase volumetrically throughout childhood and into adulthood, while other brain structures are stable or decreasing in volume. In autism spectrum disorder (ASD), the amygdala undergoes rapid early growth, making it volumetrically larger in children with ASD compared to TD children. Here we explore: (a) if dendritic arborization in the amygdala follows the pattern of protracted growth in TD and early overgrowth in ASD and (b), if spine density in the amygdala in ASD cases differs from TD from youth to adulthood. The amygdala from 32 postmortem human brains (7-46 years of age) were stained using a Golgi-Kopsch impregnation. Ten principal neurons per case were selected in the lateral nucleus and traced using Neurolucida software in their entirety. We found that both ASD and TD individuals show a similar pattern of increasing dendritic length with age well into adulthood. However, spine density is (a) greater in young ASD cases compared to age-matched TD controls (ASD age into adulthood, a phenomenon not found in TD. Therefore, by adulthood, there is no observable difference in spine density in the amygdala between ASD and TD age-matched adults (≥18 years old). Our findings highlight the unique growth trajectory of the amygdala and suggest that spine density may contribute to aberrant development and function of the amygdala in children with ASD. © 2017 Wiley Periodicals, Inc.

  16. Kinematic analysis of the lower cervical spine in the protracted and retracted neck flexion positions.

    Science.gov (United States)

    Park, So Hyun

    2015-01-01

    [Purpose] The aim of this study was to analyze lower cervical spine kinematics in protracted and retracted neck flexion positions in healthy people. [Subjects and Methods] The craniovertebral angle (CVA) and intervertebral body angles of the lower cervical spine of 10 healthy individuals were analyzed using fluoroscopy in a neutral sitting with the head in the neutral (N), protracted (Pro), and retracted (Ret) positions and with the neck in full flexion with the head in the neutral (N-fx), protracted (Pro-fx), and retracted (Ret-fx) positions. [Results] There were significant differences in the CVA and intervertebral body angle at the C3-4 level, and the Ret position showed the highest values followed by the N and Pro positions. Regarding the intervertebral body angle at the C4-5 level, the Pro position showed a higher value than the N and Ret positions. At the C6-7 level, the Pro position showed the lowest value compared with the N and Ret positions. In the CVA, the Ret-fx position showed a higher value than the N-fx and Ret-fx positions. [Conclusion] The results suggest that in the neutral sitting position, protraction is an ineffective posture due to overstress of the C6-7 segment, which is placed in a hyperflexed position at this level. Instead, retraction is the recommend posture for the patient with C6-7 degeneration, which makes for a more flexed position in the upper cervical spine and a less flexed position in the lower cervical spine.

  17. Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy.

    Science.gov (United States)

    Villarroya-Marquina, Inés; Sancho, Juan; Lorente-Poch, Leyre; Gallego-Otaegui, Lander; Sitges-Serra, Antonio

    2018-01-01

    Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Cohort prospective observational study. Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6-12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved. © 2018 European Society of Endocrinology.

  18. [Cognitive and emotional impairments in patients with protracted anxiety-phobic disorders].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Iu; Iakovenko, E A; Nikishena, I S; Anisimova, T I; Bondarchuk, Iu L

    2014-01-01

    To study cognitive and emotional impairments in patients with anxiety-phobic disorders (APDs), to comparatively analyze the clinical manifestations of acute (less than one-year) and protracted (1-to-5-year) forms of this disease, and to evaluate the efficacy of noofen used to treat this pathology. Sixty-two patients aged 18 to 50 years with APDs were examined. The investigators collected clinical history data, performed neurological examination, and assessed autonomic disorders in accordance with the questionnaire to reveal their signs, anxiety using the Hamilton anxiety rating scale, memory impairment employing the methods developed by A.R. Luria, attention disorders applying the test of variables of attention, and diagnosed emotional intelligence using the Mayer-Salovey-Caruso emotional intelligence test. Noofen 1000 mg/day was used to treat the patients. Protracted APDs were shown to be characterized by the higher degree of psychosomatic symptoms and by more pronounced impairments in attention, memory, and emotional intelligence. The data of posttreatment clinical and psychological studiesare indicative of improvements in 73.3% of cases. The findings may lead to the conclusion that noofen is highly effective in the treatment of patients with protracted APDs.

  19. Differential changes in amygdala and frontal cortex Pde10a expression during acute and protracted withdrawal

    Directory of Open Access Journals (Sweden)

    Marian L Logrip

    2014-04-01

    Full Text Available Alcohol use disorders are persistent problems with high recidivism rates despite repeated efforts to quit drinking. Neuroadaptations that result from alcohol exposure and that persist during periods of abstinence represent putative molecular determinants of the propensity to relapse. Previously we demonstrated a positive association between phosphodiesterase 10A (PDE10A gene expression and elevations in relapse-like alcohol self-administration in rats with a history of stress exposure. Because alcohol withdrawal is characterized by heightened anxiety-like behavior, activation of stress-responsive brain regions and an elevated propensity to self-administer alcohol, we hypothesized that Pde10a expression also would be upregulated in reward- and stress-responsive brain regions during periods of acute (8-10 h and protracted (6 wk alcohol withdrawal. During acute withdrawal, elevated Pde10a mRNA expression was found in the medial and basolateral amygdala, as well as the infralimbic and anterior cingulate subdivisions of the medial prefrontal cortex, relative to alcohol-naïve controls. The basolateral amygdala was the only region with elevated Pde10a mRNA expression during both acute and protracted withdrawal. In contrast to the elevations, Pde10a mRNA levels tended to be reduced during protracted withdrawal in the dorsal striatum, prelimbic prefrontal cortex, and medial amygdala. Together these results implicate heightened PDE10A expression in the basolateral amygdala as a lasting neuroadaptation associated with alcohol dependence.

  20. Correction of Angle Class II division 1 malocclusion with a mandibular protraction appliances and multiloop edgewise archwire technique

    National Research Council Canada - National Science Library

    Benedito Freitas; Heloiza Freitas; Pedro César F dos Santos; Guilherme Janson

    2014-01-01

    .... After the diagnosis of severe Angle Class II division 1 malocclusion, a mandibular protraction appliance was placed to correct the Class II relationships and multiloop edgewise archwires were used for finishing...

  1. Late maxillary protraction in patients with unilateral cleft lip and palate: a retrospective study.

    Science.gov (United States)

    Borzabadi-Farahani, Ali; Lane, Christianne J; Yen, Stephen L-K

    2014-01-01

    This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary sutural loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients. Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison. The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2-T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ⊥ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, -1.58 to 2.83), Occl P-SN (°) (-3.98, -5.99 to -1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, -0.05 to 8.15), and IMPA (°) (-5.77, -9.74 to -1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group. Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).

  2. Limb salvage surgery

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

  3. Usefulness of milnacipran in treating phantom limb pain

    Directory of Open Access Journals (Sweden)

    Matsumoto Y

    2012-11-01

    Full Text Available Yasuhide Nagoshi,1 Akira Watanabe,1 Saiko Inoue,1 Tomoki Kuroda,2 Mitsuo Nakamura,3 Yoshitake Matsumoto,4 Kenji Fukui31Department of Psychiatry (Psychosomatic Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan; 2Gojouyama Hospital, Nara, Japan; 3Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 4Matsumoto Clinic, Kyoto, JapanBackground: Amputation of an extremity often results in the sensation of a “phantom limb” where the patient feels that the limb that has been amputated is still present. This is frequently accompanied by “phantom limb pain”. We report here the use of milnacipran, a serotonin and norepinephrine reuptake inhibitor, to treat phantom limb pain after amputation of injured or diseased limbs in three patients.Methods and results: The severity of phantom pain before and during treatment was quantified using a visual analog scale. In one case, phantom limb pain responded partially to treatment with high doses of paroxetine, and then replacement with milnacipran further improved the pain relief and long-term full pain relief was achieved. In the two other cases, milnacipran was used as first-line treatment and phantom limb pain responded rapidly.Conclusion: These results suggest that milnacipran administration may be useful in phantom limb pain, possibly as a first-line treatment.Keywords: milnacipran, paroxetine, phantom limb pain, selective serotonin reuptake inhibitor (SSRI, serotonin and norepinephrine reuptake inhibitor (SNRI

  4. Limb girdle muscular dystrophies

    DEFF Research Database (Denmark)

    Vissing, John

    2016-01-01

    PURPOSE OF REVIEW: The aim of the study was to describe the clinical spectrum of limb girdle muscular dystrophies (LGMDs), the pitfalls of the current classification system for LGMDs, and emerging therapies for these conditions. RECENT FINDINGS: Close to half of all LGMD subtypes have been...

  5. Phantom limb pain

    Science.gov (United States)

    ... there Changes in the weather Stress Infection An artificial limb that does not fit properly Poor blood flow ... Move or exercise the remaining part of your arm or leg. If you are wearing your prosthesis, take it off. If you are not wearing ...

  6. Limb-Girdle Muscular Dystrophy (LGMD)

    Science.gov (United States)

    ... Blog Donate Search MDA.org Close Limb-Girdle Muscular Dystrophy (LGMD) Share print email share facebook twitter google plus linkedin Limb-Girdle Muscular Dystrophy (LGMD) What is limb-girdle muscular dystrophy? Limb- ...

  7. Cocaine craving during protracted withdrawal requires PKCε priming within vmPFC.

    Science.gov (United States)

    Miller, Bailey W; Wroten, Melissa G; Sacramento, Arianne D; Silva, Hannah E; Shin, Christina B; Vieira, Philip A; Ben-Shahar, Osnat; Kippin, Tod E; Szumlinski, Karen K

    2017-05-01

    In individuals with a history of drug taking, the capacity of drug-associated cues to elicit indices of drug craving intensifies or incubates with the passage of time during drug abstinence. This incubation of cocaine craving, as well as difficulties with learning to suppress drug-seeking behavior during protracted withdrawal, are associated with a time-dependent deregulation of ventromedial prefrontal cortex (vmPFC) function. As the molecular bases for cocaine-related vmPFC deregulation remain elusive, the present study assayed the consequences of extended access to intravenous cocaine (6 hours/day; 0.25 mg/infusion for 10 day) on the activational state of protein kinase C epsilon (PKCε), an enzyme highly implicated in drug-induced neuroplasticity. The opportunity to engage in cocaine seeking during cocaine abstinence time-dependently altered PKCε phosphorylation within vmPFC, with reduced and increased p-PKCε expression observed in early (3 days) and protracted (30 days) withdrawal, respectively. This effect was more robust within the ventromedial versus dorsomedial PFC, was not observed in comparable cocaine-experienced rats not tested for drug-seeking behavior and was distinct from the rise in phosphorylated extracellular signal-regulated kinase observed in cocaine-seeking rats. Further, the impact of inhibiting PKCε translocation within the vmPFC using TAT infusion proteins upon cue-elicited responding was determined and inhibition coinciding with the period of testing attenuated cocaine-seeking behavior, with an effect also apparent the next day. In contrast, inhibitor pretreatment prior to testing during early withdrawal was without effect. Thus, a history of excessive cocaine taking influences the cue reactivity of important intracellular signaling molecules within the vmPFC, with PKCε playing a critical role in the manifestation of cue-elicited cocaine seeking during protracted drug withdrawal. © 2016 Society for the Study of Addiction.

  8. Protracted weakening during lower crustal shearing along an extensional shear zone

    Science.gov (United States)

    degli Alessandrini, Giulia; Menegon, Luca; Giuntoli, Francesco

    2017-04-01

    This study investigates grain-scale deformation mechanisms in the mafic lower continental crust, with particular focus on the role of syn-kinematic metamorphic reactions and their product - symplectites - in promoting grain size reduction, phase mixing and thus strain localization. The investigated extensional shear zone is hosted in the Finero mafic-ultramafic complex in the Italian Southern Alps. Field and microstructural observations indicate that strain partitioned in gabbroic layers where the primary mineralogical assemblage contained amphibole, forming ultramylonites. These ultramylonites are characterized by isolated porphyroclasts of amphibole, garnet, clinopyroxene and orthopyroxene, embedded in a matrix of plagioclase (ca. 39 vol%) + amphibole (25 vol%) + clinopyroxene (18 vol%) + orthopyroxene (11 vol%) + Fe-Ti oxides (6 vol%) ± apatite (CPO with [001] axes preferentially aligned parallel to the stretching lineation, which we interpret as oriented grain growth during heterogeneous nucleation of amphibole. Pyroxenes and plagioclase lack a CPO and evidence for dislocation creep and dynamic recrystallization. Protracted shearing was initiated by syn-kinematic metamorphic reactions: garnet porphyroclasts formed orthopyroxene + plagioclase symplectites and amphibole porphyroclasts formed pyroxene + plagioclase symplectites. The latter reaction indicates that strain localization initiated with dehydration reactions leading to primary amphibole breakdown into pyroxene and plagioclase, now preserved in the ultramylonite. Geothermobarometry using plagioclase-amphibole pairs in the ultramylonites indicate temperature conditions of ca. 800˚ C and pressures from 8 to 6kbar. This suggests that protracted shearing in the ultramylonites occurred at decreasing pressure and nearly constant T. We suggest that the fluids released during the dehydration reaction were channelized in the ultramylonites and subsequently assisted amphibole nucleation in dilatant sites during

  9. Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis.

    Science.gov (United States)

    Cordasco, G; Matarese, G; Rustico, L; Fastuca, S; Caprioglio, A; Lindauer, S J; Nucera, R

    2014-08-01

    The objective of this systematic review was to estimate the efficacy of protraction facemask on the correction of Class III malocclusion in the short term. A systematic review of articles was performed using different electronic databases (PubMed, Ovid, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar). Search terms comprised 'orthopedic treatment' and 'Class III malocclusion'. The selection criteria were set in order to include in this review only randomized clinical trials (RCTs) performed treating with facemask Class III growing patients. Studies' selection, data extraction, and risk of bias's assessment were executed independently by two authors using pre-defined data forms. All pooled analyses of data were based on random effects models. A pre-specified subgroup analysis was planned to evaluate the effect of preliminary rapid palatal expansion on facemask efficacy. Three RCTs met our inclusion criteria. In total, data from 155 patients (92 treated and 63 controls) were collected. The treated group showed the following significant changes: ANB° +3.66° [95%CI (2.58, 4.74)]; SNA° +2.10 [95%CI (1.14, 3.06)]; SNB° -1.54 [95%CI (-2.13, -0.95)]; SN-palatal plane -0.82° [95%CI (-1.62, -0.02)]; and SN-mandibular plane +1.51 [95%CI (0.61, 2.41)]. Heterogeneity varied from low to moderate (mean I(2) value: 41.4 ± 20.8). Facemask is effective correcting Class III malocclusion in the short term. The skeletal modifications induced by facemask are forward displacement of maxilla, backward displacement of mandible, clockwise rotation of the mandibular plane, and counterclockwise rotation of the maxillary plane. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Microarray and cDNA sequence analysis of transcription during nerve-dependent limb regeneration

    Directory of Open Access Journals (Sweden)

    Bryant Susan V

    2009-01-01

    Full Text Available Abstract Background Microarray analysis and 454 cDNA sequencing were used to investigate a centuries-old problem in regenerative biology: the basis of nerve-dependent limb regeneration in salamanders. Innervated (NR and denervated (DL forelimbs of Mexican axolotls were amputated and transcripts were sampled after 0, 5, and 14 days of regeneration. Results Considerable similarity was observed between NR and DL transcriptional programs at 5 and 14 days post amputation (dpa. Genes with extracellular functions that are critical to wound healing were upregulated while muscle-specific genes were downregulated. Thus, many processes that are regulated during early limb regeneration do not depend upon nerve-derived factors. The majority of the transcriptional differences between NR and DL limbs were correlated with blastema formation; cell numbers increased in NR limbs after 5 dpa and this yielded distinct transcriptional signatures of cell proliferation in NR limbs at 14 dpa. These transcriptional signatures were not observed in DL limbs. Instead, gene expression changes within DL limbs suggest more diverse and protracted wound-healing responses. 454 cDNA sequencing complemented the microarray analysis by providing deeper sampling of transcriptional programs and associated biological processes. Assembly of new 454 cDNA sequences with existing expressed sequence tag (EST contigs from the Ambystoma EST database more than doubled (3935 to 9411 the number of non-redundant human-A. mexicanum orthologous sequences. Conclusion Many new candidate gene sequences were discovered for the first time and these will greatly enable future studies of wound healing, epigenetics, genome stability, and nerve-dependent blastema formation and outgrowth using the axolotl model.

  11. Effects of mandibular protraction appliance associated to fixed appliance in adults

    Directory of Open Access Journals (Sweden)

    Bruno D'Aurea Furquim

    2013-10-01

    Full Text Available OBJECTIVE: This retrospective study aimed to conduct a cephalometric evaluation of the skeletal, dental and soft tissue effects resulting from treatment of adult patients presenting Class II malocclusion, performed with a Mandibular Protraction Appliance (MPA combined with a fixed orthodontic appliance. METHODS: The sample consisted of teleradiographs obtained before and after treatment of 9 adult patients (initial mean age of 22.48 years with bilateral Class II, division 1, malocclusion. Paired t test (p < 0.05 was applied to compare initial and final values. RESULTS: t test revealed an increase in anteroinferior facial height and posterior facial height. The dental changes include: extrusion of upper incisors, buccal inclination, protrusion of lower incisors, mesialization and extrusion of mandibular molars. Regarding the soft tissue component, there was an increase in nasolabial angle in addition to upper lip retrusion. CONCLUSIONS: The effects of treating Class II malocclusion adult patients, by means of using Mandibular Protraction Appliance (MPA combined with a fixed appliance were mostly observed in the mandibular arch, and consisted of buccal inclination, protrusion and intrusion of incisors, and mesialization and extrusion of the molars.

  12. The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism

    Science.gov (United States)

    2017-01-01

    Most patients with hypocalcemia after total thyroidectomy will recover the parathyroid function in a few weeks, but some 20–30% of them will still be in the need for replacement therapy one month after surgery and about 5–10% of those will develop permanent hypoparathyroidism. Although postoperative hypocalcemia has been related to several demographic and metabolic causes, parathyroid hormone (PTH) decline, resulting from autotransplantation, inadvertent excision or devascularization of the parathyroid glands, is the common final pathway. The number of parathyroid glands remaining in situ (PGRIS) is a key variable to understand the pathogenesis of protracted hypoparathyroidism and the chances for restoration of the parathyroid function. Normal-high serum calcium concentration, probably achieved by a more intensive medical treatment at the time of hospital discharge, has been identified as an independent variable favoring recovery of the parathyroid function. This we refer to as parathyroid splinting, a hypothesis holding that putting the injured parathyroid parenchyma at rest after thyroidectomy may improve long-term outcome of protracted hypoparathyroidism. PMID:29322026

  13. Treatment Options for Class III Malocclusion in Growing Patients with Emphasis on Maxillary Protraction.

    Science.gov (United States)

    Azamian, Zeinab; Shirban, Farinaz

    2016-01-01

    It is very difficult to diagnose and treat Class III malocclusion. This type of malocclusion involves a number of cranial base and maxillary and mandibular skeletal and dental compensation components. In Class III malocclusion originating from mandibular prognathism, orthodontic treatment in growing patients is not a good choice and in most cases orthognathic surgery is recommended after the end of growth. Approximately 30-40% of Class III patients exhibit some degree of maxillary deficiency; therefore, devices can be used for maxillary protraction for orthodontic treatment in early mixed dentition. In cases in which dental components are primarily responsible for Class III malocclusion, early therapeutic intervention is recommended. An electronic search was conducted using the Medline database (Entrez PubMed), the Cochrane Collaboration Oral Health Group Database of Clinical Trials, Science Direct, and Scopus. In this review article, we described the treatment options for Class III malocclusion in growing patient with an emphasis on maxillary protraction. It seems that the most important factor for treatment of Class III malocclusion in growing patient is case selection.

  14. Three-dimensional assessment of maxillary changes associated with bone anchored maxillary protraction

    Science.gov (United States)

    Nguyen, Tung; Cevidanes, Lucia; Cornelis, Marie A.; Heymann, Gavin; de Paula, Leonardo K.; De Clerck, Hugo

    2013-01-01

    Introduction Bone-anchored maxillary protraction has been shown to be an effective treatment modality for the correction of Class III malocclusions. The purpose of this study was to evaluate 3-dimensional changes in the maxilla, the surrounding hard and soft tissues, and the circummaxillary sutures after bone-anchored maxillary protraction treatment. Methods Twenty-five consecutive skeletal Class III patients between the ages of 9 and 13 years (mean, 11.10 ± 1.1 years) were treated with Class III intermaxillary elastics and bilateral miniplates (2 in the infrazygomatic crests of the maxilla and 2 in the anterior mandible). Cone-beam computed tomographs were taken before initial loading and 1 year out. Three-dimensional models were generated from the tomographs, registered on the anterior cranial base, superimposed, and analyzed by using color maps. Results The maxilla showed a mean forward displacement of 3.7 mm, and the zygomas and the maxillary incisors came forward 3.7 and 4.3 mm, respectively. Conclusions This treatment approach produced significant orthopedic changes in the maxilla and the zygomas in growing Class III patients. PMID:22133943

  15. Biomechanical effects on maxillary protraction of the craniofacial skeleton with cleft lip and palate after alveolar bone graft.

    Science.gov (United States)

    Chen, Zhengxi; Pan, Xiaogang; Shao, Qinghua; Chen, Zhenqi

    2013-03-01

    To explore the biomechanical effects of maxillary protraction on the craniofacial skeleton in patients with unilateral cleft lip and palate (UCLP) after alveolar bone graft (ABG) and resorption of ABG, thus to provide theoretical basis for the clinical application of maxillary protraction, which can improve the facial deformity of the UCLP patients. A finite element model of a UCLP patient's skull was generated using data from spiral computed tomographic (CT) scans. Based on this finite element model, another 6 ABG finite element models were constructed to simulate ABG and resorption of ABG, respectively (nonresorption model, upper one-third resorption of the grafted bone model, upper two-thirds resorption of the grafted bone model, lower one-third resorption of the grafted bone model, lower two-thirds resorption of the grafted bone model, upper one-third and lower one-third resorption of the grafted bone model). Two additional models were developed to simulate maxillary protraction with expansion and maxillary protraction alone. All models were loaded with orthopedic force (30 degrees downward and forward to the occlusal plane, 500 g per side) on the region of alveolar of maxillary canine. Before ABG, the cleft side showed larger displacement than the noncleft side, when it came to the stress distribution in the craniofacial suture, it showed an asymmetric pattern as well. After ABG, the displacement difference between the cleft side and the noncleft side decreased, and the stress distribution in the craniofacial suture showed more symmetric than that before ABG. The pterygopalatine suture obtained the largest value, followed by zygomaticotemporal, zygomaticomaxillary, and zygomaticofrontal sutures among the observed sutures. Higher stresses and pronounced forward displacement were generated in the craniofacial sutures after maxillary protraction with expansion. Maxillary protraction after ABG performed a more favorable outcome. Among the ABG models, nonresorption

  16. Limb immobilization and corticobasal syndrome.

    Science.gov (United States)

    Graff-Radford, Jonathan; Boeve, Bradley F; Drubach, Daniel A; Knopman, David S; Ahlskog, J Eric; Golden, Erin C; Drubach, Dina I; Petersen, Ronald C; Josephs, Keith A

    2012-12-01

    Recently, we evaluated two patients with corticobasal syndrome (CBS) who reported symptom onset after limb immobilization. Our objective was to investigate the association between trauma, immobilization and CBS. The charts of forty-four consecutive CBS patients seen in the Mayo Clinic Alzheimer Disease Research Center were reviewed with attention to trauma and limb immobilization. 10 CBS patients (23%) had immobilization or trauma on the most affected limb preceding the onset or acceleration of symptoms. The median age at onset was 61. Six patients manifested their first symptoms after immobilization from surgery or fracture with one after leg trauma. Four patients had pre-existing symptoms of limb dysfunction but significantly worsened after immobilization or surgery. 23 percent of patients had immobilization or trauma of the affected limb. This might have implications for management of CBS, for avoiding injury, limiting immobilization and increasing movement in the affected limb. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Limb lengthening in achondroplasia

    Directory of Open Access Journals (Sweden)

    Sanjay K Chilbule

    2016-01-01

    Full Text Available Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%, 9.9 cm (52.8% and 9.6 cm (77.9%, respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3 rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment. Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length carries significant risk and should be undertaken only after due

  18. [Proliferation of anaerobic flora in the small intestine of infants with acute and protracted diarrhea].

    Science.gov (United States)

    da Cruz, A S; Fagundes Neto, U

    1995-01-01

    Bacterial proliferation in the small intestine can induce the protraction of diarrhea due to malabsorption of the nutrients. We performed the culture of the small intestine juice for the aerobic and anaerobic flora in 40 infants with persistent and acute diarrhea. Bacterial proliferation was observed in 32 (80%) patients, being 30 (75%) due to the aerobic microflora and 17 (43%) due to the anaerobic microflora. There was no statistical difference in the bacterial growth between acute and persistent diarrhea. The aerobic bacteria most frequently isolated was E. coli in 23 patients, and Bacteroides sp was the most prevalent anaerobic bacteria, isolated in 9 cases. The transitory flora was significantly more abundant in patients with persistent diarrhea.

  19. The resilience function of character strengths in the face of war and protracted conflict

    Directory of Open Access Journals (Sweden)

    Anat eShoshani

    2016-01-01

    Full Text Available This study investigated the role of character strengths and virtues in moderating relations between conflict exposure and psychiatric symptoms among 1078 adolescents aged 13-15 living in southern Israel, who were exposed to lengthy periods of war and political violence. Adolescents were assessed for character strengths and virtues, political conflict exposure using the Political Life Events (PLE scale, and psychiatric symptoms using the Brief Symptom Inventory and the UCLA PTSD Index. Results confirmed that political violence exposure was positively correlated with psychiatric symptoms. Interpersonal, temperance and transcendence strengths were negatively associated with psychiatric symptoms. Moderating effects of the interpersonal strengths on the relation between political violence exposure and the psychiatric and PTSD indices were confirmed. The findings extend existing knowledge about the resilience function of character strengths in exposure to protracted conflict and have important practical implications for applying strength-building practices for adolescents who grow up in war-affected environments.

  20. The Resilience Function of Character Strengths in the Face of War and Protracted Conflict.

    Science.gov (United States)

    Shoshani, Anat; Slone, Michelle

    2015-01-01

    This study investigated the role of character strengths and virtues in moderating relations between conflict exposure and psychiatric symptoms among 1078 adolescents aged 13-15 living in southern Israel, who were exposed to lengthy periods of war, terrorism and political conflict. Adolescents were assessed for character strengths and virtues, political violence exposure using the Political Life Events (PLE) scale, and psychiatric symptoms using the Brief Symptom Inventory and the UCLA PTSD Index. Results confirmed that political violence exposure was positively correlated with psychiatric symptoms. Interpersonal, temperance and transcendence strengths were negatively associated with psychiatric symptoms. Moderating effects of the interpersonal strengths on the relation between political violence exposure and the psychiatric and PTSD indices were confirmed. The findings extend existing knowledge about the resilience function of character strengths in exposure to protracted conflict and have important practical implications for applying strength-building practices for adolescents who grow up in war-affected environments.

  1. Protracted fluid-induced melting during Barrovian metamorphism in the Central Alps

    DEFF Research Database (Denmark)

    Rubatto, Daniela; Hermann, Jörg; Berger, Alfons

    2009-01-01

    that repeated melting events occurred within a single Barrovian metamorphic cycle at roughly constant temperature; that in the country rocks zircon formation was limited to the initial stages of melting, whereas further melting concentrated in the segregated leucosomes; that melting occurred at different times......The timing and dynamics of fluid-induced melting in the typical Barrovian sequence of the Central Alps has been investigated using zircon chronology and trace element composition. Multiple zircon domains in leucosomes and country rocks yield U-Pb ages spanning from ~32 to 22 Ma. The zircon formed...... in samples a few meters apart because of the local rock composition and localized influx of the fluids; and that leucosomes were repeatedly melted when fluids became available. The geochronological data force a revision of the temperature-time path of the migmatite belt in the Central Alps. Protracted...

  2. Possible Weakening Processes Imposed on California's Earthen Levees under Protracted Drought

    Science.gov (United States)

    Robinson, J. D.; Vahedifard, F.; AghaKouchak, A.

    2015-12-01

    California is currently suffering from a multiyear extreme drought and the impacts of the drought are anticipated to worsen in a warming climate. The resilience of critical infrastructure under extreme drought conditions is a major concern which has not been well understood. Thus, there is a crucial need to improve our understanding about the potential threats of drought on infrastructure and take subsequent actions in a timely manner to mitigate these threats and adopt our infrastructure for forthcoming extreme events. The need is more pronounced for earthen levees, since their functionality to protect limited water resources and dryland is more critical during drought. A significant amount of California's levee systems are currently operating under a high risk condition. Protracted drought can further threaten the structural competency of these already at-risk levee systems through several thermo-hydro mechanical weakening processes that undermine their stability. Viable information on the implications of these weakening processes, particularly on California's earthen levees, is relatively incomplete. This article discusses, from a geotechnical engineering perspective, how California's protracted drought might threaten the integrity of levee systems through the imposition of several thermo-hydro mechanical weakening processes. Pertinent facts and statistics regarding the drought in California are presented and discussed. Catastrophic levee failures and major damages resulting from drought-induce weakening processes such as shear strength reduction, desiccation cracking, land subsidence and surface erosion, fissuring and soil softening, and soil carbon oxidation are discussed to illustrate the devastating impacts that the California drought might impose on existing earthen levees. This article calls for further research in light of these potential drought-inducing weakening mechanisms to support mitigation strategies for reducing future catastrophic levee failures.

  3. Serratus anterior or pectoralis minor: Which muscle has the upper hand during protraction exercises?

    Science.gov (United States)

    Castelein, Birgit; Cagnie, Barbara; Parlevliet, Thierry; Cools, Ann

    2016-04-01

    The Serratus Anterior (SA) has a critical role in stabilizing the scapula against the thorax. Research has linked shoulder and neck disorders to impairments in the SA activation. Exercises that target the SA are included in the rehabilitation of shoulder or neck pain and mostly include a protraction component. The Pectoralis Minor (PM) functions as a synergist of the SA. From the literature it is unclear to what extent PM is activated during SA exercises. To determine the activity of SA and PM during different protraction exercises. Controlled laboratory study. 26 subjects performed 3 exercises: Modified Push-Up Plus (Wall Version), Modified Knee Push-Up Plus (Floor version) and Serratus Punch. Electromyographic (EMG) data was collected from the SA (surface) and PM (fine-wire EMG). During the Serratus Punch the SA activity was significantly higher than the PM activity. During the Modified Push-Up Plus exercises (both Wall and Floor version), the SA and PM activity were comparable. The PM showed the highest activity during the Serratus Punch and the Modified Push-Up Plus (Floor), which was significantly higher than during the Modified Push-Up Plus (Wall). The SA showed the highest activity during the Serratus Punch, which was significantly higher than during the Modified Push-Up Plus (Floor) which was in turn significantly higher than the activity during the Modified Push-Up Plus (Wall). All exercises activated the PM between 15 and 29% Maximum Voluntary Isometric Contraction and the SA between 15 and 43%. The Modified Push-Up Plus exercise against the wall and the floor activated the SA and PM to a similar degree. When maximum activation of the SA with minimal activation of the PM is desired in healthy subjects, the "Serratus punch" seems to be the optimal exercise. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Convergent evidence from alcohol-dependent humans and rats for a hyperdopaminergic state in protracted abstinence

    Science.gov (United States)

    Hirth, Natalie; Meinhardt, Marcus W.; Noori, Hamid R.; Salgado, Humberto; Torres-Ramirez, Oswaldo; Uhrig, Stefanie; Broccoli, Laura; Vengeliene, Valentina; Roßmanith, Martin; Perreau-Lenz, Stéphanie; Köhr, Georg; Sommer, Wolfgang H.; Spanagel, Rainer; Hansson, Anita C.

    2016-01-01

    A major hypothesis in addiction research is that alcohol induces neuroadaptations in the mesolimbic dopamine (DA) system and that these neuroadaptations represent a key neurochemical event in compulsive drug use and relapse. Whether these neuroadaptations lead to a hypo- or hyperdopaminergic state during abstinence is a long-standing, unresolved debate among addiction researchers. The answer is of critical importance for understanding the neurobiological mechanism of addictive behavior. Here we set out to study systematically the neuroadaptive changes in the DA system during the addiction cycle in alcohol-dependent patients and rats. In postmortem brain samples from human alcoholics we found a strong down-regulation of the D1 receptor- and DA transporter (DAT)-binding sites, but D2-like receptor binding was unaffected. To gain insight into the time course of these neuroadaptations, we compared the human data with that from alcohol-dependent rats at several time points during abstinence. We found a dynamic regulation of D1 and DAT during 3 wk of abstinence. After the third week the rat data mirrored our human data. This time point was characterized by elevated extracellular DA levels, lack of synaptic response to D1 stimulation, and augmented motor activity. Further functional evidence is given by a genetic rat model for hyperdopaminergia that resembles a phenocopy of alcohol-dependent rats during protracted abstinence. In summary, we provide a new dynamic model of abstinence-related changes in the striatal DA system; in this model a hyperdopaminergic state during protracted abstinence is associated with vulnerability for relapse. PMID:26903621

  5. Protracted ethanol withdrawal in rats: Tolerance to the anxiolytic effects of diazepam and pentobarbital but not phenobarbital

    Energy Technology Data Exchange (ETDEWEB)

    Lai, H.; Prather, P.L. (Texas Coll. of Osteopathic Medicine, Fort Worth (United States))

    1990-02-26

    Anxiety is a common symptom during ethanol withdrawal contributing to its continuous abuse and alcoholism. Ethanol withdrawal in rats produces an interoceptive discriminative stimulus (IDS) similar to that produced by the anxiogenic drug pentylenetetrazol (PTZ). This stimulus peaks at 12 hours after last dose of ethanol and thereafter the IDS is detected for several days (protracted withdrawal) by sensitization to a probe drug. previously, the authors have shown that during the protracted withdrawal, the IDS is enhanced by GABA receptor antagonists suggesting alteration of brain GABA systems. This report provides further evidence that chronic ethanol alters GABAergic systems. Rats were trained to discriminate PTZ (20 mg/kg, ip) from saline. Diazepam, pentobarbital and phenobarbital blocked the PTZ-IDS dose dependently. Ethanol, 4.5% w/v, was then given in a nutritionally complete diet for a week. On termination of the ethanol diet, rats exhibited signs and symptoms of withdrawal which returned to baseline within 3 days. During the protracted withdrawal period, the authors then redetermined the blockade of the PTZ-IDS. Significant tolerance was observed to the effectiveness of diazepam and pentobarbital, but not to phenobarbital. Since diazepam and pentobarbital produce significantly more enhancement of GABAergic activity than does phenobarbital, these data further suggest alteration of brain GABAergic systems during protracted withdrawal from ethanol.

  6. A finite element analysis of the maxillary first molar PDL with maxillary protraction in a mixed dentition Class III malocclusion.

    Science.gov (United States)

    Tanaka, O M; Araújo, E A; Oliver, D R; Behrents, R G

    2015-11-01

    To analyze the stress distribution on the PDL of the maxillary first molar in a mixed dentition Class III malocclusion, using a Hyrax-type appliance and maxillary protraction. A Class III malocclusion in the mixed dentition was reconstructed based on CBCT images. The 3D FEM comprised the maxilla, alveolar bone, right first permanent molar teeth, and PDL and consisted of 1 133 497 nodes and 573 726 elements. Maxillary protraction force was applied to a hook positioned close to the deciduous canines with 600 g and at 15°, 30°, and 45° downward angles to the maxillary occlusal plane. Analysis was carried out from the top and buccal view of the sagittal plane. The magnitude of the stresses at 15°, 30°, and 45° of protraction angulation resulted in the highest stress magnitude being in the region between the distobuccal and palatal roots, as well as on the distal surface of the mesial root. The vector direction in this area showed traction and mesial movement. With 30° and 45° protraction angulations, the stress was located only between the distobuccal and palatal roots, and the vector direction was more extrusive at 15°. The suggested orthodontic movement is in the mesial direction with a small amount of extrusion with 15° angulation and greater extrusion with 30° and 45°. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances.

    Directory of Open Access Journals (Sweden)

    Ali Forghani

    Full Text Available Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord.

  8. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances.

    Science.gov (United States)

    Forghani, Ali; Milner, Theodore E

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord.

  9. Origin of directionally tuned responses in lower limb muscles to unpredictable upper limb disturbances

    Science.gov (United States)

    Forghani, Ali; Milner, Theodore E.

    2017-01-01

    Unpredictable forces which perturb balance are frequently applied to the body through interaction between the upper limb and the environment. Lower limb muscles respond rapidly to these postural disturbances in a highly specific manner. We have shown that the muscle activation patterns of lower limb muscles are organized in a direction specific manner which changes with lower limb stability. Ankle muscles change their activity within 80 ms of the onset of a force perturbation applied to the hand which is earlier than the onset of changes in ground reaction force, ankle angle or head motion. The latency of the response is sensitive to the perturbation direction. However, neither the latency nor the magnitude of the response is affected by stiffening the arm even though this alters the magnitude and timing of motion of the body segments. Based on the short latency, insensitivity of the change in ankle muscle activation to motion of the body segments but sensitivity to perturbation direction we reason that changes in ankle muscle activation are most likely triggered by sensory signals originating from cutaneous receptors in the hand. Furthermore, evidence that the latency of changes in ankle muscle activation depends on the number of perturbation directions suggests that the neural pathway is not confined to the spinal cord. PMID:29095888

  10. Phantom limb pain after lower limb trauma: origins and treatments.

    Science.gov (United States)

    Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan

    2011-12-01

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient's quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain.

  11. Supernumerary phantom limb after stroke

    Science.gov (United States)

    Bakheit, A; Roundhill, S

    2005-01-01

    The perception of a phantom limb is commonly reported after amputations. However, only a few cases have been described after a stroke. This article presents a patient who reported a supernumerary phantom limb (pseudopolymelia) after spontaneous intracerebral haemorrhage and discusses the possible underlying mechanisms for this rare phenomenon. PMID:15749787

  12. Limb Salvage After Bone Cancer

    Science.gov (United States)

    ... usually done at least yearly. Life-long follow-up by an orthopedic surgeon is recommended. Promoting Health after Limb Salvage Physical and occupational therapy play an important role in successful rehabilitation after limb salvage surgery. Both passive and active ...

  13. Evaluation of Limb-Girdle Muscular Dystrophy

    Science.gov (United States)

    2014-03-06

    Becker Muscular Dystrophy; Limb-Girdle Muscular Dystrophy, Type 2A (Calpain-3 Deficiency); Limb-Girdle Muscular Dystrophy, Type 2B (Miyoshi Myopathy, Dysferlin Deficiency); Limb-Girdle Muscular Dystrophy, Type 2I (FKRP-deficiency)

  14. Influence of intentional ankylosis of deciduous canines to reinforce the anchorage for maxillary protraction

    Directory of Open Access Journals (Sweden)

    Luís Fernando Castaldi Tocci

    2013-02-01

    Full Text Available INTRODUCTION: This retrospective cephalometric study analyzed the influence of intentional ankylosis of deciduous canines in patients with Class III malocclusion and anterior crossbite, in the deciduous and early mixed dentition stages, treated by orthopedic maxillary expansion followed by maxillary protraction. METHODS: Lateral cephalograms of 40 patients were used, divided in 2 groups paired for age and gender. The Ankylosis Group was composed of 20 patients (10 boys and 10 girls treated with induced ankylosis and presenting initial and final mean ages of 7 years 4 months and 8 years 3 months, respectively, with a mean period of maxillary protraction of 11 months. The Control Group comprised 20 patients (10 boys and 10 girls treated without induced ankylosis, with initial and final mean ages of 7 years 8 months and 8 years 7 months, respectively, with a mean period of maxillary protraction of 11 months. Two-way analysis of variance and covariance analysis were applied to compare the initial and final cephalometric variables and the treatment changes between groups. RESULTS: According to the results, the variables evidencing the significant treatment changes between groups confirmed that the intentional ankylosis enhanced the sagittal response of the apical bases (Pg-NPerp and increased the facial convexity angles (NAP and ANB. CONCLUSIONS: The protocol involving intentional ankylosis of deciduous canines enhanced the sagittal response of the apical bases.INTRODUÇÃO: nesse estudo cefalométrico retrospectivo, analisou-se a influência da anquilose intencional de caninos decíduos em pacientes com má oclusão de Classe III e mordida cruzada anterior, nos estágios de dentição decídua e mista precoce, tratados com expansão ortopédica da maxila, seguida de tração reversa. MÉTODOS: foram utilizadas telerradiografias em norma lateral de 40 pacientes, divididos em 2 grupos pareados por idade e sexo. O Grupo Anquilose foi constituído de 20

  15. Phantom limbs and neural plasticity.

    Science.gov (United States)

    Ramachandran, V S; Rogers-Ramachandran, D

    2000-03-01

    The study of phantom limbs has received tremendous impetus from recent studies linking changes in cortical topography with perceptual experience. Systematic psychophysical testing and functional imaging studies on patients with phantom limbs provide 2 unique opportunities. First, they allow us to demonstrate neural plasticity in the adult human brain. Second, by tracking perceptual changes (such as referred sensations) and changes in cortical topography in individual patients, we can begin to explore how the activity of sensory maps gives rise to conscious experience. Finally, phantom limbs also allow us to explore intersensory effects and the manner in which the brain constructs and updates a "body image" throughout life.

  16. Management of Major Limb Injuries

    Science.gov (United States)

    Langer, Vijay

    2014-01-01

    Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries. PMID:24511296

  17. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…

  18. Describing severe limb trauma.

    Science.gov (United States)

    Arnez, Z M; Tyler, M P; Khan, U

    1999-06-01

    Seventy-nine severe limb injuries were retrospectively reviewed to compare the AO/ASIF and the Gustillo classifications. Specifically, the suitability of these classifications with respect to prognosis and management of these cases was compared. A healed and stable wound was the ultimate outcome measure. Surrogate outcome measures used were: the time to healing; the number of anaesthetics until the wounds were healed; and the number of operations until the wounds were healed. Any change in lifestyle following the injury was also assessed. The primary healing rates of the AO/ASIF groups showed significant (P Gustillo system, the primary healing rates did not show any differences between the groups. Also, differences in the other outcome measures were most pronounced when using the AO/ASIF system. Importantly, changes in lifestyle correlated with the injury score when using the AO/ASIF system (P Gustillo system was not applicable in 100% of cases. A modified AO/ASIF scoring system is proposed which provides a good predictor of outcome.

  19. Persistent variations in neuronal DNA methylation following cocaine self-administration and protracted abstinence in mice

    Directory of Open Access Journals (Sweden)

    Danay Baker-Andresen

    2015-10-01

    Full Text Available Continued vulnerability to relapse during abstinence is a characteristic of cocaine addiction and suggests that drug-induced neuroadaptations persist during abstinence. However, the precise cellular and molecular attributes of these adaptations remain equivocal. One possibility is that cocaine self-administration leads to enduring changes in DNA methylation. To address this possibility, we isolated neurons from medial prefrontal cortex and performed high throughput DNA sequencing to examine changes in DNA methylation following cocaine self-administration. Twenty-nine genomic regions became persistently differentially methylated during cocaine self-administration, and an additional 28 regions became selectively differentially methylated during abstinence. Altered DNA methylation was associated with isoform-specific changes in the expression of co-localizing genes. These results provide the first neuron-specific, genome-wide profile of changes in DNA methylation induced by cocaine self-administration and protracted abstinence. Moreover, our findings suggest that altered DNA methylation facilitates long-term behavioral adaptation in a manner that extends beyond the perpetuation of altered transcriptional states.

  20. [Effects of drug cupping therapy on immune function in chronic asthmatic bronchitis patients during protracted period].

    Science.gov (United States)

    Zhang, Cai-qing; Liang, Tie-jun; Zhang, Wei

    2006-11-01

    To observe the clinical effect of drug cupping therapy (DCT, cupping therapy with pingchuan ointment made by the authors themselves in the cups) on chronic asthmatic bronchitis (CAB) during the protracted period, and explore its effect on immune function. Seventy-seven patients were randomly divided into two groups:the treated group (n=40) treated by orally taken Liuwei Dihuang Pill (LDP) and DCT and the control group (n=37) with LDP and common cupping therapy without drug in cups. The changes of T-lymphocyte subset, levels of interferon-gamma (IFN-gamma), interleukin (IL), immunoglobulin (Ig), complement 3 and 4 (C3 and C4) were detected before and after treatment. The total effective rate was higher in the treated group than that in the control group (90.0% vs. 59.5%, P < 0.01). The levels of CD4+, CD4+ /CD8+, IL-2, IFN-gamma, C3, C4, IgA, IgG and IgM increased, while the levels of IgE, IL-4, IL-10 and CD8+ decreased after treatment in both groups (P < 0.05 or P < 0.01), the improvements were better in the treated group than that in the control group (P < 0.05). DCT shows better curative effects than that of common cupping therapy without drug, it could improve the cellular and humoral immunity in CAB patients.

  1. Phylogenetically Widespread Polyembryony in Cyclostome Bryozoans and the Protracted Asynchronous Release of Clonal Brood-Mates.

    Directory of Open Access Journals (Sweden)

    Helen L Jenkins

    Full Text Available Polyembryony-the production of multiple cloned embryos from a single fertilised egg-is a seemingly paradoxical combination of reproductive modes that nevertheless persists in diverse taxa. We document features of polyembryony in the Cyclostomata (Bryozoa-an ancient order of modular colonial marine invertebrates-that suggest a substantial reduction in the paradoxical nature of this enigmatic reproductive mode. Firstly, we provide molecular evidence for polyembryony in three exemplar species, supporting the widely cited inference that polyembryony characterises the entire order. Secondly, genotyping demonstrates protracted release of cloned offspring from the primary embryo in a given gonozooid (chamber for embryonic incubation, thus exposing the same genotype to changing environmental conditions over time. Finally, we confirm that each gonozooid produces a distinct genotype, with each primary embryo being the result of a separate fertilisation event. We hypothesise that the sustained release of one or a few genotypes against varying environmental conditions achieves levels of risk-spreading similar to those in organisms that release multiple, unique genotypes at a single time. We argue that polyembryony, specifically with the production of a large number of progeny per fertilisation event, has been favoured in the Cyclostomata over long geological periods.

  2. Serotonin 3A receptor subtype as an early and protracted marker of cortical interneuron subpopulations.

    Science.gov (United States)

    Vucurovic, Ksenija; Gallopin, Thierry; Ferezou, Isabelle; Rancillac, Armelle; Chameau, Pascal; van Hooft, Johannes A; Geoffroy, Hélène; Monyer, Hannah; Rossier, Jean; Vitalis, Tania

    2010-10-01

    To identify neocortical neurons expressing the type 3 serotonergic receptor, here we used transgenic mice expressing the enhanced green fluorescent protein (GFP) under the control of the 5-HT(3A) promoter (5-HT(3A):GFP mice). By means of whole-cell patch-clamp recordings, biocytin labeling, and single-cell reversed-transcriptase polymerase chain reaction on acute brain slices of 5-HT(3A):GFP mice, we identified 2 populations of 5-HT(3A)-expressing interneurons within the somatosensory cortex. The first population was characterized by the frequent expression of the vasoactive intestinal peptide and a typical bipolar/bitufted morphology, whereas the second population expressed predominantly the neuropeptide Y and exhibited more complex dendritic arborizations. Most interneurons of this second group appeared very similar to neurogliaform cells according to their electrophysiological, molecular, and morphological properties. The combination of 5-bromo-2-deoxyuridine injections with 5-HT(3A) mRNA detection showed that cortical 5-HT(3A) interneurons are generated around embryonic day 14.5. Although at this stage the 5-HT(3A) receptor subunit is expressed in both the caudal ganglionic eminence and the entopeduncular area, homochronic in utero grafts experiments revealed that cortical 5-HT(3A) interneurons are mainly generated in the caudal ganglionic eminence. This protracted expression of the 5-HT(3A) subunit allowed us to study specific cortical interneuron populations from their birth to their final functional phenotype.

  3. Effects of protracted cadmium exposure on gametes of the purple sea urchin, Arbacia punctulata

    Energy Technology Data Exchange (ETDEWEB)

    Bowen, W.J. III; Engel, D.W. [National Marine Fisheries Services, Beaufort, NC (United States)

    1996-03-01

    Gametes and larvae of sea urchins and more specifically Arbacia punctulata have been used extensively in embryological studies and toxicity bioassay testing. Most of the experiments and bioassays have used the fertilized eggs of different sea urchin species and measured abnormal growth, malformations, or changes in the rates of growth as a function of contaminant exposure. Guida demonstrated that cupric ion activities of <10{sup -10.5} M caused reductions in the rates of growth of Arbacia Punctulata larvae and caused incomplete or malformed pluteal skeletons. These effects occurred at cupric ion concentrations that were in the same ranges as some measured in the more contaminated estuaries in the northeastern U.S. Sunda and coworkers also used sea urchin embryonic development to test potential trace metal toxicity in water samples collected from those same estuaries, and demonstrated toxicity potentially attributable to dissolved trace metals in the water column. The purpose of these experiments was to determine if protracted sublethal exposure of sexually mature sea urchins to dissolved cadmium in sea water would affect the viability of eggs and sperm, and whether it would affect fertilization and embryonic development and ultimately the larvae. The results of the experiments support the hypothesis that spermatogenesis and oogenesis were affected by cadmium exposure.

  4. Dopamine Development in the Mouse Orbital Prefrontal Cortex Is Protracted and Sensitive to Amphetamine in Adolescence.

    Science.gov (United States)

    Hoops, Daniel; Reynolds, Lauren M; Restrepo-Lozano, Jose-Maria; Flores, Cecilia

    2018-01-01

    The prefrontal cortex (PFC) is divided into subregions, including the medial and orbital prefrontal cortices. Dopamine connectivity in the medial PFC (mPFC) continues to be established throughout adolescence as the result of the continuous growth of axons that innervated the nucleus accumbens (NAcc) prior to adolescence. During this period, dopamine axons remain vulnerable to environmental influences, such as drugs used recreationally by humans. The developmental trajectory of the orbital prefrontal dopamine innervation remains almost completely unstudied. Nonetheless, the orbital PFC (oPFC) is critical for some of the most complex functions of the PFC and is disrupted by drugs of abuse, both in adolescent humans and rodents. Here, we use quantitative neuroanatomy, axon-initiated viral-vector recombination, and pharmacology in mice to determine the spatiotemporal development of the dopamine innervation to the oPFC and its vulnerability to amphetamine in adolescence. We find that dopamine innervation to the oPFC also continues to increase during adolescence and that this increase is due to the growth of new dopamine axons to this region. Furthermore, amphetamine in adolescence dramatically reduces the number of presynaptic sites on oPFC dopamine axons. In contrast, dopamine innervation to the piriform cortex is not protracted across adolescence and is not impacted by amphetamine exposure during adolescence, indicating that dopamine development during adolescence is a uniquely prefrontal phenomenon. This renders these fibers, and the PFC in general, particularly vulnerable to environmental risk factors during adolescence, such as recreational drug use.

  5. Word-initial /r/-clusters in Swedish speaking children with typical versus protracted phonological development.

    Science.gov (United States)

    Lundeborg Hammarström, Inger

    2017-09-28

    The present study investigated word-initial (WI) /r/-clusters in Central Swedish-speaking children with and without protracted phonological development (PPD). Data for WI singleton /r/ and singleton and cluster /l/ served as comparisons. Participants were twelve 4-year-olds with PPD and twelve age- and gender-matched typically developing (TD) controls. Native speakers audio-recorded and transcribed 109 target single words using a Swedish phonology test with 12 WI C+/r/-clusters and three WI CC+/r/-clusters. The results showed significantly higher match scores for the TD children, a lower match proportion for the /r/ targets and for singletons compared with clusters, and differences in mismatch patterns between the groups. There were no matches for /r/-cluster targets in the PPD group, with all children except two in that group showing deletions for both /r/-cluster types. The differences in mismatch proportions and types between the PPD group and controls suggests new directions for future clinical practice.

  6. Predicting the effect of charged particles for instantaneous and protracted irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Herr, Lisa; Tommasino, Francesco; Seeger, Adrian; Scholz, Uwe; Friedrich, Thomas; Scholz, Michael [GSI Helmholtzzentrum fuer Schwerionenforschung, Darmstadt (Germany); Durante, Marco [GSI Helmholtzzentrum fuer Schwerionenforschung, Darmstadt (Germany); Institut fuer Festkoerperphysik, TU Darmstadt, Darmstadt (Germany)

    2012-07-01

    The local effect model (LEM) predicts the relative biological effectiveness for charged particle radiation based on the dose response of radiation with low linear energy transfer such as X-rays. The induction of DNA double strand breaks after irradiation is simulated according to the track structure of charged particles. The effect of these lesions is then derived from the effect after photon irradiation causing a similar damage pattern. The LEM has been tested thoroughly using in-vitro and in-vivo experiments as well as clinical findings of carbon ion therapy. General properties of dose response curves can be derived from the conceptual basis of the LEM. Furthermore, insight in damage repair kinetics and the response to time dependent dose delivery is gained. In this contribution, the concept of the LEM is reviewed and some examples for its applicability are briefly discussed. General properties of the dose response curves are motivated. Finally, cell survival curves after protracted irradiation as well as the measured time dependence of residual damage after instantaneous irradiation are compared with the model predictions. Here, good agreement is found.

  7. Protracted near-solidus storage and pre-eruptive rejuvenation of large magma reservoirs

    Science.gov (United States)

    Szymanowski, Dawid; Wotzlaw, Jörn-Frederik; Ellis, Ben S.; Bachmann, Olivier; Guillong, Marcel; von Quadt, Albrecht

    2017-10-01

    Building super-eruptive magma reservoirs in the cold, upper parts of Earth's crust requires a significant influx of magma over an extended period, sufficient to allow the magma to accumulate, differentiate and periodically erupt. Some models favour magma storage in a cold non-eruptible state, requiring extensive reactivation of the reservoirs before eruption, whereas others suggest storage at higher temperature and lower crystallinity, implying that magma in such reservoirs is readily eruptible. Consequently, constraining volcanic hazards requires observations directly linking magma residence timescales to the thermal state and crystallinity of storage. Here we simultaneously determine crystallization temperatures and ages of magmatic crystals of zircon and titanite in the 900 km3 Kneeling Nun Tuff (New Mexico, USA), which allows us to place tight constraints on the long-term thermal evolution of the magma reservoir. We show that zircon and titanite crystals record more than 600,000 years of magma assembly and constrain the dominant storage conditions to low temperatures, set between the granitic solidus (680 to 700 °C) and the temperature of the onset of titanite crystallization (about 720 to 730 °C). We apply the zircon-titanite systematics to a suite of other super-eruptions and suggest that protracted low-temperature storage culminating in late-stage reheating is a widespread feature of large crystal-rich eruptions.

  8. Proficient use of low spatial frequencies facilitates face memory but shows protracted maturation throughout adolescence.

    Science.gov (United States)

    Peters, Judith C; Kemner, Chantal

    2017-09-01

    Face perception is characterized by configural processing, which depends on visual information in the low spatial frequency (LSF) ranges. However, it is unclear whether LSF content is equally important for face memory. The present study investigated how face information in the low and high SF range plays a role in the configural encoding of faces for short-term and long-term recall. Moreover, we examined how SF-dependent face memorization develops in female adolescence, by comparing children (9-10-year-olds), adolescents (12-13-year-olds and 15-16-year-olds), and young adults (21-32-year-olds). Results show that similar to face perception, delayed face recognition was consistently facilitated by LSF content. However, only adults were able to adequately employ configural LSF cues for short-term recall, analogous to the slow maturation of LSF-driven configural face perception reported by previous studies. Moreover, the insensitivity to face inversion of early adolescents revealed their inadequate use of configural face cues regardless of SF availability, corroborating previous reports on an adolescent "dip" in face recognition. Like face perception, face recognition has a protracted maturational course. In (female) adolescence, sensitivity to configural LSF cues is developed, which aids not only configural face perception but also face memorization. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg

    2014-01-01

    PURPOSE: Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. METHODS: We treated 5 cases of severe protracted delirium in our ICU...... with electroconvulsive therapy (ECT) after failure of conventional medical therapy. RESULTS: The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved...... of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION: Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly...

  10. Formation of the world's largest REE deposit through protracted fluxing of carbonatite by subduction-derived fluids

    Science.gov (United States)

    Ling, Ming-Xing; Liu, Yu-Long; Williams, Ian S.; Teng, Fang-Zhen; Yang, Xiao-Yong; Ding, Xing; Wei, Gang-Jian; Xie, Lu-Hua; Deng, Wen-Feng; Sun, Wei-Dong

    2013-01-01

    Rare Earth Elements (REE) are essential to modern society but the origins of many large REE deposits remain unclear. The U-Th-Pb ages, chemical compositions and C, O and Mg isotopic compositions of Bayan Obo, the world's largest REE deposit, indicate a protracted mineralisation history with unusual chemical and isotopic features. Coexisting calcite and dolomite are in O isotope disequilibrium; some calcitic carbonatite samples show highly varied δ26Mg which increases with increasing Si and Mg; and ankerite crystals show decreases in Fe and REE from rim to centre, with highly varied REE patterns. These and many other observations are consistent with an unusual mineralisation process not previously considered; protracted fluxing of calcitic carbonatite by subduction-released high-Si fluids during the closure of the Palaeo-Asian Ocean. The fluids leached Fe and Mg from the mantle wedge and scavenged REE, Nb and Th from carbonatite, forming the deposit through metasomatism of overlying sedimentary carbonate.

  11. Increased activity of pre-motor network does not change the excitability of motoneurons during protracted scratch initiation

    DEFF Research Database (Denmark)

    Guzulaitis, Robertas; Alaburda, Aidas; Hounsgaard, Jørn Dybkjær

    2013-01-01

    Intrinsic response properties of neurons change during network activity. These changes may reinforce the initiation of particular forms of network activity. If so, the involvement of neurons in particular behaviors in multifunctional networks could be determined by up or down regulation...... of their intrinsic excitability. Here we employed an experimental paradigm of protracted scratch initiation in the integrated carapace-spinal cord preparation of adult turtles (Chrysemys scripta elegans). The protracted initiation of scratch network activity allows us to investigate the excitability of motoneurons...... and pre-motor network activity in the time interval from the start of sensory stimulation until the onset of scratch activity. Our results suggest that increased activity in the pre-motor network facilitates the onset of scratch episodes but does not change the excitability of motoneurons at the onset...

  12. Short-term glucocorticoid administration in patients with protracted and chronic gout arthritis. Part 2 — comparison of different medication forms efficacy

    Directory of Open Access Journals (Sweden)

    A A Fedorova

    2008-01-01

    Full Text Available Objective. To compare efficacy of different glucocorticoid (GC medication forms in protracted and chronic gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration — 15,2 years [7,4;20], median swollen joint count at the examination — 8 [5; 11]. The patients were randomized into 2 groups. Methylprednisolone (MP 500 mg/day iv during 2 days and placebo im once was administered in one of them, betamethasone (BM 7 mg im once and placebo iv twice — in the other. Results. Number of pts with full resolution of arthritis, recurrent exacerbation, insufficient arthritis resolution or clinically insignificant response was comparable in both groups. More rapid decrease of pain at moving was achieved during the first 2-3 days after GC administration in pts with full resolution of arthritis (p=0,03 in group receiving MP in comparison with BM. At day 14 joint damage measures did not differ between groups. Conclusion. Efficacy of short-term glucocorticoid administration does not depend on mode of administration and GC medication form (methylprednisolone 500 mg/day iv during 2 days or betamethasone 7 mg im once.

  13. Treatment Effects of Occipitomental Anchorage Appliance of Maxillary Protraction Combined with Chincup Traction in Children with Class III Malocclusion

    OpenAIRE

    Hsiang-Chien Lin; Hong-Po Chang; Hsin-Fu Chang

    2007-01-01

    Little information related to the treatment effects of the occipitomental anchorage (OMA) appliance of maxillary (Mx) protraction combined with chincup traction is available. The aim of this study was to investigate the treatment effects of the OMA orthopedic appliance on patients with Class III malocclusion. Methods: Pretreatment and post-treatment cephalometric records of 20 consecutively treated patients with Class III malocclusions were evaluated and compared with a matched sample of u...

  14. Physiotherapy after amputation of the limb

    OpenAIRE

    Pospíšil, Daniel

    2010-01-01

    In this bachelor thesis the author considers physiotherapy after amputation of the lower limb. The theoretical section describes the anatomy of the lower limb, a procedure for amputation of the lower limb, occupational theraoy and prosthesis. The author then goes on to discuss physiotherapy in relation to two case studies of patients who have had their lower limbs removed.

  15. Ethical issues in limb transplants.

    Science.gov (United States)

    Dickenson, D; Widdershoven, G

    2001-04-01

    On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self-evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost-benefit, or patient autonomy.

  16. Three-dimensional changes in the temporomandibular joint after maxillary protraction in children with skeletal Class III malocclusion.

    Science.gov (United States)

    Lee, Hyunju; Son, Woo-Sung; Kwak, Chun; Kang, Eun-Hee; Kim, Seong-Sik; Park, Soo-Byung; Kim, Yong-Il

    2016-01-01

    We evaluated 3-dimensional changes in the temporomandibular joints of children with skeletal Class III malocclusion and maxillary deficiency after facemask therapy for maxillary protraction. Eighteen children with anterior crossbite and a Class III molar relationship underwent facemask therapy for maxillary protraction, after which they exhibited positive overjet and a Class II molar relationship. Three-dimensional cone-beam computed tomography images of the patients were obtained before (T1) and after (T2) facemask protraction, and the 3-dimensional coordinates of the anatomical landmarks in T1 and T2 images were compared. After facemask therapy, the mandibular condyles of the patients were displaced outside, upward, and backward. Additionally, the anterior and posterior walls of the glenoid fossa had negative values for anteroposterior change. Three-dimensional analysis of the temporomandibular joint showed that facemask therapy resulted in bone apposition (to the anterior wall) and bone resorption (of the posterior wall) in the glenoid fossa. This bone remodeling resulted in upward and backward displacement of the condyle.(J Oral Sci 58, 501-508, 2016).

  17. Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate.

    Science.gov (United States)

    On, Sung Woon; Baek, Seung-Hak; Choi, Jin-Young

    2017-11-09

    The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement (ΔA-vertical reference plane, 4.8 mm, P plane angle, -1.5 degree, P plane angle, -1.4 degree, ΔBjork sum, -1.4 degree, Δocclusal plane to SN plane angle, -1.5 degree, ΔFMA, -1.0 degree, all P  0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage.

  18. Ubiquitous human upper-limb motion estimation using wearable sensors.

    Science.gov (United States)

    Zhang, Zhi-Qiang; Wong, Wai-Choong; Wu, Jian-Kang

    2011-07-01

    Human motion capture technologies have been widely used in a wide spectrum of applications, including interactive game and learning, animation, film special effects, health care, navigation, and so on. The existing human motion capture techniques, which use structured multiple high-resolution cameras in a dedicated studio, are complicated and expensive. With the rapid development of microsensors-on-chip, human motion capture using wearable microsensors has become an active research topic. Because of the agility in movement, upper-limb motion estimation has been regarded as the most difficult problem in human motion capture. In this paper, we take the upper limb as our research subject and propose a novel ubiquitous upper-limb motion estimation algorithm, which concentrates on modeling the relationship between upper-arm movement and forearm movement. A link structure with 5 degrees of freedom (DOF) is proposed to model the human upper-limb skeleton structure. Parameters are defined according to Denavit-Hartenberg convention, forward kinematics equations are derived, and an unscented Kalman filter is deployed to estimate the defined parameters. The experimental results have shown that the proposed upper-limb motion capture and analysis algorithm outperforms other fusion methods and provides accurate results in comparison to the BTS optical motion tracker.

  19. Protracted volcanism after large impacts: Evidence from the Sudbury impact basin

    Science.gov (United States)

    Ubide, Teresa; Guyett, Paul C.; Kenny, Gavin G.; O'Sullivan, Edel M.; Ames, Doreen E.; Petrus, Joseph A.; Riggs, Nancy; Kamber, Balz S.

    2017-04-01

    Morphological studies of large impact structures on Mercury, Venus, Mars, and the Moon suggest that volcanism within impact craters may not be confined to the shock melting of target rocks. This possibility prompted reinvestigation of the 1.85 Ga subaqueous Sudbury impact structure, specifically its 1.5 km thick immediate basin fill (Onaping Formation). Historically, breccias of this formation were debated in the context of an endogenic versus an impact-fallback origin. New field, petrographic, and in situ geochemical data document an array of igneous features, including vitric shards, bombs, sheet-like intrusions, and peperites, preserved in exquisite textural detail. The geochemistry of vitric materials is affected by alteration, as expected for subaqueous magmatic products. Earlier studies proposed an overall andesitic chemistry for all magmatic products, sourced from the underlying impact melt sheet. The new data, however, suggest progressive involvement of an additional, more magnesian, and volatile-rich magma source with time. We propose a new working model in which only the lower part of the Onaping Formation was derived by explosive "melt-fuel-coolant interaction" when seawater flooded onto the impact melt sheet in the basin floor. By contrast, we suggest that the upper 1000 m were deposited during protracted submarine volcanism and sedimentary reworking. Magma was initially sourced from the impact melt sheet and up stratigraphy, from reservoirs at greater depth. It follows that volcanic deposits in large impact basins may be related to magmatism caused by the impact but not directly associated with the impact-generated melt sheet.

  20. Fitful and protracted magma assembly leading to a giant eruption, Youngest Toba Tuff, Indonesia

    Science.gov (United States)

    Reid, Mary R; Vazquez, Jorge A.

    2017-01-01

    The paroxysmal eruption of the 74 ka Youngest Toba Tuff (YTT) of northern Sumatra produced an extraordinary 2800 km3 of non-welded to densely welded ignimbrite and co-ignimbrite ash-fall. We report insights into the duration of YTT magma assembly obtained from ion microprobe U-Th and U-Pb dates, including continuous age spectra over >50% of final zircon growth, for pumices and a welded tuff spanning the compositional range of the YTT. A relatively large subpopulation of zircon crystals nucleated before the penultimate caldera-related eruption at 501 ka, but most zircons yielded interior dates 100-300 ka thereafter. Zircon nucleation and growth was likely episodic and from diverse conditions over protracted time intervals of >100 to >500 ka. Final zircon growth is evident as thin rim plateaus that are in Th/U chemical equilibrium with hosts, and that give crystallization ages within tens of ka of eruption. The longevity and chemical characteristics of the YTT zircons, as well as evidence for intermittent zircon isolation and remobilization associated with magma recharge, is especially favored at the cool and wet eutectoid conditions that characterize at least half of the YTT, wherein heat fluxes could dissolve major phases but have only a minor effect on larger zircon crystals. Repeated magma recharge may have contributed to the development of compositional zoning in the YTT but, considered together with limited allanite, quartz, and other mineral dating and geospeedometry, regular perturbations to the magma reservoir over >400 ka did not lead to eruption until 74 ka ago.

  1. Protracted Regional Dissemination of GIM-1-Producing Serratia marcescens in Western Germany.

    Science.gov (United States)

    Wendel, Andreas F; Kaase, Martin; Autenrieth, Ingo B; Peter, Silke; Oberhettinger, Philipp; Rieber, Heime; Pfeffer, Klaus; MacKenzie, Colin R; Willmann, Matthias

    2017-03-01

    The metallo-beta-lactamase GIM-1 has been found in various bacterial host species nearly exclusively in western Germany. However, not much is known about the epidemiology of GIM-1-positive Serratia marcescens Here we report on a surprisingly protracted regional dissemination. In-hospital transmission was investigated by using conventional epidemiological tools to identify spatiotemporal links. Strain typing was performed using pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Bayesian phylogeny was used to infer the time axis of the observed occurrence. Thirteen S. marcescens strains from 10 patients from 6 different German hospitals were investigated. Suspected in-hospital transmissions were confirmed by molecular typing at a higher resolution by WGS than by PFGE. A detailed sequence analysis demonstrated the spread of one predominant strain variant but also provided evidence for transfer of the blaGIM-1 gene cassette between different strains. A Bayesian phylogenetic analysis showed that the most recent common ancestor of the identified clonal cluster could be dated back to April 1993 (95% highest posterior density interval, January 1973 to March 2003) and that this strain might have already harbored the blaGIM-1 at that time and, therewith, years before the first detection of this resistance gene in clinical specimens. This study shows a long-standing clonal and plasmid-mediated expansion of GIM-1-producing S. marcescens that might have gone unnoticed in the absence of a standardized and effective molecular screening for carbapenemases. The systematic and early detection of resistance is thus highly advisable, especially for the prevention of potentially long-term dissemination that may progress beyond control. Copyright © 2017 American Society for Microbiology.

  2. The phantom limb in dreams.

    Science.gov (United States)

    Brugger, Peter

    2008-12-01

    Mulder and colleagues [Mulder, T., Hochstenbach, J., Dijkstra, P. U., Geertzen, J. H. B. (2008). Born to adapt, but not in your dreams. Consciousness and Cognition, 17, 1266-1271.] report that a majority of amputees continue to experience a normally-limbed body during their night dreams. They interprete this observation as a failure of the body schema to adapt to the new body shape. The present note does not question this interpretation, but points to the already existing literature on the phenomenology of the phantom limb in dreams. A summary of published investigations is complemented by a note on phantom phenomena in the dreams of paraplegic patients and persons born without a limb. Integration of the available data allows the recommendation for prospective studies to consider dream content in more detail. For instance, "adaptation" to the loss of a limb can also manifest itself by seeing oneself surrounded by amputees. Such projective types of anosognosia ("transitivism") in nocturnal dreams should also be experimentally induced in normally-limbed individuals, and some relevant techniques are mentioned.

  3. Disorders of Upper Limb Movements in Ataxia-Telangiectasia.

    Directory of Open Access Journals (Sweden)

    Aasef G Shaikh

    Full Text Available Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task, while arms were outstretched (postural task, and at rest. Almost all ataxia-telangiectasia subjects (79/80 had abnormal involuntary movements, such as rhythmic oscillations (tremor, slow drifts (dystonia or athetosis, and isolated rapid movements (dystonic jerks or myoclonus. All patients with involuntary movements had both kinetic and postural tremor, while 48 (61% also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia.

  4. Multistage Carcinogenesis Modelling of Low and Protracted Radiation Exposure for Risk Assessment

    Science.gov (United States)

    Brugmans, M. J. P.; Bijwaard, H.

    Exposure to cosmic radiation in space poses an increased risk for radiation-induced cancer later in life. Modelling is essential to quantify these excess risks from low and protracted exposures to a mixture of radiation types, since they cannot be determined directly in epidemiological studies. Multistage carcinogenesis models provide a mechanistic basis for the extrapolation of epidemiological data to the regime that is relevant for radiation protection. In recent years, we have exploited the well-known two-mutation carcinogenesis model to bridge the gap between radiobiology and epidemiology. We have fitted this model to a number of animal and epidemiological data sets, using dose-response relationships for the mutational steps that are well established in cellular radiobiology. The methodology and implications for radiation risks are illustrated with analyses of two radiation-induced tumours: bone cancer from internal (high-LET and low-LET) emitters and lung cancer after radon exposure. For the risks of bone-seeking radionuclides (Ra-226, Sr-90, Pu-239), model fits to beagle data show that the dose-effect relationship for bone cancer at low intakes is linear-quadratic. This is due to a combination of equally strong linear dose-effects in the two subsequent mutational steps in the model. This supra-linear dose-effect relationship is also found in a model analysis of bone cancer in radium dial painters. This implies that at low intakes the risks from bone seekers are significantly lower than estimated from a linear extrapolation from high doses. Model analyses of radon-exposed rats and uranium miners show that lung-cancer induction is dominated by a linear radiation effect in the first mutational step. For two miner cohorts with significantly different lung cancer baselines a uniform description of the effect of radon is obtained in a joint analysis. This demonstrates the possibility to model risk transfer across populations. In addition to biologically based risk

  5. Protracted outbreak of S. Enteritidis PT 21c in a large Hamburg nursing home

    Science.gov (United States)

    Frank, Christina; Buchholz, Udo; Maaß, Monika; Schröder, Arthur; Bracht, Karl-Hans; Domke, Paul-Gerhard; Rabsch, Wolfgang; Fell, Gerhard

    2007-01-01

    Background During August 2006, a protracted outbreak of Salmonella (S.) Enteritidis infections in a large Hamburg nursing home was investigated. Methods A site visit of the home was conducted and food suppliers' premises tested for Salmonella. Among nursing home residents a cohort study was carried out focusing on foods consumed in the three days before the first part of the outbreak. Instead of relying on residents' memory, data from the home's patient food ordering system was used as exposure data. S. Enteritidis isolates from patients and suspected food vehicles were phage typed and compared. Results Within a population of 822 nursing home residents, 94 case patients among residents (1 fatality) and 17 among staff members were counted 6 through 29 August. The outbreak peaked 7 through 9 August, two days after a spell of very warm summer weather. S. Enteritidis was consistently recovered from patients' stools throughout the outbreak. Among the food items served during 5 through 7 August, the cohort study pointed to afternoon cake on all three days as potential risk factors for disease. Investigation of the bakery supplying the cake yielded S. Enteritidis from cakes sampled 31 August. Comparison of the isolates by phage typing demonstrated both isolates from patients and the cake to be the exceedingly rare phage type 21c. Conclusion Cake (various types served on various days) contaminated with S. Enteritidis were the likely vehicle of the outbreak in the nursing home. While the cakes were probably contaminated with low pathogen dose throughout the outbreak period, high ambient summer temperatures and failure to keep the cake refrigerated led to high pathogen dose in cake on some days and in some of the housing units. This would explain the initial peak of cases, but also the drawn out nature of the outbreak with cases until the end of August. Suggestions are made to nursing homes, aiding in outbreak prevention. Early outbreak detection is crucial, such that

  6. Displacement and stress distribution of the maxillofacial complex during maxillary protraction with buccal versus palatal plates: finite element analysis.

    Science.gov (United States)

    Kim, Kwang Yoo; Bayome, Mohamed; Park, Jae Hyun; Kim, Ki Beom; Mo, Sung-Seo; Kook, Yoon-Ah

    2015-06-01

    The aim of this study was to analyse the displacement and stress distribution in the maxillofacial complex during maxillary protraction with buccal and palatal plates using three-dimensional finite element analysis. Three anchorage appliance models-palatal plate (Type A), miniplate at the infrazygomatic crest (Type B), and conventional tooth-borne appliance (Type C)-were designed and integrated into a skull model. Protraction force was 500 g per side and force direction was forward and 30 degree downward to the maxillary occlusal plane. The stress distribution around the circum-maxillary sutures and the displacement of the surface landmarks were analysed. All models showed forward and upward displacement at anterior nasal spine, Point A, and prosthion and forward and downward displacement at posterior nasal spine resulting in a counter-clockwise rotation. This anterior displacement was greatest in Type A. At the maxillary process of the zygoma, upward movement was shown only in Type A, whereas downward movement was observed in Types B and C. The greatest stresses in Type A were at the pterygomaxillary and the zygomaticotemporal sutures. Type B showed the greatest stress at the frontomaxillary suture. Type A showed asymmetric results; however, it was not of clinical significance. The palatal plate resulted in wider stress distribution and more forward displacement compared to miniplate at the infrazygomatic crest area and conventional tooth-borne appliances. It might be recommended to consider the application of the palatal plate for maxillary protraction in Class III patients. © The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  7. Protracted, relapsing and demyelinating experimental autoimmune encephalomyelitis in DA rats immunized with syngeneic spinal cord and incomplete Freund's adjuvant

    DEFF Research Database (Denmark)

    Lorentzen, J C; Issazadeh-Navikas, Shohreh; Storch, M

    1995-01-01

    , protracted and relapsing EAE (SPR-EAE) after a subcutaneous immunization at the tail base with syngeneic spinal cord and incomplete Freund's adjuvant (IFA). The neurological deficits were accompanied by demyelinating inflammatory lesions in the spinal cord, with infiltrating T lymphocytes and perivascular...... deposition of immunoglobulins and complement. The induction of SPR-EAE was associated with humoral autoreactivity to myelin oligodendrocyte glycoprotein (MOG) and cellular autoreactivity to the rat myelin basic protein (MBP) peptides 69-87 and 87-101. These two peptides, as well as whole rat MBP, were...

  8. Lower-limb venous thrombosis

    African Journals Online (AJOL)

    307. Lower-limb venous thrombosis. July 2009 Vol.27 No.7 CME. Most DVTs arise in calf muscle veins, particularly within the gastrocnemius and soleus muscles (calf vein DVT). Many of these remain localised to the muscle and will not cause any clinical problem. If, however, the circumstances that initially caused the.

  9. Mechanisms of urodele limb regeneration

    Science.gov (United States)

    2017-01-01

    Abstract This review explores the historical and current state of our knowledge about urodele limb regeneration. Topics discussed are (1) blastema formation by the proteolytic histolysis of limb tissues to release resident stem cells and mononucleate cells that undergo dedifferentiation, cell cycle entry and accumulation under the apical epidermal cap. (2) The origin, phenotypic memory, and positional memory of blastema cells. (3) The role played by macrophages in the early events of regeneration. (4) The role of neural and AEC factors and interaction between blastema cells in mitosis and distalization. (5) Models of pattern formation based on the results of axial reversal experiments, experiments on the regeneration of half and double half limbs, and experiments using retinoic acid to alter positional identity of blastema cells. (6) Possible mechanisms of distalization during normal and intercalary regeneration. (7) Is pattern formation is a self‐organizing property of the blastema or dictated by chemical signals from adjacent tissues? (8) What is the future for regenerating a human limb? PMID:29299322

  10. Limb salvage in tibial hemimelia.

    Science.gov (United States)

    Eamsobhana, Perajit; Kaewpornsawan, Kamolporn

    2012-09-01

    To study the results of treatment of tibial hemimelia with limb salvage procedure in term of patient satisfaction, clinical results and complications. From 1993 to 2007 the authors treated six cases of tibial hemimelia with limb salvage procedures. Three legs of type Ia and four legs of type IV tibial hemimelia classified by Jones classification. The age at the operation ranged from 2 to 11 years. For type Ia cases, the Brown procedure,foot centralization and ilizarov lengthening of the fibula were used to correct limb length discrepancy. For type IV the foot centralization, soft tissue release and ilizarov lengthening were used to correct limb length discrepancy. The follow-up range from 4 to 10 years. In two patients with type Ia, one patient could bear weight without gait aids, the other walked with orthosis and axillary crutch because this patient had bilateral Ia type and knee instability with progressive flexion contracture due to weakness of the quadriceps muscle. All patients with type IV can walk independently without gait aids. Three patients were performed limb lengthening. One case was fibular lengthening following Brown procedure in Ia type. Two cases were tibial lengthening in type IV The mean lengthening was 5.1 cm. Mean lengthening index was 2.4. Satisfactory functional and cosmetic results were achieved in all patients with partial deficiency, whereas in patients with completely deficiency of the limbs, none of the 3 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture and persistent ligamentous instability. Nevertheless, in these 3 legs, all patients were ultimately able to withstand weight bearing. Patients and families were satisfied even though patients must have multiple surgery to correct deformities of the foot and the knee joint, as well as leg-length discrepancy and also a prolong treatment time. Limb salvage procedure in tibial

  11. [Phantom limb pain: from physiopathology to prevention].

    Science.gov (United States)

    Roullet, S; Nouette-Gaulain, K; Brochet, B; Sztark, F

    2009-05-01

    First described in 1545, phantom limb pain is a frequent complication after limb amputation, described by 60 to 85% of amputees. Stump pain, phantom limb sensation and phantom limb pain are often combined. Physiopathology is complex and peripheral, medullar and cortical mechanisms are combined. Pharmacological preventive treatments as well as regional anaesthesia techniques have equivalent results. Such treatments must be investigated more precisely as postoperative rehabilitation of amputees mostly depends on pain relief.

  12. Psychophysical correlates of phantom limb experience.

    Science.gov (United States)

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intensity of any phantom limb sensation or pain they experienced. The results from both sessions showed that mean skin temperature was significantly lower at the stump than the contralateral limb in the groups with phantom limb pain and non-painful phantom limb sensations, but not among subjects with no phantom limb at all. In addition, stump skin conductance responses correlated significantly with the intensity of non-painful phantom limb paresthesiae but not other qualities of sensation or pain. Between-limb measures of pressure sensitivity were not significantly different in any group. The results suggest that the presence of a phantom limb, whether painful or painless, is related to the sympathetic-efferent outflow of cutaneous vasoconstrictor fibres in the stump and stump neuromas. The hypothesis of a sympathetic-efferent somatic-afferent mechanism involving both sudomotor and vasoconstrictor fibres is proposed to explain the relationship between stump skin conductance responses and non-painful phantom limb paresthesiae. It is suggested that increases in the intensity of phantom limb paresthesiae follow bursts of sympathetic activity due to neurotransmitter release onto apposing sprouts of large diameter primary afferents located in stump neuromas, and decreases correspond to periods of relative sympathetic inactivity. The results of the study agree with recent suggestions that phantom limb pain is not a unitary syndrome, but a symptom class with each class subserved by

  13. Homeomorphisms Between Limbs of the Mandelbrot Set

    DEFF Research Database (Denmark)

    Branner, Bodil; Fagella, Nuria

    1999-01-01

    Using a family of higher degree polynomials as a bridge, together with complex surgery techniques, we construct a homeomorphism between any two limbs of the Mandelbrot set of equal denominator. Induced by these homeomorphisms and complex conjugation, we obtain an involution between each limb...... of the limbs in the plane. As usual we plough in the dynamical planes and harvest in the parameter space....

  14. Peripheral nervous system origin of phantom limb pain.

    Science.gov (United States)

    Vaso, Apostol; Adahan, Haim-Moshe; Gjika, Artan; Zahaj, Skerdi; Zhurda, Tefik; Vyshka, Gentian; Devor, Marshall

    2014-07-01

    Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review.

    Science.gov (United States)

    Nielsen, R M; Olsen, K S; Lauritsen, A Oe; Boesen, H C

    2014-10-01

    Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy. The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Cross-modal symbolic processing can elicit either an N2 or a protracted N2/N400 response.

    Science.gov (United States)

    Griffiths, Oren; Le Pelley, Mike E; Jack, Bradley N; Luque, David; Whitford, Thomas J

    2016-07-01

    A cross-modal symbolic paradigm was used to elicit EEG activity related to semantic incongruence. Twenty-five undergraduate students viewed pairings of visual lexical cues (e.g., DOG) with congruent (50% of trials) or incongruent (50%) auditory nonlexical stimuli (animal vocalizations; e.g., sound of a dog woofing or a cat meowing). In one condition, many different pairs of congruent/incongruent stimuli were shown, whereas in a second condition only two pairs of stimuli were repeatedly shown. A typical N400-like pattern of incongruence-related activity (including activity in the N2 time window) was evident in the condition using many stimuli, whereas the incongruence-related activity in the two-stimuli condition was confined to differential N2-like activity. A supplementary analysis excluded stimulus characteristics as the source of this differential activity between conditions. We found that a single individual performing a fixed task can demonstrate either a protracted N400-like pattern of activity or a more temporally focused N2-like pattern of activity in response to the same stimulus, which suggests that the N2 may be a precursor to the protracted N400 response. © 2016 Society for Psychophysiological Research.

  17. Cephalometric Outcomes of Maxillary Expansion and Protraction in Patients With Unilateral Cleft Lip and Palate After Two Types of Palatoplasty.

    Science.gov (United States)

    Tome, Wakako; Yashiro, Kohtaro; Kogo, Mikihiko; Yamashiro, Takashi

    2016-11-01

      To clarify the differences in the long-term effects of maxillary expansion (ME) and protraction (MP) in patients with complete unilateral cleft lip, alveolus, and palate (UCLP) undergoing two types of palatoplasty.   Retrospective longitudinal study.   Institutional study.   Thirty-eight patients with UCLP treated at Osaka University Dental Hospital, Japan, were divided into two groups: 19 patients were treated using Wardill-Kilner push-back palatoplasty (PB), and 19 patients were treated with early two-stage palatoplasty according to the modified Furlow technique (ETS). All patients exhibited a short maxilla at the initial orthodontic visit and were treated with ME using a quad helix appliance and MP with a face mask. Lateral cephalometric data recorded in the initial stage were compared with those obtained at the end of treatment.   The dentoskeletal features and facial soft tissue profile were evaluated before and after orthodontic treatment. The variation and rate of change during treatment were also calculated. The Mann-Whitney U test was used for the statistical analyses.   The ETS group showed significantly greater SNA, SNB, and U1-Pp angles and smaller SN-Mp angles than the PB group after face mask treatment. The variation in the anteroposterior length of the maxilla during treatment was significantly greater in the ETS group than in the PB group.   Maxillary protraction was more efficiently accomplished in the patients with UCLP after early two-stage palatoplasty compared with push-back palatoplasty.

  18. Clinical benefit response of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Okusaka, Takuji; Okada, Shuichi; Ishii, Hiroshi [National Cancer Center, Tokyo (Japan). Hospital] [and others

    1998-04-01

    Pancreatic cancer is a highly virulent disease with a poor prognosis. Although objective tumor response to chemotherapy and/or radiotherapy is low, some patients show an improvement in their symptoms after treatments, without obvious tumor regression. We assessed the clinical benefit of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer. Sixteen patients were enrolled in this study. The clinical benefit response to the chemoradiotherapy was evaluated by 2 indicators, including pain (intensity of pain and consumption of morphine) and performance status. A patient was defined to be a clinical benefit responder if 1 of these 2 variables was positive, and the other variable was positive or stable. Seven patients (44%) responded. Six patients (38%) were classified as stable, and 3 (19%) as nonresponders. The survival period in responders was significantly longer than that in nonresponders and stable patients. Concurrent external-beam radiation therapy, with protracted 5-fluorouracil infusion, may be a meaningful treatment for locally advanced pancreatic cancer. (author)

  19. Impaired response inhibition in the rat 5 choice continuous performance task during protracted abstinence from chronic alcohol consumption.

    Directory of Open Access Journals (Sweden)

    Cristina Irimia

    Full Text Available Impaired cognitive processing is a hallmark of addiction. In particular, deficits in inhibitory control can propel continued drug use despite adverse consequences. Clinical evidence shows that detoxified alcoholics exhibit poor inhibitory control in the Continuous Performance Task (CPT and related tests of motor impulsivity. Animal models may provide important insight into the neural mechanisms underlying this consequence of chronic alcohol exposure though pre-clinical investigations of behavioral inhibition during alcohol abstinence are sparse. The present study employed the rat 5 Choice-Continuous Performance Task (5C-CPT, a novel pre-clinical variant of the CPT, to evaluate attentional capacity and impulse control over the course of protracted abstinence from chronic intermittent alcohol consumption. In tests conducted with familiar 5C-CPT conditions EtOH-exposed rats exhibited impaired attentional capacity during the first hours of abstinence and impaired behavioral restraint (increased false alarms during the first 5d of abstinence that dissipated thereafter. Subsequent tests employing visual distractors that increase the cognitive load of the task revealed significant increases in impulsive action (premature responses at 3 and 5 weeks of abstinence, and the emergence of impaired behavioral restraint (increased false alarms at 7 weeks of abstinence. Collectively, these findings demonstrate the emergence of increased impulsive action in alcohol-dependent rats during protracted alcohol abstinence and suggest the 5C-CPT with visual distractors may provide a viable behavioral platform for characterizing the neurobiological substrates underlying impaired behavioral inhibition resulting from chronic intermittent alcohol exposure.

  20. Livelihoods, power, and food insecurity: adaptation of social capital portfolios in protracted crises--case study Burundi.

    Science.gov (United States)

    Vervisch, Thomas G A; Vlassenroot, Koen; Braeckman, Johan

    2013-04-01

    The failure of food security and livelihood interventions to adapt to conflict settings remains a key challenge in humanitarian responses to protracted crises. This paper proposes a social capital analysis to address this policy gap, adding a political economy dimension on food security and conflict to the actor-based livelihood framework. A case study of three hillsides in north Burundi provides an ethnographic basis for this hypothesis. While relying on a theoretical framework in which different combinations of social capital (bonding, bridging, and linking) account for a diverse range of outcomes, the findings offer empirical insights into how social capital portfolios adapt to a protracted crisis. It is argued that these social capital adaptations have the effect of changing livelihood policies, institutions, and processes (PIPs), and clarify the impact of the distribution of power and powerlessness on food security issues. In addition, they represent a solid way of integrating political economy concerns into the livelihood framework. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

  1. Protracted treatment with diazepam increases the turnover of putative endogenous ligands for the benzodiazepine/. beta. -carboline recognition site

    Energy Technology Data Exchange (ETDEWEB)

    Miyata, M.; Mocchetti, I.; Ferrarese, C.; Guidotti, A.; Costa, E.

    1987-03-01

    DBI (diazepam-binding inhibitor) is a putative neuromodulatory peptide isolated from rat brain that acts on ..gamma..-aminobutyric acid-benzodiazepine-Cl/sup -/ ionosphore receptor complex inducing ..beta..-carboline-like effects. The authors used a cDNA probe complementary to DBI mRNA and a specific antibody for rat DBI to study in rat brain how the dynamic state of DBI can be affected after protected (three times a day for 10 days) treatment with diazepam and chlordiazepoxide by oral gavage. Both the content of DBI and DBI mRNA increased in the cerebellum and cerebral cortex but failed to change in the hippocampus and striatum of rats receiving this protracted benzodiazepine treatment. Acute treatment with diazepam did not affect the dynamic state of brain DBI. An antibody was raised against a biologically active octadecaneuropeptide derived from the tryptic digestion of DBI. The combined HPLC/RIA analysis of rat cerebellar extracts carried out with this antibody showed that multiple molecular forms of the octadecaneuropeptide-like reactivity are present and all of them are increased in rats receiving repeated daily injections of diazepam. It is inferred that tolerance to benzodiazepines in associated with an increase in the turnover rate of DBI, which may be responsible for the ..gamma..-aminobutyric acid receptor desensitization that occurs after protracted benzodiazepine administration.

  2. Characterizing isotopic variability of primary production and consumers in Great Plains ecosystems during protracted regional drought

    Science.gov (United States)

    Haveles, A. W.; Fox-Dobbs, K.; Talmadge, K. A.; Fetrow, A.; Fox, D. L.

    2012-12-01

    Over the last few years (2010-2012), the Great Plains of the central USA experienced protracted drought conditions, including historically severe drought during Summer, 2011. Drought severity in the region generally decreases with increasing latitude, but episodic drought is a fundamental trait of grassland ecosystems. Documenting above ground energy and nutrient flow with current drought is critical to understanding responses of grassland ecosystems in the region to predicted increased episodicity of rainfall and recurrence of drought due to anthropogenic climate change. Characterization of biogeochemical variability of modern ecosystems at the microhabitat, local landscape, and regional scales is also necessary to interpret biogeochemical records of ancient grasslands based on paleosols and fossil mammals. Here, we characterize three grassland ecosystems that span the drought gradient in the Great Plains (sites in the Texas panhandle, southwest Kansas, and northwest Nebraska). We measured δ13C and δ15N values of plants and consumers to characterize the biogeochemical variability within each ecosystem. Vegetation at each site is a mix of trees, shrubs, herbs, and cool- and warm-growing season grasses (C3 and C4, respectively). Thus, consumers have access to isotopically distinct sources of forage that vary in abundance with microhabitat (e.g., open grassland, shrub thicket, riparian woodland). Observations indicate herbivorous arthropod (grasshoppers and crickets) abundance follows drought severity, with high abundance of many species in Texas, and low abundance of few species in Nebraska. Small mammal (rodents) abundance follows the inverse pattern with 0.8%, 3.2% and 17.2% capture success in Texas, Kansas and Nebraska, respectively. The inverse abundance patterns of consumer groups may result from greater sensitivity of small mammal consumers with high metabolic needs to lower local net primary productivity and forage quality under drought conditions. As a

  3. Pattern Formation in Vertebrate Limbs

    Science.gov (United States)

    1995-05-08

    embryological systems was sporadic. A resurgence of interest occurred in the 1960 ’ s. It was at this time that Wolpert presented his concept of positional...as are changes in receptors on the plasma membrane (Hood, Huang, & Dreyer, 1977) . 11 DEVELOPMENT AND PATTERNS IN THE EMBRYONIC CHICKEN LIMB The...Development i. Stages 1 to 6 The period of gestation for the chicken is 20 to 21 days and is divided into a series of stages identified by

  4. Major limb amputation in Ibadan.

    Science.gov (United States)

    Ogunlade, S O; Alonge, T O; Omololu, A B O; Gana, J Y; Salawu, S A

    2002-12-01

    A prospective study of patients who had major limb amputation at the University College Hospital Ibadan over a 5-year period is presented. One hundred and one major limb amputations were performed within this period (71 Males, 30 Females, M:F = 2.3:1). Trauma accounted for 48% of the cases followed by diabetes in 26%, soft tissue infection in 13% and tumours also in 13%. The major post-op complication was wound infection. In accordance with the findings in other centers, a higher proportion of the amputations (69%) were carried out in the lower limbs. Patient's refusal to accept amputation resulted in a delay in amputation in 49 patients. This delay (before surgery) ranged from 1 day to 150 days, with a mean of 15.49 (SD 9.V). From this study, we found that a reduction in vehicular accidents and increasing emphasis on efficient foot care (and glycaemic control) in the diabetic may significantly reduce the rate of amputations in our environment.

  5. Studies of limb-dislodging forces acting on an ejection seat occupant.

    Science.gov (United States)

    Schneck, D J

    1980-03-01

    A mathematical theory is being developed in order to calculate the aerodynamic loading to which a pilot is exposed during high-speed ejections. Neglecting the initial effects of flow separation, results thus far indicate that a pilot's musculoskeletal system is not likely to withstand the tendency for limb-flailing if he is ejecting at Mach numbers in excess of about 0.7. This tendency depends very strongly upon the angle at which the pilot's limbs intercept a high-speed flow; the forces that cause limb dislodgement increase dramatically with speed of ejection. Examining the time-course of limb-dislodging forces after the initial onset of windblast, the theory further predicts the generation of a double vortex street pattern on the downstream side of the limbs of an ejection seat occupant. This results in the corresponding appearance of oscillating forces tending to cause lateral motion (vibration) of the limbs. The amplitude and frequency of these oscillating forces are also very dependent on the Mach number of ejection and the angle at which the pilot's limbs intercept the flow. However, even at moderate Mach numbers, the frequency can be as high as 100 cycles per second, and the amplitude rapidly exceeds a pilot's musculo-skeletal resistive powers for Mach numbers above 0.7.

  6. Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis.

    Science.gov (United States)

    Lin, Yifan; Guo, Runzhi; Hou, Liyu; Fu, Zhen; Li, Weiran

    2018-02-10

    The objective of this study was to evaluate the stability of treatment effects of maxillary protraction therapy in Class III children. Multiple electronic databases were searched from 01/1996 to 10/2016. Randomized clinical trials, controlled clinical trials, and cohort studies with untreated Class III controls and a follow-up over 2 years were considered for inclusion. The methodological quality of the studies and publication bias were evaluated. Mean differences and 95% confidence intervals (CI) of six variables (SNA, SNB, ANB, mandibular plane angle, overjet, and lower incisor angle) were calculated. Ten studies were included in the qualitative analysis, and four studies were included in the quantitative analysis. Compared with the control group, after treatment, the treated group showed significant changes: SNA +1.79° (95% CI: 1.23, 2.34), SNB -1.16° (95% CI -2.08, -0.24), ANB +2.92° (95% CI 2.40, 3.44), mandibular plane angle +1.41° (95% CI 0.63, 2.20), overjet +3.94 mm (95% CI 2.17, 5.71) and lower incisor angle -3.07° (95% CI -4.92, -1.22). During follow-up, the changes in five variables reflected significant relapse. Overall, the treated group showed significant changes only in ANB +1.66° (95% CI 0.97, 2.35) and overjet +2.41 mm (95% CI 1.60, 3.23). Maxillary protraction can be a short-term effective therapy and might improve sagittal skeletal and dental relationships in the medium term. But some skeletal and dental variables showed significant relapse during the follow-up period. Long-term studies are still required to further evaluate its skeletal benefits. The study evaluated the medium-term stability of skeletal and dental effects of maxillary protraction in Class III children and discussed whether the therapy can reduce the need for orthognathic surgery.

  7. Dentofacial effects of bone-anchored maxillary protraction: a controlled study of consecutively treated Class III patients.

    Science.gov (United States)

    De Clerck, Hugo; Cevidanes, Lucia; Baccetti, Tiziano

    2010-11-01

    In this cephalometric investigation, we analyzed the treatment effects of bone-anchored maxillary protraction (BAMP) with miniplates in the maxilla and mandible connected by Class III elastics in patients with Class III malocclusion. The treated sample consisted of 21 Class III patients consecutively treated with the BAMP protocol before the pubertal growth spurt (mean age, 11.10 ± 1.8 years) and reevaluated after BAMP therapy, about 1 year later. The treated group was compared with a matched control group of 18 untreated Class III subjects. Significant differences between the treated and control groups were assessed with independent-sample t tests (P maxillary structures of about 4 mm, and favorable mandibular changes exceeded 2 mm. Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  8. Excitability of jcBNST neurons is reduced in alcohol-dependent animals during protracted alcohol withdrawal.

    Directory of Open Access Journals (Sweden)

    Attila Szücs

    Full Text Available Alcohol dependence and withdrawal has been shown to cause neuroadaptive changes at multiple levels of the nervous system. At the neuron level, adaptations of synaptic connections have been extensively studied in a number of brain areas and accumulating evidence also shows the importance of alcohol dependence-related changes in the intrinsic cellular properties of neurons. At the same time, it is still largely unknown how such neural adaptations impact the firing and integrative properties of neurons. To address these problems, here, we analyze physiological properties of neurons in the bed nucleus of stria terminalis (jcBNST in animals with a history of alcohol dependence. As a comprehensive approach, first we measure passive and active membrane properties of neurons using conventional current clamp protocols and then analyze their firing responses under the action of simulated synaptic bombardment via dynamic clamp. We find that most physiological properties as measured by DC current injection are barely affected during protracted withdrawal. However, neuronal excitability as measured from firing responses under simulated synaptic inputs with the dynamic clamp is markedly reduced in all 3 types of jcBNST neurons. These results support the importance of studying the effects of alcohol and drugs of abuse on the firing properties of neurons with dynamic clamp protocols designed to bring the neurons into a high conductance state. Since the jcBNST integrates excitatory inputs from the basolateral amygdala (BLA and cortical inputs from the infralimbic and the insular cortices and in turn is believed to contribute to the inhibitory input to the central nucleus of the amygdala (CeA the reduced excitability of the jcBNST during protracted withdrawal in alcohol-dependent animals will likely affect ability of the jcBNST to shape the activity and output of the CeA.

  9. Testing the Protracted Lexical Restructuring Hypothesis: The Effects of Position and Acoustic-Phonetic Clarity on Sensitivity to Mispronunciations in Children and Adults

    Science.gov (United States)

    Bowey, Judith A.; Hirakis, Eliana

    2006-01-01

    Although developmental increases in the size of the position effect within a mispronunciation detection task have been interpreted as consistent with a view of the lexical restructuring process as protracted, the position effect itself might not be reliable. The current research examined the effects of position and clarity of acoustic-phonetic…

  10. Improving Outcome in Malignant Pleural Mesothelioma (MPM) Using Pulsed-Protracted External Beam Radiation (PERT) and Intrapleural Delivery of Stem Cells

    Science.gov (United States)

    2014-09-01

    Malignant Pleural Mesothelioma (MPM) survival remains poor despite multidisciplinary treatment involving aggressive surgery, chemotherapy and... Mesothelioma (MPM) survival remains poor despite multidisciplinary treatment involving aggressive surgery, chemotherapy and adjuvant radiotherapy (RT... Mesothelioma (MPM) Using Pulsed-Protracted External Beam Radiation (PERT) and Intrapleural Delivery of

  11. Lower limb amputation for diabetic foot.

    Science.gov (United States)

    Ohsawa, S; Inamori, Y; Fukuda, K; Hirotuji, M

    2001-01-01

    We amputated 35 limbs of 27 patients with diabetic foot from March 1988 to March 1998. The mean age of the patients at the time of operation was 67 years, and the mean follow-up period was 27 months. Thirteen patients died in the period from 1 day to 39 months after the operation. All patients suffering from diabetic foot were referred to our department for surgical procedures after failure of conservative treatment conducted elsewhere. Their feet were classified into grade 2-3 in 18 limbs, grade 4-5 in 11 limbs, and gangrene of the lower leg and entire foot in 2 limbs, as classified by the Wagner system. Two patients had cellulitis of the foot and two other limbs had infectious gonarthritis. All patients had type 2 diabetes with poor blood sugar control, and 90% were treated by insulin. All patients suffered from diabetic neuropathy. Half of the patients were put on hemodialysis because of diabetic nephropathy. More than 60% of the patients suffered from arteriosclerosis obliterans. The amputation level of the limb was determined by skin thermography, but the patient's will was critical. The initial amputation levels were: débridement and synovectomy in 4 limbs, toe and digital ray in 15 limbs, transmetatarsal in 3 limbs, transtibial in 9 limbs, transfemoral amputations in 4 limbs. Upper level reamputation was conducted on 15 limbs. Logistic regression analysis revealed that lower temperature of the amputation site, being female, and being elderly were significant risk factors in reamputation. Skin thermography was one of the effective determinants of amputation level, in order to avoid reamputation.

  12. Customizable Rehabilitation Lower Limb Exoskeleton System

    OpenAIRE

    Riaan Stopforth

    2012-01-01

    Disabled people require assistance with the motion of their lower limbs to improve rehabilitation. Exoskeletons used for lower limb rehabilitation are highly priced and are not affordable to the lowerincome sector of the population. This paper describes an exoskeleton lower limb system that was designed keeping in mind that the cost must be as low as possible. The forward kinematic system that is used must be a simplified model to decrease computational time, yet allow the exoskeleton to be a...

  13. LIMB SALVAGE IN DIABETIC FOOT INFECTION

    OpenAIRE

    J. Ramanaiah; M. Pavani; N. Dinesh Kumar Reddy; Sai Subrahmanyam

    2017-01-01

    BACKGROUND Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. Limb salvage procedures may prevent eventual limb loss, the need of a major limb amputation, decrease total cost and may restore full ambulation earlier. MATERIALS ...

  14. Angular Limb Deformities: Growth Retardation.

    Science.gov (United States)

    McCarrel, Taralyn M

    2017-08-01

    Angular limb deformities are common in foals; however, the importance of the deformity and if treatment is required depend on the degree of deformity relative to normal conformation for stage of growth, the breed and discipline expectations, age, and response to conservative therapies. This article addresses the importance of the foal conformation examination to determine which foals need surgical intervention to correct an angular deformity and when. Techniques for surgical growth retardation include the transphyseal staple, screw and wire transphyseal bridge, and transphyseal screw. Appropriate timing for intervention for each location and complications associated with each procedure are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Endograft Limb Occlusion in EVAR

    DEFF Research Database (Denmark)

    Taudorf, M; Jensen, L P; Vogt, K C

    2014-01-01

    occlusions were recorded and compared with a defined control group. Three different indices were used to describe the tortuosity of the iliac vessels based on preoperative CTA: pelvic artery index of tortuosity (PAI), common iliac artery index of tortuosity (CAI), and a visual description of vessel......% at 3 years. Logistic regression showed that iliac artery tortuosity (DIS) (p = .001) and body mass index (p = .007) had a significant impact on graft patency. CONCLUSION: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting...

  16. Extracellular Control of Limb Regeneration

    Science.gov (United States)

    Calve, S.; Simon, H.-G.

    Adult newts possess the ability to completely regenerate organs and appendages. Immediately after limb loss, the extracellular matrix (ECM) undergoes dramatic changes that may provide mechanical and biochemical cues to guide the formation of the blastema, which is comprised of uncommitted stem-like cells that proliferate to replace the lost structure. Skeletal muscle is a known reservoir for blastema cells but the mechanism by which it contributes progenitor cells is still unclear. To create physiologically relevant culture conditions for the testing of primary newt muscle cells in vitro, the spatio-temporal distribution of ECM components and the mechanical properties of newt muscle were analyzed. Tenascin-C and hyaluronic acid (HA) were found to be dramatically upregulated in the amputated limb and were co-expressed around regenerating skeletal muscle. The transverse stiffness of muscle measured in situ was used as a guide to generate silicone-based substrates of physiological stiffness. Culturing newt muscle cells under different conditions revealed that the cells are sensitive to both matrix coating and substrate stiffness: Myoblasts on HA-coated soft substrates display a rounded morphology and become more elongated as the stiffness of the substrate increases. Coating of soft substrates with matrigel or fibronectin enhanced cell spreading and eventual cell fusion.

  17. Limb apraxia in corticobasal syndrome.

    Science.gov (United States)

    Stamenova, Vessela; Roy, Eric A; Black, Sandra E

    2011-04-01

    Corticobasal syndrome (CBS) is a progressive neurodegenerative disorder with asymmetric presentation and course characterized by degeneration of basal ganglia and cortical structures. Limb apraxia is a commonly observed deficit in CBS. Few studies have examined comprehensively the nature of deficits in limb apraxia. The goal of our study was to investigate the severity of deficits in various conceptual and gesture production task modalities. CBS patients were divided in two groups based on the side of brain that was initially affected by the disease. Ten patients with right hemisphere presentation (RHP) and seven with left hemisphere presentation (LHP) were included. The results showed that while selective conceptual tasks deficits were present in both groups, the overall picture suggests preserved conceptual representations of tools and actions in CBS patients with either LHP or RHP. Both groups were impaired relative to controls on gesture production tasks. Performance on transitive gestures was more severely affected in both groups than intransitive gestures. Imitation was more severely affected than pantomime, suggesting deficits in visuomotor transformations. The addition of verbal cuing during concurrent imitation affected only the LHP patients, rendering them more impaired relative to controls in their imitation with verbal cuing as opposed to their imitation only performance. Imitation of non-representational gestures was least accurate and intransitive gestures were most accurate. Patients were more severely impaired relative to controls when holding the object and when they were shown pictures of tools to pantomime. Copyright © 2010 Elsevier Srl. All rights reserved.

  18. Adjustments to amputation and an artificial limb in lower limb amputees

    NARCIS (Netherlands)

    Sinha, Richa; van den Heuvel, Wim J. A.; Arokiasamy, Perianayagam

    Background: Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. Objectives: To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and

  19. Advances in endovascular treatment of critical limb ischemia.

    LENUS (Irish Health Repository)

    Yan, Bryan P

    2011-04-01

    Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease. In the absence of timely revascularization, CLI carries high risk of mortality and amputation. Over the past decade, endovascular revascularization has rapidly become the preferred primary treatment strategy for CLI, especially for the treatment of below-the-knee disease. Advances in percutaneous devices and techniques have expanded the spectrum of patients with CLI who are deemed candidates for revascularization. This review will focus on advances in endovascular options for the treatment of CLI, in particular for below-the-knee disease.

  20. Comprehensive treatment for gas gangrene of the limbs in earthquakes.

    Science.gov (United States)

    Wang, Yue; Lu, Bo; Hao, Peng; Yan, Meng-ning; Dai, Ke-rong

    2013-10-01

    Mortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients. We retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China's Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene. Of 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died. In earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.

  1. The heart in limb girdle muscular dystrophy

    NARCIS (Netherlands)

    van der Kooi, A. J.; de Voogt, W. G.; Barth, P. G.; Busch, H. F.; Jennekens, F. G.; Jongen, P. J.; de Visser, M.

    1998-01-01

    OBJECTIVE: To assess the frequency, nature, and severity of cardiac abnormalities in limb girdle muscular dystrophy, and its relation to age and weakness in various genotypes. DESIGN: In 26 autosomal dominant, 38 autosomal recessive, and 33 sporadic strictly defined patients with limb girdle

  2. Lower Limb Disabilities Following Motorcyle Crashes | Kortor ...

    African Journals Online (AJOL)

    ... caused by amputation, fracture, post traumatic arthritis and joint stiffness. The objective of this study was to assess the nature and severity of lower limb disability resulting from motorcycle crashes. Methodology: All victims of motorcycle accident with lower limb injuries who were treated at NKST Rehabilitation Hospital from ...

  3. Claimed walking distance of lower limb amputees

    NARCIS (Netherlands)

    Geertzen, JHB; Bosmans, JC; Van der Schans, CP; Dijkstra, PU

    2005-01-01

    Purpose: Walking ability in general and specifically for lower limb amputees is of major importance for social mobility and ADL independence. Walking determines prosthesis prescription. The aim of this study was to mathematically analyse factors influencing claimed walking distance of lower limb

  4. Update on embryology of the upper limb.

    Science.gov (United States)

    Al-Qattan, Mohammad M; Kozin, Scott H

    2013-09-01

    Current concepts in the steps of upper limb development and the way the limb is patterned along its 3 spatial axes are reviewed. Finally, the embryogenesis of various congenital hand anomalies is delineated with an emphasis on the pathogenetic basis for each anomaly. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Sports participation of Dutch lower limb amputees

    NARCIS (Netherlands)

    Bragaru, Mihail; Meulenbelt, Hendrik; Dijkstra, Pieter U.; Geertzen, Jan H.B.; Dekker, Rienk

    2013-01-01

    Objective: To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. Study design: A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation

  6. Limb-segment selection in drawing behaviour

    NARCIS (Netherlands)

    Meulenbroek, R G; Rosenbaum, D A; Thomassen, A.J.W.M.; Schomaker, L R

    How do we select combinations of limb segments to carry out physical tasks? Three possible determinants of limb-segment selection are hypothesized here: (1) optimal amplitudes and frequencies of motion for the effectors; (2) preferred movement axes for the effectors; and (3) a tendency to continue

  7. LIMB-SEGMENT SELECTION IN DRAWING BEHAVIOR

    NARCIS (Netherlands)

    MEULENBROEK, RGJ; ROSENBAUM, DA; THOMASSEN, AJWM; SCHOMAKER, LRB; Schomaker, Lambertus

    How do we select combinations of limb segments to carry out physical tasks? Three possible determinants of limb-segment selection are hypothesized here: (1) optimal amplitudes and frequencies of motion for the effectors; (2) preferred movement axes for the effectors; and (3) a tendency to continue

  8. Genetics Home Reference: limb-girdle muscular dystrophy

    Science.gov (United States)

    ... Health Conditions Limb-girdle muscular dystrophy Limb-girdle muscular dystrophy Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Limb-girdle muscular dystrophy is a term for a group of diseases ...

  9. [Thalidomide (Contergan) induced limb deficiency in Hungary?].

    Science.gov (United States)

    Gidai, János; Bács, Eva; Czeizel, Endre

    2009-06-21

    A 47 year old female with severe deficiency of three limbs visited our Genetic Counselling Clinic and asked us to give her a certificate that her complex limb deficiency was caused by thalidomide (Contergan). According to her explanation, her mother used this drug during pregnancy which was given to her by her sister, who lived in West Germany. The characteristic signs of thalidomide embryopathy are: radial type limb deficiency including most severe forms of phocomelia and amelia, ear abnormalities. In the case of this woman, however, FFU (femoral-fibula-ulna) complex was found: bilateral femur hypoplasia (F), and fibular hypoplasia (F) with the lack of Vth and IVth toes, in addition with ulnar hypoplasia (U) with the deficiency of Vth and IVth fingers in her right upper limb. The left upper limb was not affected. Besides that, she was treated with schizophrenia. In conclusion, there is no association between the supposed thalidomide use during pregnancy and FFU complex.

  10. Limb Regeneration in Xenopus laevis Froglet

    Directory of Open Access Journals (Sweden)

    Makoto Suzuki

    2006-01-01

    Full Text Available Limb regeneration in amphibians is a representative process of epimorphosis. This type of organ regeneration, in which a mass of undifferentiated cells referred to as the “blastema” proliferate to restore the lost part of the amputated organ, is distinct from morphallaxis as observed, for instance, in Hydra, in which rearrangement of pre-existing cells and tissues mainly contribute to regeneration. In contrast to complete limb regeneration in urodele amphibians, limb regeneration in Xenopus, an anuran amphibian, is restricted. In this review of some aspects regarding adult limb regeneration in Xenopus laevis, we suggest that limb regeneration in adult Xenopus, which is pattern/tissue deficient, also represents epimorphosis.

  11. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees.

    Science.gov (United States)

    Poor Zamany Nejatkermany, Mahtab; Modirian, Ehsan; Soroush, Mohammadreza; Masoumi, Mehdi; Hosseini, Maryam

    2016-01-01

    To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation. All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test. There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP. Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.

  12. Limb Laterality Recognition Score: A Reliable Clinical Measure Related to Phantom Limb Pain.

    Science.gov (United States)

    Wong, Christopher Kevin; Wong, Caitlin Kimberly

    2017-08-24

    To explore the usefulness of the limb laterality recognition score as a clinical measure of phantom limb pain, regarding test-retest reliability and association of limb laterality recognition scores with phantom limb pain measures. Retrospective cohort. Community support group. Eleven adults who averaged 4.8 years since lower limb amputation due to vascular pathologies (N = 9), trauma (N = 1), and cancer (N = 1). Subjects self-reported amputated limb pain using the sensation subsection of the Prosthetic Evaluation Questionnaire and back and sound limb pain. Using numbered iPads that corresponded to the self-reports, subjects played the Recognise Foot game to assess limb laterality recognition ability. Subjects identified the laterality of 20 foot images, within two seconds each. The software collected accuracy and speed scores in basic, vanilla, and context conditions for two rounds in random order. Basic showed feet against black backgrounds, vanilla showed feet with various monochromatic backgrounds, and context showed feet in clothed or environmental contexts. So that greater accuracy in less time meant a better score, accuracy scores were divided by completion speed. Intraclass correlation coefficient (ICC)3,1 assessed test-retest reliability. Correlations between accuracy/speed and phantom limb pain measures were assessed with Spearman's rho (categorical) and Pearson coefficients (continuous). Accuracy/speed test-retest reliability was strong (ICC = 0.72) and inversely associated with phantom limb pain frequency (context rho = 0.72). Limb laterality recognition accuracy/speed in the context condition had good test-retest reliability and correlated strongly with phantom limb pain frequency. Accuracy/speed limb laterality recognition ability relates to phantom limb pain and may be a valid clinical or research measure.

  13. Myeloid leukaemia frequency after protracted exposure to ionizing radiation: experimental confirmation of the flat dose-response found in ankylosing spondylitis after a single treatment course with x-rays

    Energy Technology Data Exchange (ETDEWEB)

    Mole, R.H.; Major, I.R. (Medical Research Council, Harwell (UK). Radiobiological Research Unit)

    1983-01-01

    The dose-response for leukaemia induction by exposure to ionizing radiation protracted over several weeks was largely independent of dose not only in X-rayed patients with ankylosing spondylitis but also in experimentally ..gamma..-rayed CBA/H mice. In the experiment the induced leukaemia frequency of acute myeloid leukaemia was independent of a several thousand-fold variation in physical dose rate. Any difference in leukaemia induction between brief and protracted exposures must therefore depend on specifically biological consequences of protracted exposures. Experimental analysis is required to provide the guides for inference about risks of low level exposure from observations on relatively heavily irradiated populations.

  14. Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia.

    Science.gov (United States)

    Shah, M; Martin, A; Myers, B; MacSweeney, S; Richards, T

    2010-09-01

    Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system. In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2-13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days). Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.

  15. Cross-limb interference during motor learning.

    Directory of Open Access Journals (Sweden)

    Benedikt Lauber

    Full Text Available It is well known that following skill learning, improvements in motor performance may transfer to the untrained contralateral limb. It is also well known that retention of a newly learned task A can be degraded when learning a competing task B that takes place directly after learning A. Here we investigate if this interference effect can also be observed in the limb contralateral to the trained one. Therefore, five different groups practiced a ballistic finger flexion task followed by an interfering visuomotor accuracy task with the same limb. Performance in the ballistic task was tested before the training, after the training and in an immediate retention test after the practice of the interference task for both the trained and the untrained hand. After training, subjects showed not only significant learning and interference effects for the trained limb but also for the contralateral untrained limb. Importantly, the interference effect in the untrained limb was dependent on the level of skill acquisition in the interfering motor task. These behavioural results of the untrained limb were accompanied by training specific changes in corticospinal excitability, which increased for the hemisphere ipsilateral to the trained hand following ballistic training and decreased during accuracy training of the ipsilateral hand. The results demonstrate that contralateral interference effects may occur, and that interference depends on the level of skill acquisition in the interfering motor task. This finding might be particularly relevant for rehabilitation.

  16. Functionality of i-LIMB and i-LIMB pulse hands: case report.

    Science.gov (United States)

    van der Niet, Olga; Bongers, Raoul M; van der Sluis, Corry K

    2013-01-01

    The availability of various multiarticulated prosthetic hands makes determining differences in functionality between these hands relevant. The current study asked whether the functionality of these hands increased with time of use and whether grip force and robustness improved. A 45-year-old man with wrist disarticulation used the i-LIMB and the i-LIMB Pulse hands in a series of tests covering all functional levels as described in the framework of the International Classification of Functioning, Disability and Health. Using the i-LIMB for 1 yr improved Southampton Hand Assessment Procedure function scores. However, the i-LIMB Pulse did not improve much over 5 mo of training, possibly because of the intense training in the month prior to the first i-LIMB Pulse tests. The i-LIMB Pulse hand generally showed higher scores on the tests and better grip strength and robustness than the i-LIMB. The i-LIMB Pulse has overcome the shortcomings of the i-LIMB hand. The preset grip patterns simplified the complex control of the multiarticulated i-LIMB hand, which contributed to patient satisfaction.

  17. Observation of limb movements reduces phantom limb pain in bilateral amputees

    Science.gov (United States)

    Tung, Monica L; Murphy, Ian C; Griffin, Sarah C; Alphonso, Aimee L; Hussey-Anderson, Lindsey; Hughes, Katie E; Weeks, Sharon R; Merritt, Victoria; Yetto, Joseph M; Pasquina, Paul F; Tsao, Jack W

    2014-01-01

    Background Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy. Objective Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP. Methods We randomly assigned 20 bilateral lower limb amputees with PLP to visual observation (n = 11) or mental visualization (n = 9) treatment. Treatment consisted of seven discrete movements which were mimicked by the amputee’s phantom limbs moving while visually observing the experimenter’s limbs moving, or closing the eyes while visualizing and attempting the movements with their phantom limbs, respectively. Participants performed movements for 20 min daily for 1 month. Response to therapy was measured using a 100-mm visual analog scale (VAS) and the McGill Short-Form Pain Questionnaire (SF-MPQ). Results Direct visual observation significantly reduced PLP in both legs (P < 0.05). Amputees assigned to the mental visualization condition did not show a significant reduction in PLP. Interpretation Direct visual observation therapy is an inexpensive and effective treatment for PLP that is accessible to bilateral lower limb amputees. PMID:25493277

  18. The effects of speed on the in vivo activity and length of a limb muscle during the locomotion of the iguanian lizard Dipsosaurus dorsalis.

    Science.gov (United States)

    Nelson, F E; Jayne, B C

    2001-10-01

    The caudofemoralis muscle is the largest muscle that inserts onto the hindlimb of most ectothermic tetrapods, and previous studies hypothesize that it causes several movements that characterize the locomotion of vertebrates with a sprawling limb posture. Predicting caudofemoralis function is complicated because the muscle spans multiple joints with movements that vary with speed. Furthermore, depending on when any muscle is active relative to its change in length, its function can change from actively generating mechanical work to absorbing externally applied forces. We used synchronized electromyography, sonomicrometry and three-dimensional kinematics to determine in vivo caudofemoralis function in the desert iguana Dipsosaurus dorsalis for a wide range of speeds of locomotion from a walk to nearly maximal sprinting (50-350 cm s(-1)). Strain of the caudofemoralis increased with increasing tail elevation and long-axis rotation and protraction of the femur. However, knee extension only increased caudofemoralis strain when the femur was protracted. The maximum and minimum length of the caudofemoralis muscle and its average shortening velocity increased from the slowest speed up to the walk-run transition, but changed little with further increases in speed. The times of muscle shortening and lengthening were often not equal at higher locomotor speeds. Some (20-25 ms) activity occurred during lengthening of the caudofemoralis muscle before footfall. However, most caudofemoralis activity was consistent with performing positive mechanical work to flex the knee shortly after foot contact and to retract and rotate the femur throughout the propulsive phase.

  19. Sensorimotor incongruence alters limb perception and movement.

    Science.gov (United States)

    Osumi, Michihiro; Nobusako, Satoshi; Zama, Takuro; Taniguchi, Megumi; Shimada, Sotaro; Morioka, Shu

    2017-09-21

    Altered limb ownership or heaviness has been observed in patients with hemiplegia, chronic pain, and several other conditions. Although these sensations are thought to be caused by sensorimotor incongruence, few studies have systematically verified this relationship. In addition, it remains unclear whether these subjective sensations affect movement execution. In a psychophysical experiment, we systematically investigated the relationships between sensorimotor integration and subjective limb perception, such as sense of ownership/heaviness, and verified the relationship between subjective limb perception and movement execution. Thirty-nine healthy participants were enrolled, and a visual feedback delay system was used to systematically evoke sensorimotor incongruence. Participants periodically flexed and extended their wrist while seeing a delayed image of their hand under five delay conditions (0, 150, 250, 350, 600ms). During wrist movement, electromyography (EMG) activity in flexor carpi radialis (FCR) was recorded. Also, to analyze the change in muscle activity and movement speed, the values of integral and peak frequency were calculated. To record changes in the subjective limb perception of the altered limb ownership and heaviness, we used a 7-point Likert scale for each participant. We found that altered ownership and heaviness increased with increasing feedback delay. Also, muscle activity and movement speed decreased with visual feedback delay. There was no significant correlation between subjective altered limb perception (i.e., altered limb ownership and heaviness) and muscle activity or movement speed. We systematically demonstrated that limb ownership, heaviness, muscle activation and movement speed were altered by sensorimotor incongruence. However, our study did not reveal the relationships between these factors. These results indicate the existence of different mechanisms governing subjective limb perception and movement execution. In the future, we

  20. Treatment effects of occipitomental anchorage appliance of maxillary protraction combined with chincup traction in children with Class III malocclusion.

    Science.gov (United States)

    Lin, Hsiang-Chien; Chang, Hong-Po; Chang, Hsin-Fu

    2007-05-01

    Little information related to the treatment effects of the occipitomental anchorage (OMA) appliance of maxillary (Mx) protraction combined with chincup traction is available. The aim of this study was to investigate the treatment effects of the OMA orthopedic appliance on patients with Class III malocclusion. Pretreatment and post-treatment cephalometric records of 20 consecutively treated patients with Class III malocclusions were evaluated and compared with a matched sample of untreated Class III control subjects. The OMA appliance is effective for correcting skeletal Class III malocclusion in growing children. The treatment effects of this orthopedic appliance were considered to be from both skeletal and dentoalveolar changes. The skeletal effects were mainly obtained by stimulating forward growth of the Mx complex with negligible rotation of the Mx plane and restraining forward advancement of the mandible (Mn) with backward and downward rotation of the Mn plane. The observed dentoalveolar effects were mostly due to the labial tipping movement of the Mx incisors. Our results suggest that the OMA orthopedic appliance can correct the mesial jaw relationship and negative incisal over jet. This appliance is effective for correcting skeletal Class III malocclusion with both midface deficiency and Mn prognathism in growing children.

  1. Are non-poor households always less vulnerable? The case of households exposed to protracted civil war in Southern Sudan.

    Science.gov (United States)

    Deng, Luka Biong

    2008-09-01

    Civil wars in Africa are now the leading contributory cause of vulnerability of rural communities. Understanding vulnerability during civil war is critical for humanitarian response and post-conflict rehabilitation planning. The lack of understanding of vulnerability has led existing studies to make sweeping generalizations, either by equating the dynamics of vulnerability during civil wars with vulnerability in other risk events, or by projecting people in the 'war zones' as unable to cope and subsequently becoming vulnerable. This paper is an attempt to gain a more nuanced understanding of the dynamics of vulnerability during protracted civil war. It shows that during civil war the non-poor are not necessarily less vulnerable than poor households. The idea that people caught up in civil war are all vulnerable is not supported by the findings of this paper. It shows that the 'standard' pattern of vulnerability to drought is similar to that during exogenous counter-insurgency warfare, while a different pattern of vulnerability to endogenous shocks is identified.

  2. Maxillary protraction in patients with cleft lip and palate in mixed dentition: cephalometric evaluation after completion of growth.

    Science.gov (United States)

    Susami, Takafumi; Okayasu, Mari; Inokuchi, Takato; Ohkubo, Kazumi; Uchino, Natsuko; Uwatoko, Kiwako; Takahashi-Ichikawa, Naoko; Nagahama, Kouhei; Takato, Tsuyoshi

    2014-09-01

    Objective : To clarify the short- and long-term effects of maxillary protraction (MP) in mixed dentition in patients with unilateral cleft lip and palate (UCLP). Design : Retrospective study. Setting : University of Tokyo Hospital. Patients and Intervention : Eleven Japanese patients with UCLP in mixed dentition were treated with MP and followed up until the completion of growth. Multibracket treatment had been performed after MP treatment in all patients. Main Outcome Measure : Lateral cephalograms taken before and after MP and after completion of growth were used. Posterior and anterior vertical reference lines (PV, AV) were used to measure the horizontal movements of point A, pogonion, and maxillary first molar (U6). SNA, SNB, ANB, maxillary and mandibular length, mandibular plane angle, Wits value, upper incisor inclination, overjet, and overbite were also measured. Results : Large variation was found in the effects of MP, and five patients eventually required orthognathic surgery. In average change with MP, the maxilla showed favorable forward growth. Point A had moved forward from PV but not AV. The mandible rotated backward. However, ANB and the Wits value did not improve. U6 moved forward, and the overjet improved. After MP, the skeletal Class III relationship became severe. Conclusions : MP was effective as an early treatment for UCLP patients. However, its effects showed large variation and were in conflict with facial growth. Conscientious explanation of the expected effects and associated problems should be given to the patients/parents before its application.

  3. Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Óscar Alfredo Juárez-León

    2015-01-01

    Full Text Available Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on 99Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of −4.2. A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS. After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term “Protracted HBS” in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

  4. Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review

    Science.gov (United States)

    Juárez-León, Óscar Alfredo; Gómez-Sámano, Miguel Ángel; Cuevas-Ramos, Daniel; Almeda-Valdés, Paloma; López-Flores A La Torre, Manuel Alejandro; Reza-Albarrán, Alfredo Adolfo; Gómez-Pérez, Francisco Javier

    2015-01-01

    Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on 99Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of −4.2). A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS). After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term “Protracted HBS” in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS. PMID:26640724

  5. The effects of protracted graphomotor tasks on tripod pinch strength and handwriting performance in children with dysgraphia.

    Science.gov (United States)

    Engel-Yeger, Batya; Rosenblum, Sara

    2010-01-01

    To examine the impact of prolonged graphomotor tasks on tripod-pinch strength and on handwriting process and product measures of children with dysgraphia and typical peers. Participants were 51 children in third to fifth grades, divided into two groups: 23 children with dysgraphia and 28 typical peers, as determined by the Handwriting Proficiency Screening Questionnaire. The procedure included two sessions, with a 15-min break between sessions. In each session, the participants performed two tasks: the visual-motor control subtest of Bruininks-Oseretsky and a handwriting copying task, both performed on an electronic tablet as part of the Computerised Penmanship Evaluation Tool. Tripod pinch strength was evaluated before and after each session. Significantly lower tripod-pinch strength was found among children with dysgrphia in comparison to typically developed peers. This deterioration in tripod-pinch strength was associated with a significant deterioration in handwriting process and product measures along the protracted task. Pinch force that is required for mastering the handwriting tool needs to be considered in the evaluation process of children with dysgraphia. Combining the pinch factor with an evaluation of handwriting's process and product may supply a better insight about the child's deficits and assist in focusing treatment objectives.

  6. Atypical Parathyroid Adenoma Complicated with Protracted Hungry Bone Syndrome after Surgery: A Case Report and Literature Review.

    Science.gov (United States)

    Juárez-León, Óscar Alfredo; Gómez-Sámano, Miguel Ángel; Cuevas-Ramos, Daniel; Almeda-Valdés, Paloma; López-Flores A La Torre, Manuel Alejandro; Reza-Albarrán, Alfredo Adolfo; Gómez-Pérez, Francisco Javier

    2015-01-01

    Hungry Bone Syndrome refers to the severe and prolonged hypocalcemia and hypophosphatemia, following parathyroidectomy in patients with hyperparathyroidism. We present the case of an eighteen-year-old woman with a four-year history of hyporexia, polydipsia, weight loss, growth retardation, and poor academic performance. The diagnostic work-up demonstrated primary hyperparathyroidism with hypercalcemia of 13.36 mg/dL, a PTH level of 2551 pg/mL, bone brown tumors, and microcalcifications within pancreas and kidneys. Neck ultrasonography revealed a parathyroid adenoma of 33 × 14 × 14 mm, also identified on (99)Tc-sestamibi scan. Bone densitometry showed decreased Z-Score values (total lumbar Z-Score of -4.2). A right hemithyroidectomy and right lower parathyroidectomy were performed. Pathological examination showed an atypical parathyroid adenoma, of 3.8 g of weight and 2.8 cm in diameter. After surgery she developed hypocalcemia with tetany and QTc interval prolongation. The patient required 3 months of oral and intravenous calcium supplementation due to Hungry Bone Syndrome (HBS). After 42 months, she is still under oral calcium. Usually HBS lasts less than 12 months. Therefore we propose the term "Protracted HBS" in patients with particularly long recovery of 1 year. We present a literature review of the diagnosis, pathophysiology, and treatment of HBS.

  7. Customizable Rehabilitation Lower Limb Exoskeleton System

    Directory of Open Access Journals (Sweden)

    Riaan Stopforth

    2012-10-01

    Full Text Available Disabled people require assistance with the motion of their lower limbs to improve rehabilitation. Exoskeletons used for lower limb rehabilitation are highly priced and are not affordable to the lowerincome sector of the population. This paper describes an exoskeleton lower limb system that was designed keeping in mind that the cost must be as low as possible. The forward kinematic system that is used must be a simplified model to decrease computational time, yet allow the exoskeleton to be adjustable according to the patient's leg dimensions.

  8. Muscle Selection for Focal Limb Dystonia

    Directory of Open Access Journals (Sweden)

    Barbara Illowsky Karp

    2017-12-01

    Full Text Available Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.

  9. Muscle Selection for Focal Limb Dystonia.

    Science.gov (United States)

    Karp, Barbara Illowsky; Alter, Katharine

    2017-12-29

    Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia.

  10. Comparison of the effects of maxillary protraction using facemask and miniplate anchorage between unilateral and bilateral cleft lip and palate patients.

    Science.gov (United States)

    Ahn, Hyo-Won; Kim, Keun-Woo; Yang, Il-Hyung; Choi, Jin-Young; Baek, Seung-Hak

    2012-09-01

    To determine the difference in the effects of facemask with miniplate (FM-MP) anchorage on maxillary protraction in growing cleft patients between unilateral (UCLP) and bilateral cleft lip and palate (BCLP) groups. The samples consisted of a UCLP group (N  =  15, 13 boys and 2 girls; mean age 10.98 years; mean protraction duration 2.37 years) and a BCLP group (N  =  15, all boys; mean age 11.42 years; mean protraction duration 2.36 years), who were treated with the same surgical technique (rotation and advancement flap and double opposing Z-plasty) by one surgeon and with FM-MP by one orthodontist. Lateral cephalograms were taken before (T1) and after FM-MP (T2). Fourteen skeletal and dental variables were measured. Independent and paired t-tests were performed for statistical analysis. There were no differences in mean age and values of variables at the T1 stage and in the duration of protraction between the two groups. The BCLP group showed less advancement of point A than the UCLP group (ΔA-vertical reference plane, 2.51 mm vs 4.06 mm, P palatal plane in two groups was minimal (-0.36° vs -0.87°), no difference was observed with regard to clockwise rotation of the mandible (0.46° vs -0.07°). There were no differences in the degree of labioversion of the maxillary incisor (8.16° vs 7.10°), linguoversion of the mandibular incisor (-2.66° vs -2.14°), and increase in overjet (5.39 mm vs 5.70 mm) between the two groups. In FM-MP therapy of growing cleft patients under the conditions of this study, the UCLP group shows a more favorable change in maxillary advancement than the BCLP group.

  11. Protracted Administration of L-Asparaginase in Maintenance Phase Is the Risk Factor for Hyperglycemia in Older Patients with Pediatric Acute Lymphoblastic Leukemia.

    Directory of Open Access Journals (Sweden)

    Hideki Yoshida

    Full Text Available Although L-asparaginase related hyperglycemia is well known adverse event, it is not studied whether the profile of this adverse event is affected by intensification of L-asparaginase administration. Here, we analyzed the profile of L-asparaginase related hyperglycemia in a 1,176 patients with pediatric acute lymphoblastic leukemia treated according to the Japan Association of Childhood Leukemia Study ALL-02 protocol using protracted L-asparaginase administration in maintenance phase. We determined that a total of 75 L-asparaginase related hyperglycemia events occurred in 69 patients. Although 17 events (17/1176, 1.4% developed in induction phase, which was lower incidence than those (10-15% in previous reports, 45 events developed during the maintenance phase with protracted L-asparaginase administration. Multivariate analysis showed that older age at onset (≥ 10 years was a sole independent risk factor for L-asparaginase-related hyperglycemia (P<0.01, especially in maintenance phase. Contrary to the previous reports, obesity was not associated with L-asparaginase-related hyperglycemia. These findings suggest that protracted administration of L-asparaginase is the risk factor for hyperglycemia when treating adolescent and young adult acute lymphoblastic leukemia patients.

  12. Protracted Administration of L-Asparaginase in Maintenance Phase Is the Risk Factor for Hyperglycemia in Older Patients with Pediatric Acute Lymphoblastic Leukemia

    Science.gov (United States)

    Yoshida, Hideki; Imamura, Toshihiko; Saito, Akiko M.; Takahashi, Yoshihiro; Suenobu, So-ichi; Hasegawa, Daiichiro; Deguchi, Takao; Hashii, Yoshiko; Kawasaki, Hirohide; Endo, Mikiya; Hori, Hiroki; Suzuki, Nobuhiro; Kosaka, Yoshiyuki; Kato, Koji; Yumura-Yagi, Keiko; Hara, Junichi; Oda, Megumi; Sato, Atsushi; Horibe, Keizo

    2015-01-01

    Although L-asparaginase related hyperglycemia is well known adverse event, it is not studied whether the profile of this adverse event is affected by intensification of L-asparaginase administration. Here, we analyzed the profile of L-asparaginase related hyperglycemia in a 1,176 patients with pediatric acute lymphoblastic leukemia treated according to the Japan Association of Childhood Leukemia Study ALL-02 protocol using protracted L-asparaginase administration in maintenance phase. We determined that a total of 75 L-asparaginase related hyperglycemia events occurred in 69 patients. Although 17 events (17/1176, 1.4%) developed in induction phase, which was lower incidence than those (10–15%) in previous reports, 45 events developed during the maintenance phase with protracted L-asparaginase administration. Multivariate analysis showed that older age at onset (≥10 years) was a sole independent risk factor for L-asparaginase-related hyperglycemia (Phyperglycemia. These findings suggest that protracted administration of L-asparaginase is the risk factor for hyperglycemia when treating adolescent and young adult acute lymphoblastic leukemia patients. PMID:26317422

  13. [The clinical study of protraction face mask combining with MEAW technique to correct skeletal Class III malocclusion in the early permanent tooth].

    Science.gov (United States)

    Yan, Hong-Hai; Zhang, Guo-Xing; Zhang, Zhi-Ming

    2008-06-01

    To investigate the clinical effects of combined multiloop Edgewise arch wire(MEAW) with protraction facemask to treat Class III malocclusion in early permanent dentition, and compare the changes of the periodental tissue and teeth between pre- and post- treatment to explore the mechenism of the method applied to correct Class III malocclusion. 23 cases with Class III malocclusion were selected, including 11 males and 12 females, aged from 12 to 14 years old. MEAW and protraction facemask were used to treat Class III malocclusion in early permanent dentition. Lateral cephalometric films were taken for comparison in three stages:before the treatment(T1), seven months (T2) after treatment and in the end of the treatment(T3).SPSS10.0 software package was used for statistical analysis. The alveolar bone changes mainly happaned in the T2 stage, SNA increased by 2.37 degrees in average, OP-MP increased by 4.85 degrees in average; Wits increased by 2. 50 degrees in average. The difference was significant(P<0.05). However there was no significant difference between T2 and T3 stage. In the T2 stage,the overjet and overbite increased 4.43mm and 2.66mm in average, and increase continued after treatment. It is suggested that MEAW with protraction facemask is an effective technique to treat Class III malocclusion in early permanent dentition by improving maxillary growth.

  14. Molecular and evolutionary basis of limb field specification and limb initiation.

    Science.gov (United States)

    Tanaka, Mikiko

    2013-01-01

    Specification of limb field and initiation of limb development involve multiple steps, each of which is tightly regulated both spatially and temporally. Recent developmental analyses on various vertebrates have provided insights into the molecular mechanisms that specify limb field and have revealed several genetic interactions of signals involved in limb initiation processes. Furthermore, new approaches to the study of the developmental mechanisms of the lateral plate mesoderm of amphioxus and lamprey embryos have given us clues to understand the evolutionary scenarios that led to the acquisition of paired appendages during evolution. This review highlights such recent findings and discusses the mechanisms of limb field specification and limb bud initiation during development and evolution. © 2012 The Authors Development, Growth & Differentiation © 2012 Japanese Society of Developmental Biologists.

  15. Estudo cefalométrico prospectivo dos efeitos da terapia de tração reversa da maxila associada à mecânica intermaxilar Prospective cephalometric study of the effects of maxillary protraction therapy associated with intermaxillary mechanics

    Directory of Open Access Journals (Sweden)

    Juliana de Oliveira da Luz Fontes

    2011-12-01

    Full Text Available OBJETIVO: o diagnóstico e o tratamento precoce do Padrão III são temas ainda muito discutidos na literatura ortodôntica. A tração reversa associada à expansão rápida da maxila constitui a abordagem mais popular e estudada, produzindo os melhores resultados no menor período de tempo. O foco deste estudo foi avaliar as mudanças gradativas ocorridas no complexo dentofacial em crianças com Padrão III de crescimento tratadas com tração reversa da maxila associada à mecânica intermaxilar. MÉTODOS: a amostra foi constituída por 10 pacientes Padrão III, com média de idade de 8 anos e 2 meses ao início do tratamento, tratados consecutivamente com aparelho expansor de Haas modificado, arco lingual modificado, elásticos intermaxilares e máscara de Petit para tração reversa da maxila por 9 meses. Foram realizadas 4 telerradiografias em norma lateral de cada paciente, uma correspondente ao início do tratamento e as demais em intervalos regulares de 3 meses (T1, T2, T3 e T4. As grandezas cefalométricas foram comparadas entre os tempos através de Análise de Variância de Medidas Repetidas, complementada pelo Teste de Comparações Múltiplas de Tukey. RESULTADOS: pôde-se observar que as alterações esqueléticas mais significativas ocorreram nos primeiros 3 meses de tratamento, sendo que, após esse período, elas se mantiveram constantes até o final do tratamento. Ocorreram poucas compensações dentárias e as alterações verticais ocorridas apresentaram significado clínico reduzido. CONCLUSÃO: a terapia empregada obteve não só uma correção do trespasse horizontal entre as arcadas, mas também uma melhora no relacionamento sagital entre as bases ósseas e na estética tegumentar.OBJECTIVE: The early diagnosis and treatment of skeletal Class III (Pattern III is still a much debated topic in orthodontic literature. Maxillary protraction associated with rapid maxillary expansion is the most popular and widely researched

  16. The Mouse Limb Anatomy Atlas: An interactive 3D tool for studying embryonic limb patterning

    OpenAIRE

    DeLaurier April; Burton Nicholas; Bennett Michael; Baldock Richard; Davidson Duncan; Mohun Timothy J; Logan Malcolm PO

    2008-01-01

    Abstract Background The developing mouse limb is widely used as a model system for studying tissue patterning. Despite this, few references are available that can be used for the correct identification of developing limb structures, such as muscles and tendons. Existing textual references consist of two-dimensional (2D) illustrations of the adult rat or mouse limb that can be difficult to apply when attempting to describe the complex three-dimensional (3D) relationship between tissues. Result...

  17. Ways Children Adjust to Limb Loss

    Science.gov (United States)

    ... children learn these skills so well. About younger children Parents, do not be surprised if your young child ... Kellye Campbell, RN, ARNP published in the magazine, Expectations: Parenting Children and Teens With Limb Differences Atlas of Amputations ...

  18. Upper limb injuries associated with rock climbing.

    OpenAIRE

    Bannister, P; Foster, P

    1986-01-01

    Four cases of upper limb injuries secondary to rock-climbing or training for rock climbing are presented. All four cases had diagnosis and treatment delayed because of unawareness of the range of injuries seen in high grade rock climbing.

  19. Fingernails Yield Clues to Limb Regeneration

    Science.gov (United States)

    ... Spotlight on Research Fingernails Yield Clues to Limb Regeneration By Kirstie Saltsman, Ph.D. | January 5, 2014 ... Diseases has uncovered chemical signals that drive the regeneration of lost digit tips in mice. The findings, ...

  20. Rapid Prototyping

    Science.gov (United States)

    1999-01-01

    Javelin, a Lone Peak Engineering Inc. Company has introduced the SteamRoller(TM) System as a commercial product. The system was designed by Javelin during a Phase II NASA funded small commercial product. The purpose of the invention was to allow automated-feed of flexible ceramic tapes to the Laminated Object Manufacturing rapid prototyping equipment. The ceramic material that Javelin was working with during the Phase II project is silicon nitride. This engineered ceramic material is of interest for space-based component.

  1. Acupuncture treatment of phantom limb pain and phantom limb sensation in a primary care setting.

    Science.gov (United States)

    Davies, Arwel

    2013-03-01

    A 45-year-old man presented with phantom limb pain and phantom limb sensation 12 weeks after an above-elbow amputation of his right arm. He underwent seven sessions of acupuncture at weekly intervals carried out by his general practitioner on his intact left arm, with complete relief of the phantom limb pain and considerable improvement of the phantom limb sensation of his right arm. This case demonstrates the possible benefits from the use of short acupuncture sessions for a potentially chronic condition undertaken within the constraints of a busy general medical practice.

  2. Mirror Therapy for Phantom Limb Pain

    OpenAIRE

    Kim, Sae Young; Kim, Yun Young

    2012-01-01

    Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain.

  3. Muscle Selection for Focal Limb Dystonia

    OpenAIRE

    Barbara Illowsky Karp; Katharine Alter

    2017-01-01

    Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this artic...

  4. Van Nes rotationplasty with segmental limb resection.

    Science.gov (United States)

    Krajbich, J I; Carroll, N C

    1990-07-01

    Segmental limb resection is becoming a practical alternative to limb ablation in tumor surgery. The addition of Van Nes rotationplasty to provide a pseudo knee joint has been found to be a practical, functional addition facilitating prosthesis use. This procedure has now been used successfully in 21 children with malignant neoplasms, with few complications. The surgical technique, as outlined, produces significantly improved functional results over an above-knee amputation or hip disarticulation.

  5. 21 CFR 890.3420 - External limb prosthetic component.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb prosthetic component. 890.3420... External limb prosthetic component. (a) Identification. An external limb prosthetic component is a device... total prosthesis. Examples of external limb prosthetic components include the following: Ankle, foot...

  6. Isolated primary lymphedema tarda of the upper limb.

    Science.gov (United States)

    Shariati, Farzaneh; Ravari, Hasan; Kazemzadeh, Gholamhossein; Sadeghi, Ramin

    2013-03-01

    Primary lymphedema tarda is considered as a congenital disease with late presentation. Primary lymphedema tarda usually affects lower limbs, and primary lymphedema tarda of the upper limbs usually accompanies lower limb lymphedema. In the current case report, we present an 80-year-old male patient with isolated left upper limb swelling that lymphoscintigraphy imaging proved to be lymphedema.

  7. LOWER LIMB ASYMMETRIES IN RHYTHMIC GYMNASTICS ATHLETES.

    Science.gov (United States)

    Frutuoso, Anderson Simas; Diefenthaeler, Fernando; Vaz, Marco Aurélio; Freitas, Cintia de la Rocha

    2016-02-01

    Different limb training demands and limb preference may determine anthropometric and muscle force inter-limb asymmetries in Rhythmic Gymnastics (RG) athletes. The purpose of this study was to evaluate the influence of lateral preference of the lower extremity on anthropometric, range of motion, and isokinetic torque measurements of RG athletes. Cross sectional study. Lower limb anthropometric measurements (girth, estimated anatomical cross-sectional area), hip, knee and ankle range of motion, flexor and extensor isokinetic torques (angular velocities = 60, 180, e 240 °·s(-1)) and bilateral asymmetry index were evaluated in 11 international level Rhythmic Gymnastics athletes (17.9 ± 4.0 years of age; 9.1 ± 5,1 years of experience; 26.8 ± 6.0 weekly training hours). The preferred limb showed larger thigh girth and anatomical cross-sectional area, higher ankle dorsiflexor range of motion, higher hip flexor torque at 60 °·s(-1) and higher plantarflexor torque at 180 °·s(-1) compared to the non-preferred limb. The observed differences seem to be strictly related to lateral preference and rhythmic gymnastics training. 3.

  8. LIMB SALVAGE IN DIABETIC FOOT INFECTION

    Directory of Open Access Journals (Sweden)

    J. Ramanaiah

    2017-02-01

    Full Text Available BACKGROUND Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. Limb salvage procedures may prevent eventual limb loss, the need of a major limb amputation, decrease total cost and may restore full ambulation earlier. MATERIALS AND METHODS Seventy five septic diabetic feet were treated with NPWT between 2014 and 2016. Debridement with or without partial foot amputation was followed. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle. RESULTS In this series, 33 cases were managed initially by debridement and slough excision, 11 patients underwent incision and drainage for abscess and three patients underwent fasciotomy. Seven cases who presented with gangrene of toes were treated with ray amputation. Below-knee amputation was done in 21 cases. In most of the cases, limb salvage was possible. CONCLUSION A comprehensive treatment approach incorporating surgical and nonsurgical therapies are required to avoid major limb amputations in severe diabetic foot infections.

  9. LIMB Demonstration Project Extension and Coolside Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Goots, T.R.; DePero, M.J.; Nolan, P.S.

    1992-11-10

    This report presents results from the limestone Injection Multistage Burner (LIMB) Demonstration Project Extension. LIMB is a furnace sorbent injection technology designed for the reduction of sulfur dioxide (SO[sub 2]) and nitrogen oxides (NO[sub x]) emissions from coal-fired utility boilers. The testing was conducted on the 105 Mwe, coal-fired, Unit 4 boiler at Ohio Edison's Edgewater Station in Lorain, Ohio. In addition to the LIMB Extension activities, the overall project included demonstration of the Coolside process for S0[sub 2] removal for which a separate report has been issued. The primary purpose of the DOE LIMB Extension testing, was to demonstrate the generic applicability of LIMB technology. The program sought to characterize the S0[sub 2] emissions that result when various calcium-based sorbents are injected into the furnace, while burning coals having sulfur content ranging from 1.6 to 3.8 weight percent. The four sorbents used included calcitic limestone, dolomitic hydrated lime, calcitic hydrated lime, and calcitic hydrated lime with a small amount of added calcium lignosulfonate. The results include those obtained for the various coal/sorbent combinations and the effects of the LIMB process on boiler and plant operations.

  10. Poststroke hypertonicity: upper limb assessment and treatment.

    Science.gov (United States)

    Marciniak, Christina

    2011-01-01

    Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.

  11. Limb apraxia in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Rapaić Dragan

    2014-01-01

    Full Text Available Background/Aim. There are almost no studies on apraxia in people with multiple sclerosis. Although the white matter is damaged in MS, it is not the only location in which the pathological changes are present. Demyelinated lesions in the cortex have recently been recognized as important components of multiple sclerosis pathology. The aim of this study was to determine whether apraxia is present among people with MS, and the importance of demographic characteristics and impairment of functional systems at conceptualization and execution of movements. Methods. The experimental group consisted of 30 patients, mean age 51.34 ± 7.70 years. The patients in the experimental group were diagnosed with MS according to the McDonald criteria. The control group consisted of 30 healthy subjects, mean age 50.30 ± 10.47 years. For research purposes, we used the following instruments: Questionnaire for Collecting Demographic Data, Kurtzke Functional Systems Scores, Waterloo-Sunnybrook Apraxia Battery (WatAB. Execution of motion tasks that are a part of the Watwere incorporated in the System for the Observation and Analysis of Motor Behavior. Results. Our study showed that limb apraxia was common in people with MS. Apraxia was present during pantomime in 26.70% of the patients, and during the imitation of movements in 44.80% of the patients. Gender, age, education level, duration of disease and a form of MS did not determine the quality of conceptualization and execution of movements. The time elapsed from the last exacerbation was a determinant of quality of executed movements. Impairments of functional systems predicted impairments of movement execution. The expanded disability scale score correlated with the severity of apraxia. Conclusion. Our study confirm the presence of apraxia in MS. It is necessary to carry out further studies using functional magnetic resonance imaging, as well as the conduct longitudinal studies to determine the precise structure of

  12. Regenerative Engineering and Bionic Limbs.

    Science.gov (United States)

    James, Roshan; Laurencin, Cato T

    2015-03-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been made in technological, material and in prosthesis integration where researchers are now exploring artificial prosthesis that integrate with the residual tissues and function based on signal impulses received from the residual nerves. Efforts are focused on challenging experts in different disciplines to integrate ideas and technologies to allow for the regeneration of injured tissues, recording on tissue signals and feed-back to facilitate responsive movements and gradations of muscle force. A fully functional replacement and regenerative or integrated prosthesis will rely on interface of biological process with robotic systems to allow individual control of movement such as at the elbow, forearm, digits and thumb in the upper extremity. Regenerative engineering focused on the regeneration of complex tissue and organ systems will be realized by the cross-fertilization of advances over the past thirty years in the fields of tissue engineering, nanotechnology, stem cell science, and developmental biology. The convergence of toolboxes crated within each discipline will allow interdisciplinary teams from engineering, science, and medicine to realize new strategies, mergers of disparate technologies, such as biophysics, smart bionics, and the healing power of the mind. Tackling the clinical challenges, interfacing the biological process with bionic technologies, engineering biological control of the electronic systems, and feed-back will be the important goals in regenerative engineering over the next

  13. Lower Triassic stromatolites in Luodian County, Guizhou Province, South China: evidence for the protracted devastation of the marine environments.

    Science.gov (United States)

    Ezaki, Y; Liu, J B; Adachi, N

    2012-01-01

    Stromatolites are one of the oldest and most intriguing organosedimentary deposits. In contrast to stromatolites of the Precambrian to Early Ordovician, Phanerozoic equivalents occurred episodically under specific conditions. A group of previously undescribed stromatolites in composition occur in the Lower Triassic (Olenekian) at the Dajiang section in the Luodian region of Guizhou Province, South China. We described the textures of these stromatolites with the aim of determining the genetic mechanisms and revealing the nature of interactions between micro-organisms and marine environments. Mesoscopic features show that the stromatolites consist of several sets of stacked slices, and that they are embedded in alternating beds of fine and coarse microsphere packstones that include aggregates of microspheres, forming grapestones and lumps. Microscopically, the stromatolites consist of spar- and dolomite-infilled microspheres (average diameter, 100 μm), micrites, peloids, small-sized pyrite framboids (average diameter, 5.8 μm) and fenestrae. Micrite-dominant intercalations accentuate laminated textures at a mesoscopic level and are laterally continuous with micrite-rich parts in surrounding interstromatolites, indicating the simultaneous, widespread deposition of these layers. The microspheres and associated micrites were the products of in situ microbial activity, probably sulphate-reducing or anoxygenic phototrophic bacteria, which led to the formation of these unusual stromatolites. Even during a protracted period of harsh marine conditions, the micrite-rich carpets were deposited intermittently on the stromatolites and their surroundings under severely anoxic/sulphidic conditions. The presence of Early Triassic stromatolites and their subtle but important vertical variations in texture provide a record of temporal changes in marine conditions during geobiologically critical intervals. © 2011 Blackwell Publishing Ltd.

  14. Primary Cytomegalovirus Infection in Seronegative Kidney Transplant Patients Is Associated with Protracted Cold Ischemic Time of Seropositive Donor Organs.

    Science.gov (United States)

    Schlott, Fabian; Steubl, Dominik; Hoffmann, Dieter; Matevossian, Edouard; Lutz, Jens; Heemann, Uwe; Hösel, Volker; Busch, Dirk H; Renders, Lutz; Neuenhahn, Michael

    2017-01-01

    Human Cytomegalovirus (CMV) can lead to primary infection or reactivation in CMV-seronegative or -seropositive kidney transplant recipients, respectively. Complications comprise severe end-organ diseases and acute or chronic transplant rejection. Risk for CMV manifestation is stratified according to the CMV-IgG-serostatus, with donor+/recipient- (D+/R-) patients carrying the highest risk for CMV-replication. However, risk factors predisposing for primary infection in CMV-seronegative recipients are still not fully elucidated. Therefore, we monitored D+/R- high-risk patients undergoing kidney transplantation in combination with antiviral prophylaxis for the incidence of CMV-viremia for a median follow-up time of 784 days (156-1155 days). In this period, we analyzed the functional CMV-specific T cell response by intracellular cytokine staining and CMV-serology by ELISA. Only four of eight D+/R- patients developed clinically relevant CMV-viremia followed by seroconversion. Viremia triggered expansion of functional CMV-specific T cells correlating with protection against secondary CMV-reactivations. In contrast, all other patients remained permanently aviremic and showed no immunological correlate of infection after discontinuation of antiviral prophylaxis for up to three years. Comparing cold ischemic times (CIT) of viremic (median = 1020 min; 720-1080 min) and aviremic patients (median = 335 min; 120-660 min) revealed significantly (p = 0.0286) protracted CIT in patients with primary CMV-infection. Taken together, primary CMV-infection affects only a subgroup of D+/R- patients correlating with length of CIT. Therefore, patients with extended CIT should be thoroughly monitored for CMV-replication well beyond discontinuation of antiviral prophylaxis. In contrast, patients with short CIT remained permanently uninfected and might benefit from shorter prophylactic treatment.

  15. Vulnerability of Rosickyite as a Potential Martian Biosignature Due to Microbially Mediated Response to Protracted Environmental Stress

    Science.gov (United States)

    Archer, R.

    2016-12-01

    Abstract: The discovery of the presence of a potential microbially mediated biosignature (rosickyite) from Bad Water Basin, California, by Douglas and Yang [1] invited the proposal that rosickyite may be stable over geological timescales and if found on Mars, indicate past life. Isotopic δ13C and δ15N profiles, and pH pore water analysis from the same 2002 microbial mat as Douglas and Yang (ibid) indicated bulk primary production consistent with nitrogen fixation in the upper canopy driving downcore biogeochemistry. We resampled this same location thirteen (13) years later to test the hypothesis of rosickyite as a robust biosignature over the decadal scale [2] detectable by bulk powder XRD and to again examine both the δ13C and δ15N stable isotope profile and pore water pH. In contrast to findings of 2002, XRD results from 2015 failed to find evidence of rosickyite bulk powder XRD signals. Likewise, 2015 δ13C and δ15N stable isotope results, together with pH and together with new δ34S results indicated a shift in metabolic regimes towards net denitrification and, we hypothesized, net dissolution of previously present rosickyte associated with carbon burial. Mass mortality was ruled out after determining a total community viability >90%. Implications for these results are two-fold. The first implication is that terrestrial Mars analogues are dynamic systems warranting continuous sampling over changing stressors such as periods of protracted drought [3] and, were ancient microbial communities present on Mars, such assemblages of microbes and minerals would likely have been tightly coupled and conditionally vulnerable to similar diagenesis and false negative results. References: [1] Douglas, S. et al. (2002) Geol., 30, 1151-1154. [2] Archer R. et al. AGU EOS Proc.(2002) [3] Aiger, E. et. al., Circle of Blue, 11, (2014), 1344- 1345.

  16. Short course of glucocorticoids in patients with protracted and chronic gout arthritis. Part I: predictors of therapy efficacy

    Directory of Open Access Journals (Sweden)

    A A Fedorova

    2008-01-01

    Full Text Available Objective. To reveal short course of glucocorticoid (GC therapy efficacy predictors in pts with gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration - 15,2 years [7,4;20], median swollen joint count at the examination — 8 [5; 11]. The patients were randomized into 2 groups. Methylprednisolone was administered in one of them, betamethasone — in the other. Results, four variants of treatment response were described: full resolution of arthritis — 24 (41%, recurrent exacerbation — 28 (48%, insufficient arthritis resolution — 2 (3% and clinically insignificant (unresponders — 5 (8% pts. Pts in group with arthritis recurrence at the entry were significantly younger than pts with resolved arthritis (52 [47;60] and 59 [52;68] respectively, U-test p=0,02, had more inflamed joints (9 [7,5; 11 ] and 5 [4;9[ respectively, U-test p=0,02, longer duration of last exacerbation (52 [8;52[ and 13 [7,5;52J respectively, U-test p>0,05, higher values of pain, joint index and swelling index (U-test p<0,04. Pts with insufficient arthritis resolution and unresponders had most severe gout course. Conclusion. The study allowed to reveal features which determine efficacy of short course of GC therapy in pts with protracted and chronic gout arthritis: inflamed joint count, duration of the last exacerbation and chronic renal insufficiency. Proposed an algorithm allowing to predict efficacy of GC short course in each pt.

  17. A doppler study of blood flow change of lower limb arteries after transfemoral angiography

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    Kim, Jong Chul; Park, Chan Sup; Yeon, Kyung Mo; Yun, Yong Soo [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1987-10-15

    Perspective evaluation of lower limb arterial blood flow velocity and vascular complications of percutaneous transfemoral arterial catheterization was carried out in 26 children at S. N. U. H. Children's Hospital from Dec. 1985 to May 1986. Common femoral and popliteal arterial velocity signals of both limbs were monitored and compared by doppler duplex sonography (Diasonics DRF-400) immediately after angiography and at 24-48 hours later. In most cases, the average velocity of proximal femoral artery and popliteal artery of puncture site was slower than that of the other limb vessels. In complication group of thromboembolism (19%), the catheterization time was longer, the catheter size was larger, the velocity discrepancy of both limb arteries was larger, the doppler velocity profile was more irregular, and the diurnal change of arterial velocity discrepancy was slower than in normal control group. It is recommended that the catheterization time is less than 30 minutes and the catheter diameter is less than two-fifths of the femoral arterial diameter. Systemic heparinization within 24 hours is required if the catheterization time is longer of blood flow disturbance is detected on doppler examination. The doppler duplex sonography is a simple, rapid, and noninvasive technique for assessing lower limb hemodynamics, especially in patients undergoing transfemoral arterial catherization.

  18. The functional anatomy of suggested limb paralysis.

    Science.gov (United States)

    Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W

    2013-02-01

    Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Structured movement representations of a phantom limb associated with phantom limb pain.

    Science.gov (United States)

    Osumi, Michihiro; Sumitani, Masahiko; Wake, Naoki; Sano, Yuko; Ichinose, Akimichi; Kumagaya, Shin-Ichiro; Kuniyoshi, Yasuo; Morioka, Shu

    2015-09-25

    The relation between phantom limb pain (PLP) and the movement representation of a phantom limb remains controversial in several areas of neurorehabilitation, although there are a few studies in which the representation of phantom limb movement was precisely evaluated. We evaluated the structured movement representation of a phantom limb objectively using a bimanual circle-line coordination task. We then investigated the relation between PLP and the structured movement representation. Nine patients with a brachial plexus avulsion injury were enrolled who perceived a phantom limb and had neuropathic pain. While blindfolded, the participants repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb simultaneously. "Drawing of circles" by the phantom limb resulted in an oval transfiguration of the vertical lines ("bimanual coupling" effect). We used an arbitrary ovalization index (OI) to quantify the oval transfiguration. When the OI neared 100%, the trajectory changed toward becoming more circular. A significant negative correlation was observed between the intensity of PLP and the OI (r=-0.66, pphantom limb are necessary for alleviating PLP. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Reorganization of gait after limb-saving surgery of the lower limb.

    NARCIS (Netherlands)

    Visser, E. de; Veth, R.P.H.; Schreuder, H.W.B.; Duysens, J.E.J.; Mulder, T.W.

    2003-01-01

    OBJECTIVE: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients. DESIGN: All patients were recovering from some form of treatment to tumors of the lower limbs.

  1. Reorganization of gait after limb-saving surgery of the lower limb

    NARCIS (Netherlands)

    de Visser, E; Veth, RPH; Schreuder, HWB; Duysens, J; Mulder, T

    2003-01-01

    Objective: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients. Design: All patients were recovering from some form of treatment to tumors of the lower limbs.

  2. The role of limb perfusion studies in the paediatric ischaemic limb ...

    African Journals Online (AJOL)

    The causes of limb ischaemia were meningococcal septicaemia (n=9), septic shock (n=6), hypovolaemic shock due to gastroenteritis (n=4), and electrical burns (n=1). The clinical, scan and surgical findings correlated in 40/48 imaged limbs. In one leg the findings did not correlate, but the perfusion scan results predicted the ...

  3. Moving a generalised limb : a simulation with consequences for theories on limb control

    NARCIS (Netherlands)

    Otten, E

    The movement control of articulated limbs in vertebrates has been explained in terms of equilibrium points and moving equilibrium points or virtual trajectories. These hypotheses state that the nervous system makes the control Of multi-segment limbs easier by simply planning in terms of these

  4. Reacting while moving: influence of right limb movement on left limb reaction.

    Science.gov (United States)

    Kennedy, Deanna M; Wang, Chaoyi; Shea, Charles H

    2013-09-01

    An experiment was designed to determine whether the activation of a muscle group (flexors or extensors) used to produce an ongoing movement of one limb influenced the reaction time and associated initiation of elbow flexion or extension movements of the contralateral limb. Right-handed participants in the bimanual groups were asked to produce a pattern of flexion/extension movements defined by a sine wave (period = 2 s, amplitude = 16°) with the right limb. While performing the right limb movement, participants were instructed that they were to react as quickly as possible by making a flexion or extension movement with their left limb when the cursor they were using to track the sine wave changed color. Participants in the unimanual groups performed the left limb reaction time task but were not asked to make right limb movements. The reaction time stimulus occurred once in each trial and was presented at one of six locations on one of the six cycles comprising the sinusoidal waveform. Participants performed 7 blocks of 6 test trials. Reaction time was calculated as the time interval between the color change of the cursor and the initiation of the response with the left limb. Movement time was calculated as the interval of time between the initiation of the response and the left limb cursor crossing the upper or lower boundary line. Mean reaction of the left limb was significantly influenced by the concurrent type of movement (flexion/extension) of the right limb. Reaction times were shorter on trials in which both limbs were initiating movement with homologous muscles as compared to trials in which the limbs were initiating movement with non-homologous muscles. No differences were detected when the stimuli were presented during the ballistic phase of the right limb movement, and no differences at any position were detected for the unimanual groups. This result is consistent with the notion that neural crosstalk can influence the time required to react to a

  5. Effect of lower limb rehabilitation robot on lower limb motor function of hemiplegic patients after stroke

    Directory of Open Access Journals (Sweden)

    Jian-liang LU

    2017-07-01

    Full Text Available Objective To observe the rehabilitation effect of lower limb rehabilitation robot training on the lower limb motor function of hemiplegic patients after stroke. Methods A total of 60 stroke patients (duration < 6 months accepted conventional rehabilitation training combined with body weight support treadmill training (BWSTT group, N = 30 or conventional rehabilitation training combined with lower limb rehabilitation robot training (Robot group, N = 30. Fugl - Meyer Assessment Scale for Lower Extremity (FMA-LE was used to evaluate lower limb motor function. Berg Balance Scale (BBS was used to evaluate balance function. Lower limb rehabilitation robot torque feedback system was used to evaluate lower limb muscle strength. All evaluations were performed before and after 8-week training.   Results Compared with before training, the FMA-LE score (P = 0.000, BBS score (P = 0.000, hemiplegic side of hip joint feedback torque value (HJTV, P = 0.000 and knee joint feedback torque value (KJTV, P = 0.000 were increased in both groups after 8-week training. Compared with BWSTT group, the hemiplegic side of HJTV (P = 0.000 and KJTV (P = 0.000 were increased in Robot group after 8-week training, while the FMA-LE score (P = 0.118 and BBS score (P = 0.159 had no statistically significant difference between 2 groups.  Conclusions The lower limb rehabilitation robot or body weight support treadmill training combined with conventional rehabilitation training could improve the lower limb motor function of hemiplegic patients after stroke. The lower limb rehabilitation robot training was better than body weight support treadmill training on the recovery of lower limb muscle strength. DOI: 10.3969/j.issn.1672-6731.2017.05.004  

  6. Supernumerary and absent limbs and digits of the lower limb: a review of the literature.

    Science.gov (United States)

    Klaassen, Zachary; Shoja, Mohammadali M; Tubbs, R Shane; Loukas, Marios

    2011-07-01

    Anatomical history over centuries includes description of a wide variety of malformations involving the lower limbs. This article offers an organized review of these diverse abnormalities, including new understanding of mechanisms through recent discoveries in genetics and molecular biology. In 19th century Europe, a number of unique anomalies were reported, as well as evidence of foot amputations occurring in ancient Peruvian culture. Embryologically, the limbs develop early, with the lower limb being recognizable for the first time at stage 13 of development. By stage 23, the toes are clearly defined and by birth, although the legs appear bowed, the tibia and fibula are straight. Removal of the apical ectodermal ridge results in cessation of limb development, conversely, a second apical ectodermal ridge results in duplication of distal structures. Supernumerary limbs have been documented to occur as part of a teratoma with unique morphology and accompanying blood supply. Additionally, many examples of polydactyly occur in the foot postulating that deletion of chromosome 22q11 is involved in postaxial polydactyly. Such deletions occur near the middle of the chromosome at a location designated q11.2 (i.e., on the long arm of one of the pair of chromosomes 22) and this syndrome is also referred to as DiGeorge syndrome, which has a prevalence estimated at 1:4,000. Absence of the lower limbs has also been noted, with hypoplasia of the fibula being the most common manifestation of congenital bone absences in the lower limb. In addition to fibular aplasia, cases of tibial aplasia have been reported. This article is important for surgeons attempting correctional repair of lower limb anomalies, as well as providing analysis of the historical, anatomical and clinical aspects of supernumerary and absent limbs and digits for the lower limb. Copyright © 2011 Wiley-Liss, Inc.

  7. Neck muscle fatigue alters upper limb proprioception.

    Science.gov (United States)

    Zabihhosseinian, Mahboobeh; Holmes, Michael W R; Murphy, Bernadette

    2015-05-01

    Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position. The purpose of this study was to determine whether fatigue of the cervical extensors muscles (CEM) using a submaximal fatigue protocol alters the ability to recreate a previously presented elbow angle with the head in a neutral position. Twelve healthy individuals participated. CEM activity was examined bilaterally using surface electromyography, and kinematics of the elbow joint was measured. The fatigue protocol included an isometric neck extension task at 70 % of maximum until failure. Joint position error increased following fatigue, demonstrating a significant main effect of time (F 2, 18 = 19.41, p ≤ 0.0001) for absolute error. No significant differences were found for variable error (F 2, 18 = 0.27, p = 0.76) or constant error (F 2, 18 = 1.16 of time, p ≤ 0.33). This study confirms that fatigue of the CEM can reduce the accuracy of elbow joint position matching. This suggests that altered afferent input from the neck subsequent to fatigue may impair upper limb proprioception.

  8. Phantom pain in bilateral upper limb amputation.

    Science.gov (United States)

    Modirian, Ehsan; Shojaei, Hadi; Soroush, Mohammad Reza; Masoumi, Mahdi

    2009-01-01

    To alert health professionals on presence and extent of phantom pain and sensation following bilateral upper limb amputation. Of a total of 140 war-related bilateral upper limb amputees in Iran, 103 subjects were thoroughly examined in this cross-sectional study by a physical medicine specialist. The patients were questioned for the presence of phantom pain and sensations, and frequency and intensity of the feeling were recorded. At 17.1 +/- 6.1 years after injury, 82.0% of the 103 amputees suffered from phantom sensation, including varying degrees of phantom limb pain in 53.9% of stumps. Phantom phenomena had a higher frequency in the right extremities, but this was not statistically significant (p > 0.01). Of those amputees who had phantom pain or sensation, 51.2% reported that they 'always' had phantom limb sensation; and approximately one-fourth of the subjects (24.6%) 'always' had phantom pain. Among the stumps who reported phantom pain (N=112), the pain was excruciating (38.5%), distressing (34.9%) or discomforting (25.6%). A significant statistical relation between phantom limb sensation and level of amputation was observed (p phantom pain; medical and surgical modalities only bring temporary relief, and less than 1% of the respondents achieve permanent relief through different treatment methods.

  9. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Science.gov (United States)

    Subedi, Bishnu; Grossberg, George T.

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  10. Pharmacological interventions for phantom limb pain.

    Science.gov (United States)

    Fang, Jun; Lian, Yan-hong; Xie, Kang-jie; Cai, Shu-nü

    2013-02-01

    To review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain. Both Chinese and English language literatures were searched using MEDLINE (1982 - 2011), Pubmed (1982 - 2011) and the Index of Chinese Language Literature (1982 - 2011). Data from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review. By reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyl-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions. Although there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyl-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.

  11. Phantom Limb Pain: Mechanisms and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Bishnu Subedi

    2011-01-01

    Full Text Available The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

  12. The unstable knee in congenital limb deficiency.

    Science.gov (United States)

    Mindler, Gabriel T; Radler, Christof; Ganger, Rudolf

    2016-12-01

    Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asymptomatic in daily activity. However, instability can appear during deformity correction and bone-lengthening procedures, leading to flexion contracture or subluxation of the knee. A review of pediatric orthopaedic literature on different factors of knee instability, state-of-the-art treatment options in congenital limb deficiency and in cases of lengthening-related knee subluxation is presented and the authors' preferred treatment methods are described. Leg lengthening and deformity correction in patients with congenital limb deficiencies can be achieved with various techniques, such as guided growth, monolateral or circular external fixation and intramedullary lengthening nails. Radiographic assessment and clinical examination of the knee stability are obligatory to estimate the grade of instability prior to surgical procedures. Preparatory surgery, as well as preventive measures such as bracing, bridging of the knee and intensive physical therapy, can help to avoid subluxation during lengthening in unstable knees. Adequate surgical techniques, preventive measures and early detection of signs of subluxation can lead to good functional results in patients with congenital limb deficiency.

  13. Lower limb surgery in Duchenne muscular dystrophy.

    Science.gov (United States)

    Forst, J; Forst, R

    1999-05-01

    Two hundred and thirteen of 428 patients with Duchenne muscular dystrophy (DMD) of a prospective and open study were operated on bilaterally with hip and knee release, aponeurectomy of the iliotibial band and Achilles tendon lengthening. In 87 patients the operation was carried out during early restrictions of the lower limb joint mobility at an average age of 6.56 years (4.02-8.26, SD 1.42). The follow-up was on average 5.4 years (0.25-9.01, SD 2.7). This group was compared to a control group (natural history) consisting of 100 non-operated DMD patients. A significant (P contrast to the patients of the control group all treated patients between ages 6 and 8 years could walk independently. The positive influence of early lower limb surgery could also be shown by the development of Hammersmith motor ability score, CIDD (Council of Investigation of Duchenne Dystrophy) grading and Vignos scale. Nevertheless, in consideration of the well-known course of DMD not only the prolongation of ambulation but also the achieved prolongation of assisted standing ability with no or mild contractures are aims of lower limb surgery. Since no improvement of muscle strength could be observed after lower limb surgery, further studies have to investigate if additionally administered steroids can prolong ambulation after early lower limb surgery.

  14. The motor cortex and its role in phantom limb phenomena.

    Science.gov (United States)

    Reilly, Karen T; Sirigu, Angela

    2008-04-01

    Limb amputation results in plasticity of connections between the brain and muscles; the cortical motor representation of the missing limb seemingly disappears. The disappearance of the hand's motor representation is, however, difficult to reconcile with evidence that a perceptual representation of the missing limb persists in the form of a phantom limb endowed with sensory and motor qualities. Here, we argue that despite considerable reorganization within the motor cortex of upper-limb amputees, the representation of the amputated hand does not disappear. We hypothesize that two levels of hand-movement representation coexist within the primary motor cortex; at one level, limb movements are specified in terms of arm and hand motor commands, and at another level, limb movements are specified as muscles synergies. We propose that primary motor cortex reorganization after amputation concerns primarily the upper limb's muscular map but not its motor command map and that the integrity of the motor command map underlies the existence of the phantom limb.

  15. Modified hyrax splint for rapid maxillary expansion in esthetically concerned patients

    Directory of Open Access Journals (Sweden)

    Sarabjeet Singh Sandhu

    2015-01-01

    Full Text Available The orthodontic treatment of Class III malocclusion with a maxillary deficiency is often treated with maxillary protraction either with or without maxillary expansion. The routine procedure for rapid maxillary expansion includes banding on first premolars/first deciduous molars and the permanent first molars. However in some patients who are esthetically very conscious, banding of the first premolar would not be a good esthetic option. So for such circumstances we have designed a modified hyrax splint, which does not need the first premolars to be banded.

  16. Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Sinha S

    2005-01-01

    Full Text Available We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs′ had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.

  17. Phantom limb pain: a nursing perspective.

    Science.gov (United States)

    Virani, Anila; Green, Theresa; Turin, Tanvir C

    2014-09-09

    Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees' quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.

  18. Vascular access in critical limb ischemia.

    Science.gov (United States)

    Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

    2016-01-01

    Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Cross-limb Interference during motor learning

    DEFF Research Database (Denmark)

    Lauber, Benedikt; Jensen, Jesper Lundbye; Keller, Martin

    2013-01-01

    It is well known that following skill learning, improvements in motor performance may transfer to the untrained contralateral limb. It is also well known that retention of a newly learned task A can be degraded when learning a competing task B that takes place directly after learning A. Here we....... Importantly, the interference effect in the untrained limb was dependent on the level of skill acquisition in the interfering motor task. These behavioural results of the untrained limb were accompanied by training specific changes in corticospinal excitability, which increased for the hemisphere ipsilateral...... to the trained hand following ballistic training and decreased during accuracy training of the ipsilateral hand. The results demonstrate that contralateral interference effects may occur, and that interference depends on the level of skill acquisition in the interfering motor task. This finding might...

  20. Limb Girdle Muscular Dystrophy (LGMD): Case Report.

    Science.gov (United States)

    Kanitkar, Shubhangi A; Kalyan, Meenakshi; Gaikwad, Anu N; Makadia, Ankit; Shah, Harshad

    2015-01-01

    We report a young male of autosomal recessive limb girdle muscular dystrophy (LGMD) with positive family history presented with gradual onset proximal muscle weakness in all four limbs since eight years and thinning of shoulders, arms and thighs. Neurological examination revealed atrophy of both shoulders with wasting of both deltoids thinning of thighs and pseudo hypertrophy of both calves, hypotonia in all four limbs. Gower's sign was positive. Winging of scapula was present. Power was 3/5 at both shoulders, 4/5 at both elbows, 5/5 at both wrists, 3/5 at both hip joints, 3/5 at both knees, 5/5 at both ankles. All deep tendon reflexes and superficial reflexes were present with plantars bilateral flexors. Electromyography (EMG) showed myopathic pattern. He had elevated creatinine phosphokinase levels and muscle biopsy findings consistent with muscular dystrophy.

  1. Negative Affect and Excessive Alcohol Intake Incubate during Protracted Withdrawal from Binge-Drinking in Adolescent, But Not Adult, Mice

    Directory of Open Access Journals (Sweden)

    Kaziya M. Lee

    2017-07-01

    Full Text Available Binge-drinking is common in underage alcohol users, yet we know little regarding the biopsychological impact of binge-drinking during early periods of development. Prior work indicated that adolescent male C57BL6/J mice with a 2-week history of binge-drinking (PND28-41 are resilient to the anxiogenic effects of early alcohol withdrawal. Herein, we employed a comparable Drinking-in-the-Dark model to determine how a prior history of binge-drinking during adolescence (EtOHadolescents influences emotionality (assayed with the light-dark box, marble burying test, and the forced swim test and the propensity to consume alcohol in later life, compared to animals without prior drinking experience. For additional comparison, adult mice (EtOHadults with comparable drinking history (PND56-69 were subdivided into groups tested for anxiety/drinking either on PND70 (24 h withdrawal or PND98 (28 days withdrawal. Tissue from the nucleus accumbens shell (AcbSh and central nucleus of the amygdala (CeA was examined by immunoblotting for changes in the expression of glutamate-related proteins. EtOHadults exhibited some signs of hyperanxiety during early withdrawal (PND70, but not during protracted withdrawal (PND98. In contrast, EtOHadolescents exhibited robust signs of anxiety-l and depressive-like behaviors when tested as adults on PND70. While all alcohol-experienced animals subsequently consumed more alcohol than mice drinking for the first time, alcohol intake was greatest in EtOHadolescents. Independent of drinking age, the manifestation of withdrawal-induced hyperanxiety was accompanied by reduced Homer2b expression within the CeA and increased Group1 mGlu receptor expression within the AcbSh. The present data provide novel evidence that binge-drinking during adolescence produces a state characterized by profound negative affect and excessive alcohol consumption that incubates with the passage of time in withdrawal. These data extend our prior studies on the

  2. Negative Affect and Excessive Alcohol Intake Incubate during Protracted Withdrawal from Binge-Drinking in Adolescent, But Not Adult, Mice.

    Science.gov (United States)

    Lee, Kaziya M; Coehlo, Michal A; Solton, Noah R; Szumlinski, Karen K

    2017-01-01

    Binge-drinking is common in underage alcohol users, yet we know little regarding the biopsychological impact of binge-drinking during early periods of development. Prior work indicated that adolescent male C57BL6/J mice with a 2-week history of binge-drinking (PND28-41) are resilient to the anxiogenic effects of early alcohol withdrawal. Herein, we employed a comparable Drinking-in-the-Dark model to determine how a prior history of binge-drinking during adolescence (EtOHadolescents) influences emotionality (assayed with the light-dark box, marble burying test, and the forced swim test) and the propensity to consume alcohol in later life, compared to animals without prior drinking experience. For additional comparison, adult mice (EtOHadults) with comparable drinking history (PND56-69) were subdivided into groups tested for anxiety/drinking either on PND70 (24 h withdrawal) or PND98 (28 days withdrawal). Tissue from the nucleus accumbens shell (AcbSh) and central nucleus of the amygdala (CeA) was examined by immunoblotting for changes in the expression of glutamate-related proteins. EtOHadults exhibited some signs of hyperanxiety during early withdrawal (PND70), but not during protracted withdrawal (PND98). In contrast, EtOHadolescents exhibited robust signs of anxiety-l and depressive-like behaviors when tested as adults on PND70. While all alcohol-experienced animals subsequently consumed more alcohol than mice drinking for the first time, alcohol intake was greatest in EtOHadolescents. Independent of drinking age, the manifestation of withdrawal-induced hyperanxiety was accompanied by reduced Homer2b expression within the CeA and increased Group1 mGlu receptor expression within the AcbSh. The present data provide novel evidence that binge-drinking during adolescence produces a state characterized by profound negative affect and excessive alcohol consumption that incubates with the passage of time in withdrawal. These data extend our prior studies on the effects

  3. Short term administration of glucocorticoids in patients with protracted and chronic gout arthritis. Part III – frequency of adverse events

    Directory of Open Access Journals (Sweden)

    A A Fedorova

    2009-01-01

    Full Text Available Objective. To assess frequency of adverse events during short term administration of gluco- corticoid (GC in protracted and chronic gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration – 15,2 years [7,4;20], median swollen joint count at the examination – 8 [5;11]. The patients were randomized into 2 groups. Methylprednisolone (MP 500 mg/day iv during 2 days and placebo im once was administered in one of them, betamethasone (BM 7 mg im once and placebo iv twice – in the other. Clinical evaluation of inflamed joints was performed every day. Standard laboratory examination and ECG were done before drug administration, at 3rd, 7th, and 14th day of follow up. Immunoreactive insulin level was evaluated before drug administration and at day 14. Blood pressure (BP was measured every day. Results. After first GC administration BP elevated in 28 (47% pts. In pts not having appropriate BP values BP elevated in 73% of cases. Pts with appropriate BP values showed less frequent BP elevation – 38% (p=0,02. In 8 (13% pts at day 3 after GC administration ECG signs of myocardial blood supply deterioration were revealed. Glucose level elevated in 10 (17% pts and after the second BM administration – in 5 (8% pts. Cholesterol level did not significantly change after 14 days of follow up but in 28 (47% pts it increased in comparison with baseline. Trigliceride level significantly decreased at day 14 from 149 [106; 187] to 108 [66,5; 172] mg/dl (p=0,02. 26 (44% pts had face hyperemia, 4 (7% –42 palpitation and 2 (3,4% – bitter taste. Conclusion. Administration of short course of GC in pts with gout requires monitoring of possible adverse events. Antihypertensive therapy providing appropriate BP

  4. Audiovisual Simultaneity Judgment and Rapid Recalibration throughout the Lifespan.

    Directory of Open Access Journals (Sweden)

    Jean-Paul Noel

    Full Text Available Multisensory interactions are well established to convey an array of perceptual and behavioral benefits. One of the key features of multisensory interactions is the temporal structure of the stimuli combined. In an effort to better characterize how temporal factors influence multisensory interactions across the lifespan, we examined audiovisual simultaneity judgment and the degree of rapid recalibration to paired audiovisual stimuli (Flash-Beep and Speech in a sample of 220 participants ranging from 7 to 86 years of age. Results demonstrate a surprisingly protracted developmental time-course for both audiovisual simultaneity judgment and rapid recalibration, with neither reaching maturity until well into adolescence. Interestingly, correlational analyses revealed that audiovisual simultaneity judgments (i.e., the size of the audiovisual temporal window of simultaneity and rapid recalibration significantly co-varied as a function of age. Together, our results represent the most complete description of age-related changes in audiovisual simultaneity judgments to date, as well as being the first to describe changes in the degree of rapid recalibration as a function of age. We propose that the developmental time-course of rapid recalibration scaffolds the maturation of more durable audiovisual temporal representations.

  5. Neurocognitive and psychiatric dimensions of hot, but not cool, impulsivity predict HIV sexual risk behaviors among drug users in protracted abstinence.

    Science.gov (United States)

    Wilson, Michael J; Vassileva, Jasmin

    2016-03-01

    Impulsivity is an important risk factor for HIV risky drug and sexual behaviors. Research identifies hot (i.e. affectively-mediated, reward-based) and cool (motoric, attentional, independent of context) neurocognitive and psychiatric dimensions of impulsivity, though the impact of specific drugs of abuse on these varieties of impulsivity remains an open question. The present study examined the associations of neurocognitive and psychiatric varieties of hot and cool impulsivity with measures of lifetime and recent sexual risk behaviors among users of different classes of drugs. The study sample was comprised of drug users in protracted (> 1 year) abstinence: heroin mono-dependent (n = 61), amphetamine mono-dependent (n = 44), and polysubstance dependent (n = 73). Hot impulsivity was operationalized via neurocognitive tasks of reward-based decision-making and symptoms of psychopathy. Cool impulsivity was operationalized via neurocognitive tasks of response inhibition and symptoms of attention deficit/hyperactivity disorder (ADHD). Hot impulsivity was associated with sexual risk behaviors among heroin and amphetamine users in protracted abstinence, whereas cool impulsivity was not associated with sexual risk behaviors among any drug-using group. Neurocognitive hot impulsivity was associated with recent (past 30-day) sexual risk behaviors, whereas psychopathy was associated with sexual risk behaviors during more remote time-periods (past 6 month and lifetime) and mediated the association between heroin dependence and past 6-month sexual risk behaviors. Assessments and interventions aimed at reducing sexual risk behaviors among drug users should focus on hot neurocognitive and psychiatric dimensions of impulsivity, such as decision-making and psychopathy. Cool dimensions of impulsivity such as response inhibition and ADHD were not related to sexual risk behaviors among drug users in protracted abstinence.

  6. Phantom limb perception interferes with motor imagery after unilateral upper-limb amputation.

    Science.gov (United States)

    Lyu, Yuanyuan; Guo, Xiaoli; Bekrater-Bodmann, Robin; Flor, Herta; Tong, Shanbao

    2016-02-16

    A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb.

  7. The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

    Science.gov (United States)

    Cole, Grayson Lee; Millis, Darryl

    2017-01-16

    Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.

  8. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  9. [Phantom limb pain. Psychological treatment strategies].

    Science.gov (United States)

    Diers, M; Flor, H

    2013-04-01

    Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes.

  10. Successful peripheral neuromodulation for phantom limb pain.

    Science.gov (United States)

    Cornish, Philip; Wall, Cindy

    2015-04-01

    For decades, the heterogeneity of the amputee population and the complex interaction of biopsychosocial factors have confounded researchers' attempts to develop an effective treatment for phantom limb pain. Therefore, it remains difficult to treat, and affected patients often experience decreased quality of life, increased psychological distress, and poorer health outcomes. In the case study, we report a novel strategy for the peripheral placement of neuromodulation leads for the treatment of phantom limb pain in a patient who subsequently described complete and consistent pain relief independent of significant variations in psychosocial stress. Wiley Periodicals, Inc.

  11. Cocaine-associated lower limb ischemia.

    LENUS (Irish Health Repository)

    Collins, Chris G

    2011-07-25

    Cocaine-associated thrombosis has been reported in the literature with reports of vascular injuries to cardiac, pulmonary, intestinal, placental, and musculoskeletal vessels; however, injury of the pedal vessels is rare. We report on a 31-year-old man who presented 2 months following a cocaine binge with limb-threatening ischemia without an otherwise identifiable embolic source. Angiography confirmed extensive occlusive disease of the tibioperoneal vessels. The patient improved following therapy with heparin and a prostacyclin analogue. Cocaine-induced thrombosis should be considered in patients presenting with acute arterial insufficiency in the lower limb without any other identifiable cause.

  12. Creation of distal canine limb lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Chen, H.C.; Pribaz, J.J.; O' Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  13. Syndecan-3 in limb skeletal development.

    Science.gov (United States)

    Kosher, R A

    1998-10-15

    Syndecan-3 is a member of a family of heparan sulfate proteoglycans that function as extracellular matrix receptors and as co-receptors for growth factors and signalling molecules. A variety of studies indicate that syndecan-3 is involved in several aspects of limb morphogenesis and skeletal development. Syndecan-3 participates in limb outgrowth and proliferation in response to the apical ectodermal ridge; mediates cell-matrix and/or cell-cell interactions involved in regulating the onset of chondrogenesis; may be involved in regulating the onset of osteogenesis and joint formation and, plays a role in regulating the proliferation of epiphyseal chondrocytes during endochondral ossification.

  14. Lower limb amputations in Trondheim, Norway

    OpenAIRE

    Wits?, Eivind; Lium, Arne; Lydersen, Stian

    2010-01-01

    Background and purpose In the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later. Patients and methods In 2004?07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994?1997. From 1996 through 2006, we registered t...

  15. Periodic Limb Movements During Sleep Mimicking REM Sleep Behavior Disorder: A New Form of Periodic Limb Movement Disorder.

    Science.gov (United States)

    Gaig, Carles; Iranzo, Alex; Pujol, Montserrat; Perez, Hernando; Santamaria, Joan

    2017-03-01

    To describe a group of patients referred because of abnormal sleep behaviors that were suggestive of rapid eye movement (REM) sleep behavior disorder (RBD) in whom video-polysomnography ruled out RBD and showed the reported behaviors associated with vigorous periodic limb movements during sleep (PLMS). Clinical history and video-polysomnography review of patients identified during routine visits in a sleep center. Patients were 15 men and 2 women with a median age of 66 (range: 48-77) years. Reported sleep behaviors were kicking (n = 17), punching (n = 16), gesticulating (n = 8), falling out of bed (n = 5), assaulting the bed partner (n = 2), talking (n = 15), and shouting (n = 10). Behaviors resulted in injuries in 3 bed partners and 1 patient. Twelve (70.6%) patients were not aware of displaying abnormal sleep behaviors that were only noticed by their bed partners. Ten (58.8%) patients recalled unpleasant dreams such as being attacked or chased. Video-polysomnography showed (1) frequent and vigorous stereotyped PLMS involving the lower limbs, upper limbs, and trunk (median PLMS index 61.2; median PLMS index in NREM sleep 61.9; during REM sleep only 8 patients had PLMS and their median PLMS index in REM sleep was 39.5); (2) abnormal behaviors (e.g., punching, groaning) during some of the arousals that immediately followed PLMS in NREM sleep; and (3) ruled out RBD and other sleep disorders such as obstructive sleep apnea. Dopaminergic agents were prescribed in 14 out of the 17 patients and resulted in improvement of abnormal sleep behaviors and unpleasant dreams in all of them. After dopaminergic treatment, follow-up video-polysomnography in 7 patients showed a decrease in the median PLMS index from baseline (108.9 vs. 19.2, p = .002) and absence of abnormal behaviors during the arousals. Abnormal sleep behaviors and unpleasant dreams simulating RBD symptomatology may occur in patients with severe PLMS. In these cases, video-polysomnography ruled out RBD and

  16. The Mouse Limb Anatomy Atlas: An interactive 3D tool for studying embryonic limb patterning

    Directory of Open Access Journals (Sweden)

    DeLaurier April

    2008-09-01

    Full Text Available Abstract Background The developing mouse limb is widely used as a model system for studying tissue patterning. Despite this, few references are available that can be used for the correct identification of developing limb structures, such as muscles and tendons. Existing textual references consist of two-dimensional (2D illustrations of the adult rat or mouse limb that can be difficult to apply when attempting to describe the complex three-dimensional (3D relationship between tissues. Results To improve the resources available in the mouse model, we have generated a free, web-based, interactive reference of limb muscle, tendon, and skeletal structures at embryonic day (E 14.5 http://www.nimr.mrc.ac.uk/3dlimb/. The Atlas was generated using mouse forelimb and hindlimb specimens stained using immunohistochemistry to detect muscle and tendon. Limbs were scanned using Optical Projection Tomography (OPT, reconstructed to make 3D models and annotated using computer-assisted segmentation tools in Amira 3D Visualisation software. The annotated dataset is visualised using Java, JAtlasView software. Users click on the names of structures and view their shape, position and relationship with other structures within the 3D model and also in 2D virtual sections. Conclusion The Mouse Limb Anatomy Atlas provides a novel and valuable tool for researchers studying limb development and can be applied to a range of research areas, including the identification of abnormal limb patterning in transgenic lines and studies of models of congenital limb abnormalities. By using the Atlas for "virtual" dissection, this resource offers an alternative to animal dissection. The techniques we have developed and employed are also applicable to many other model systems and anatomical structures.

  17. Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients.

    Science.gov (United States)

    Gracies, J M; Marosszeky, J E; Renton, R; Sandanam, J; Gandevia, S C; Burke, D

    2000-12-01

    To assess acceptability, effects on swelling, resting posture, spasticity, and active (AROM) and passive range of motion (PROM) of individually tailored upper limb Lycra garments, designed as dynamic splints to exert directional pull on certain limb segments, when worn for 3 hours by hemiplegic patients. Crossover trial. Outpatient and inpatient rehabilitation center. Convenience sample of 16 patients with hemiparesis and upper limb spasticity caused by a stroke more than 3 weeks before the study. Assessments performed at the start and end of a 3-hour period during a standard rehabilitation day when the patients were and were not wearing the garment. (1) Comfort assessed by questionnaire; (2) circumference of each limb segment; (3) resting posture at elbow and wrist; (4) spasticity at shoulder, elbow, and wrist using the Tardieu scale; and (5) AROM and PROM at shoulder, elbow, and wrist measured using a goniometer; (6) elbow proprioception using McCloskey's method; (7) visual neglect syndrome using the line bisection test. Differences between changes occurring with and without the garment were compared using Wilcoxon's signed rank test for ordinal variables (spasticity grading) and Student's t test for continuous variables (all other data). During 3 hours, garments worn on the arm by patients with hemiplegia (1) were comfortable, (2) improved wrist posture and reduced wrist and finger flexor spasticity, (3) reduced swelling in patients with swollen limbs (digit circumference decreased by 4%; pspastic muscles when worn for several hours each day, have rapid splinting and antispastic effects on wrist and fingers in patients with hemiplegia. These garments may help severely affected patients with major spasticity or painful swollen limbs.

  18. Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics

    Science.gov (United States)

    Consumer Guide for Amputees: A Guide to Lower Limb Prosthetics: Part I -- Prosthetic Design: Basic Concepts Volume 8 · ... wanted to have available a comprehensive explanation of limb prosthetics written in easily understood language for amputee consumers. ...

  19. Management of fibular hemimelia: amputation or limb lengthening

    National Research Council Canada - National Science Library

    Naudie, D; Hamdy, R C; Fassier, F; Morin, B; Duhaime, M

    1997-01-01

    .... There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique...

  20. Dominant limb asymmetry associated with prospective injury ...

    African Journals Online (AJOL)

    The purpose of the study was to identify associations between dominant lower limb asymmetry in unanticipated agility performance and prospective injury occurrence. Female netball players (N=24) performed unanticipated 180° turn agility sprints on both the dominant and non-dominant legs interspersed with an additional ...

  1. Motor correlates of phantom limb pain.

    Science.gov (United States)

    Kikkert, Sanne; Mezue, Melvin; Henderson Slater, David; Johansen-Berg, Heidi; Tracey, Irene; Makin, Tamar R

    2017-10-01

    Following amputation, individuals ubiquitously report experiencing lingering sensations of their missing limb. While phantom sensations can be innocuous, they are often manifested as painful. Phantom limb pain (PLP) is notorious for being difficult to monitor and treat. A major challenge in PLP management is the difficulty in assessing PLP symptoms, given the physical absence of the affected body part. Here, we offer a means of quantifying chronic PLP by harnessing the known ability of amputees to voluntarily move their phantom limbs. Upper-limb amputees suffering from chronic PLP performed a simple finger-tapping task with their phantom hand. We confirm that amputees suffering from worse chronic PLP had worse motor control over their phantom hand. We further demonstrate that task performance was consistent over weeks and did not relate to transient PLP or non-painful phantom sensations. Finally, we explore the neural basis of these behavioural correlates of PLP. Using neuroimaging, we reveal that slower phantom hand movements were coupled with stronger activity in the primary sensorimotor phantom hand cortex, previously shown to associate with chronic PLP. By demonstrating a specific link between phantom hand motor control and chronic PLP, our findings open up new avenues for PLP management and improvement of existing PLP treatments. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. An approach to the painful upper limb

    African Journals Online (AJOL)

    The clinical findings are key to pinpointing the pain source. History. Cervical and upper limb pain may present in isolation or be associated with altered sensation. .... Positive test is presence of 'electric-like sensations' down spine or extremities. Myelopathy. Hoffmann's sign. Passive snapping flexion of middle finger distal ...

  3. Running With an Elastic Lower Limb Exoskeleton.

    Science.gov (United States)

    Cherry, Michael S; Kota, Sridhar; Young, Aaron; Ferris, Daniel P

    2016-06-01

    Although there have been many lower limb robotic exoskeletons that have been tested for human walking, few devices have been tested for assisting running. It is possible that a pseudo-passive elastic exoskeleton could benefit human running without the addition of electrical motors due to the spring-like behavior of the human leg. We developed an elastic lower limb exoskeleton that added stiffness in parallel with the entire lower limb. Six healthy, young subjects ran on a treadmill at 2.3 m/s with and without the exoskeleton. Although the exoskeleton was designed to provide ~50% of normal leg stiffness during running, it only provided 24% of leg stiffness during testing. The difference in added leg stiffness was primarily due to soft tissue compression and harness compliance decreasing exoskeleton displacement during stance. As a result, the exoskeleton only supported about 7% of the peak vertical ground reaction force. There was a significant increase in metabolic cost when running with the exoskeleton compared with running without the exoskeleton (ANOVA, P exoskeletons for human running are human-machine interface compliance and the extra lower limb inertia from the exoskeleton.

  4. Upper limb injuries associated with rock climbing.

    Science.gov (United States)

    Bannister, P; Foster, P

    1986-01-01

    Four cases of upper limb injuries secondary to rock-climbing or training for rock climbing are presented. All four cases had diagnosis and treatment delayed because of unawareness of the range of injuries seen in high grade rock climbing. PMID:3730754

  5. Scavenging energy from human limb motions

    Science.gov (United States)

    Fan, Kangqi; Yu, Bo; Tang, Lihua

    2017-04-01

    This paper proposes a nonlinear piezoelectric energy harvester (PEH) to scavenge energy from human limb motions. The proposed PEH is composed of a ferromagnetic ball, a sleeve, and two piezoelectric cantilever beams each with a magnetic tip mass. The ball is used to sense the swing motions of human limbs and excite the beams to vibrate. The two beams, which are sensitive to the excitation along the radialis or tibial axis, generate electrical outputs. Theoretical and experimental studies are carried out to examine the performance of the proposed PEH when it is fixed at the wrist, thigh and ankle of a male who travels at constant velocities of 2 km/h, 4 km/h, 6 km/h, and 8 km/h on a treadmill. The results indicate that the low-frequency swing motions of human limbs are converted to higher-frequency vibrations of piezoelectric beams. During each gait cycle, different excitations produced by human limbs can be superposed and multiple peaks in the voltage output can be generated by the proposed PEH. Moreover, the voltage outputs of the PEH increase monotonously with the walking speed, and the maximum effective voltage is obtained when the PEH is mounted at the ankle under the walking speed of 8 km/h.

  6. Limb disparity and wing shape in pterosaurs.

    Science.gov (United States)

    Dyke, G J; Nudds, R L; Rayner, J M V

    2006-07-01

    The limb proportions of the extinct flying pterosaurs were clearly distinct from their living counterparts, birds and bats. Within pterosaurs, however, we show that further differences in limb proportions exist between the two main groups: the clade of short-tailed Pterodactyloidea and the paraphyletic clades of long-tailed rhamphorhynchoids. The hindlimb to forelimb ratios of rhamphorhynchoid pterosaurs are similar to that seen in bats, whereas those of pterodactyloids are much higher. Such a clear difference in limb ratios indicates that the extent of the wing membrane in rhamphorhynchoids and pterodactyloids may also have differed; this is borne out by simple ternary analyses. Further, analyses also indicate that the limbs of Sordes pilosus, a well-preserved small taxon used as key evidence for inferring the extent and shape of the wing membrane in all pterosaurs, are not typical even of its closest relatives, other rhamphorhynchoids. Thus, a bat-like extensive hindlimb flight membrane, integrated with the feet and tail may be applicable only to a small subset of pterosaur diversity. The range of flight morphologies seen in these extinct reptiles may prove much broader than previously thought.

  7. 21 CFR 890.3475 - Limb orthosis.

    Science.gov (United States)

    2010-04-01

    ... extremities to support, to correct, or to prevent deformities or to align body structures for functional... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Limb orthosis. 890.3475 Section 890.3475 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES...

  8. Inducible limb-shaking transitory ischemic attacks

    DEFF Research Database (Denmark)

    Rosenbaum, Sverre; Ovesen, Christian; Futrell, Nancy

    2016-01-01

    with exercise-induced weakness associated with tremor in his right arm. His left internal carotid artery was occluded at the bifurcation. Administration of statin and antiplatelet did not relieve his symptoms, and his stereotypic, exercise-induced "limb-shaking" episodes persisted. He underwent successful...

  9. Limb conservation using non vascularised fibular grafts

    African Journals Online (AJOL)

    graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high .... preserved in a diluted blood with normal saline till ; anastomosis was commenced. He also had cable grafting of the ... arm muscles was performed at the same time. The forearm was supported in below elbow ...

  10. Infantile lipofibromatosis of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Teo, Harvey E.L.; Peh, Wilfred C.G. [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Chan, Mei-Yoke [KK Women' s and Children' s Hospital, Department of Paediatric Medicine, Singapore (Singapore); Walford, Norman [Tan Tock Seng Hospital, Department of Pathology, Singapore (Singapore)

    2005-12-01

    The imaging features of extensive lipofibromatosis presenting in a 1-day-old female infant are reported. This lesion involved her entire right upper limb, extending from the axilla to the palm of the hand. Radiographs showed marked deformity and thinning of all the right upper-limb bones due to pressure effect of soft-tissue enlargement, especially affecting the distal humerus and proximal forearm bones. Magnetic resonance imaging showed a huge soft-tissue mass infiltrating most of the muscles of the entire upper limb, with bony erosion. The mass was largely T1-isointense, moderately T2-hyperintense and showed marked enhancement. There were intra-lesional signal changes consistent with fatty elements. A lesion debulking procedure was performed and the histology was that of lipofibromatosis. The limb was found to be non-viable after the procedure and a subsequent above-elbow amputation was performed. Although the resection margins were not clear, she had no further recurrence over a subsequent 3-year follow-up period. (orig.)

  11. Atypical supernumerary phantom limb and phantom limb pain in two patients with pontine hemorrhage.

    Science.gov (United States)

    Yoo, Seung Don; Kim, Dong Hwan; Jeong, Yong Seol; Chon, Jinmann; Bark, Jihea

    2011-06-01

    Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

  12. Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects.

    Science.gov (United States)

    Yatabe, Marília; Garib, Daniela Gamba; Faco, Renato André de Souza; de Clerck, Hugo; Janson, Guilherme; Nguyen, Tung; Cevidanes, Lucia Helena Soares; Ruellas, Antonio Carlos

    2017-09-01

    The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate. The cleft group comprised 24 patients with unilateral cleft lip and palate and Class III malocclusion with mean initial and final ages of 11.8 and 13.2 years, respectively. The noncleft group comprised 24 noncleft patients with Class III malocclusion with mean initial and final ages of 11.9 and 12.9 years, respectively. Cone-beam computed tomography examinations were performed before and after BAMP therapy in both groups and superimposed at the cranial base. Three-dimensional displacements of maxillary landmarks were quantified and visualized with color-coded maps and semitransparent superimpositions. The t test corrected for multiple testing (Holm-Bonferroni method), and the paired t test was used for statistical comparison between groups and sides, respectively (P maxillary displacements in the cleft group with no significant differences compared with the noncleft group. The maxillary first molars of the cleft group showed significantly greater medial displacement than did those in the noncleft group. The zygoma showed significantly greater lateral displacement at the cleft side compared with the noncleft side. BAMP caused similar amounts of maxillary protraction in patients with and without unilateral cleft lip and palatem with discrete differences between the cleft side and the noncleft side. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  13. Immersive VR in Phantom Limb Pain Therapy of Amputee Patients Due to Critical Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Zanfir Ana-Maria

    2017-09-01

    Full Text Available Introduction: Phantom limb pain (PLP occurs in approximately 75% of patients who undergo limb amputation. In identifying the etiopathogenic mechanisms, multidisciplinary approaches are increasingly important in explaining the causality based on neurological and psychological factors. PLP has many negative effects on the amputee's physical and mental integrity, which is why a variety of treatments have been conceived, whose effectiveness is rather limited.

  14. Catheter-directed thrombolysis for acute limb ischemia

    NARCIS (Netherlands)

    Schrijver, AM

    2016-01-01

    Acute limb ischemia occurs due to a sudden decrease in blood flow to the limb, usually caused by a thrombus or embolus, resulting not only in a potential threat to the viability of the limb, but also a high risk of death. Endovascular techniques have become the preferred treatment over the last

  15. 21 CFR 890.3410 - External limb orthotic component.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External limb orthotic component. 890.3410 Section... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3410 External limb orthotic component. (a) Identification. An external limb orthotic component is a device...

  16. 21 CFR 890.3500 - External assembled lower limb prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External assembled lower limb prosthesis. 890.3500... (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3500 External assembled lower limb prosthesis. (a) Identification. An external assembled lower limb prosthesis...

  17. Facts about Upper and Lower Limb Reduction Defects

    Science.gov (United States)

    ... occur when a part of or the entire arm (upper limb) or leg (lower limb) of a fetus fails ... for each child. Potential treatments include: Prosthetics (artificial limbs) Orthotics (splints or braces) Surgery Rehabilitation (physical or occupational therapy) It is important to ...

  18. Genetic study of congenital limb anomalies among Egyptian children

    African Journals Online (AJOL)

    The remaining eighty five (85) patients constituting (60.7%) of enrolled cases comprised two groups: those with limb defects as part of a well defined genetic syndrome (Syndromic limb defects) (76 patients - 54.3%) and those with limb defects as part of a chromosomal aberration syndrome (9 patients - 6.4%). Genealogical ...

  19. 7 CFR 51.1220 - Leaf or limb rub injury.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Leaf or limb rub injury. 51.1220 Section 51.1220... STANDARDS) United States Standards for Grades of Peaches Definitions § 51.1220 Leaf or limb rub injury. “Leaf or limb rub injury” means that the scarring is not smooth, not light colored, or aggregates more...

  20. Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation.

    Science.gov (United States)

    Kurichi, Jibby E; Kwong, Pui; Vogel, W Bruce; Xie, Dawei; Cowper Ripley, Diane; Bates, Barbara E

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and 3 yr mortality postsurgery among Veterans with lower-limb amputation (LLA). We conducted a retrospective observational study that included 4,578 Veterans hospitalized for LLA and discharged in fiscal years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3 yr anniversary of the surgical date. Of the Veterans with LLA, 1,300 (28.4%) received a prescription for a prosthetic limb within 1 yr after the surgical amputation. About 46% (n = 2,086) died within 3 yr of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 yr of the surgical anniversary. After adjustment, Veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than Veterans without a prescription, with a hazard ratio of 0.68 (95% confidence interval: 0.60-0.77). Findings demonstrated that Veterans with LLA who received a prescription for a prosthetic limb within 1 yr after the surgical amputation were less likely to die within 3 yr of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics.

  1. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The axolotl limb blastema: cellular and molecular mechanisms driving blastema formation and limb regeneration in tetrapods

    Science.gov (United States)

    McCusker, Catherine; Bryant, Susan V.

    2015-01-01

    Abstract The axolotl is one of the few tetrapods that are capable of regenerating complicated biological structures, such as complete limbs, throughout adulthood. Upon injury the axolotl generates a population of regeneration‐competent limb progenitor cells known as the blastema, which will grow, establish pattern, and differentiate into the missing limb structures. In this review we focus on the crucial early events that occur during wound healing, the neural−epithelial interactions that drive the formation of the early blastema, and how these mechanisms differ from those of other species that have restricted regenerative potential, such as humans. We also discuss how the presence of cells from the different axes of the limb is required for the continued growth and establishment of pattern in the blastema as described in the polar coordinate model, and how this positional information is reprogrammed in blastema cells during regeneration. Multiple cell types from the mature limb stump contribute to the blastema at different stages of regeneration, and we discuss the contribution of these types to the regenerate with reference to whether they are “pattern‐forming” or “pattern‐following” cells. Lastly, we explain how an engineering approach will help resolve unanswered questions in limb regeneration, with the goal of translating these concepts to developing better human regenerative therapies. PMID:27499868

  3. Acute Effect of Static Stretching on Lower Limb Movement Performance by Using STABL Virtual Reality System.

    Science.gov (United States)

    Ameer, Mariam A; Muaidi, Qassim I

    2017-07-17

    The effect of acute static stretch (ASS) on the lower limb RT has been recently questioned to decrease the risk of falling and injuries in situations requiring a rapid reaction, as in the cases of balance disturbance. The main purpose of this study was to detect the effect of ASS on the lower limb RT by using virtual reality device. Two Group Control Group design. Research laboratory. The control and experimental groups were formed randomly from sixty female university students. Each participant in the experimental group was tested before and after ASS for the quadriceps, hamstrings and planter flexor muscles, and compared with the control group with warming-up exercise only. The stretching program involved warming-up in the form of circular running inside the lab for 5 minutes followed by stretching of each muscle group thrice, to the limit of discomfort of 45 s, with resting period of 15s between stretches. The measurements included the RT of the dominant lower extremity by using the dynamic stability program, STABL Virtual Reality System (Model No. DIZ 2709, Motek Medical and Force Link Merged Co., Amsterdam). There was statistically significant reduction (F = 162, P= .00) in post-test RT between the two groups, and significant decrease in RT after stretching, in the experimental group (7.5%) (P= .00). ASS of the lower limb muscles tends to decrease the lower limb RT and improve movement performance.

  4. Comparative anatomy and muscle architecture of selected hind limb muscles in the Quarter Horse and Arab.

    Science.gov (United States)

    Crook, T C; Cruickshank, S E; McGowan, C M; Stubbs, N; Wakeling, J M; Wilson, A M; Payne, R C

    2008-02-01

    The Quarter Horse (bred for acceleration) and the Arab (bred for endurance) are situated at either end of the equine athletic spectrum. Studies into the form and function of the leg muscles in human sprint and endurance runners have demonstrated that differences exist in their muscle architecture. It is not known whether similar differences exist in the horse. Six Quarter Horse and six Arab fresh hind limb cadavers were dissected to gain information on the muscle mass and architecture of the following muscles: gluteus medius; biceps femoris; semitendinosus; vastus lateralis; gastrocnemius; tibialis cranialis and extensor digitorum longus. Specifically, muscle mass, fascicle length and pennation angle were quantified and physiological cross-sectional area (PCSA) and maximum isometric force were estimated. The hind limb muscles of the Quarter Horse were of a significantly greater mass, but had similar fascicle lengths and pennation angles when compared with those of the Arab; this resulted in the Quarter Horse hind limb muscles having greater PCSAs and hence greater isometric force potential. This study suggests that Quarter Horses as a breed inherently possess large strong hind limb muscles, with the potential to accelerate their body mass more rapidly than those of the Arab.

  5. A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients.

    Science.gov (United States)

    Richardson, Cliff; Crawford, Kath; Milnes, Karen; Bouch, Elizabeth; Kulkarni, Jai

    2015-08-01

    To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  6. Infrared optoelectronic volumetry, the ideal way to measure limb volume.

    Science.gov (United States)

    Tierney, S; Aslam, M; Rennie, K; Grace, P

    1996-11-01

    The aim of the study was to compare a novel infrared optoelectronic system (Perometer) of limb volume measurement with water displacement and two indirect measurement techniques. A prospective experimental study. In 10 healthy male volunteers (20 limbs) we compared limb volume measurements obtained by water displacement, infrared perometry, the disc model method and the frustrum method. In a further 17 patients with swollen limbs due to lymphatic (9 limbs) or venous (11 limbs) disease, perometry was compared to the disc model method and the frustrum method only. In normal limbs, mean +/- S.D. limb volume using water displacement was 1802 +/- 268 ml. Perometer values agreed almost exactly (1809 +/- 262 ml, r = 0.97, variation +/- 7% by limits of agreement) but both the disc (1923 +/- 306 ml, r = 0.90, variation +/- 14%) and frustrum (1905 +/- 372 ml, r = 0.72, variation +/- 28%) methods significantly overestimated limb volumes (p perometry. Perometry is a novel, extremely accurate and easy method for assessing limb volume. It provides more accurate results than traditional indirect measurement of limb volume and potentially is a very useful clinical and research tool.

  7. Phantom limb pain from spinal sarcoma: a case report.

    Science.gov (United States)

    Cruz, Ernesto; Dangaria, Harsh T

    2013-07-01

    Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  8. Critical analysis of upper limb replantations

    Directory of Open Access Journals (Sweden)

    Rames Mattar Junior

    2006-06-01

    Full Text Available Objective: The authors analyze the follow-up of results in 62 adultpatients who had traumatic amputations in the upper limb andwho underwent successful replantation procedures from 1994 to2004. Methods: The levels of amputation were in fingers or thumbin 48, hand in 5, wrist in 4, forearm in 2 and arm in 3 patients. Allpatients were treated in a rehabilitation program of specializedhand therapy. A simplified questionnaire was used to evaluate thereturn to work activities using the operated limb, either in theformal or informal economy, and the patient’s satisfaction rateconcerning the surgical procedure. Results: It was noted that 85.5%of patients returned to some work activity using the operated limband 96.8% of patients are satisfied with the results. Conclusions:Patients submitted to successful replantation present a high rateof satisfaction and return to work activities.

  9. Lower-Limb Rehabilitation Robot Design

    Science.gov (United States)

    Bouhabba, E. M.; Shafie, A. A.; Khan, M. R.; Ariffin, K.

    2013-12-01

    It is a general assumption that robotics will play an important role in therapy activities within rehabilitation treatment. In the last decade, the interest in the field has grown exponentially mainly due to the initial success of the early systems and the growing demand caused by increasing numbers of stroke patients and their associate rehabilitation costs. As a result, robot therapy systems have been developed worldwide for training of both the upper and lower extremities. This paper investigates and proposes a lower-limb rehabilitation robot that is used to help patients with lower-limb paralysis to improve and resume physical functions. The proposed rehabilitation robot features three rotary joints forced by electric motors providing linear motions. The paper covers mechanism design and optimization, kinematics analysis, trajectory planning, wearable sensors, and the control system design. The design and control system demonstrate that the proposed rehabilitation robot is safe and reliable with the effective design and better kinematic performance.

  10. Can neural blocks prevent phantom limb pain?

    Science.gov (United States)

    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain.

  11. A Brief History of Limb Lengthening.

    Science.gov (United States)

    Birch, John G

    2017-09-01

    In the last 35 years, orthopaedic surgeons have witnessed 3 major advances in the technique of limb lengthening: "distraction osteogenesis" facilitated by Gavriil Ilizarov method and infinitely-adaptable circular fixator with fine-wire bone fragment fixation; the introduction of the "6-strut" computer program-assisted circular fixators to effect complex deformity correction simultaneously; and the development of motorized intramedullary lengthening nails. However, the principles and associated complications of these techniques are on the basis of observations by Codivilla, Putti, and Abbott from as much as 110 years ago. This review notes the contribution of these pioneers in limb lengthening, and the contribution of Thor Heyerdahl principles of tolerance and diversity to the dissemination of Ilizarov principles to the Western world.

  12. Intra-limb coordinative adaptations in cycling.

    Science.gov (United States)

    Sides, Deborah; Wilson, Cassie

    2012-03-01

    This study aimed to establish the nature of lower extremity intra-limb coordination variability in cycling and to investigate the coordinative adaptations that occur in response to changes in cadence and work rate. Six trained and six untrained males performed nine pedalling bouts on a cycle ergometer at various cadences and work rates (60, 90, and 120 revolutions per minute (rpm) at 120, 210, and 300W). Three-dimensional kinematic data were collected and flexion/extension angles of the ankle, knee, and hip joints were subsequently calculated. These data were used to determine two intra-limb joint couplings [hip flexion/extension-knee flexion/extension (HK) and knee flexion/extension-ankle plantar-flexion/dorsi-flexion (KA)], which were analysed using continuous relative phase analysis. Trained participants displayed significantly (p cycling is necessary before any recommendations can be made.

  13. Limb-shaking transient ischemic attack

    Directory of Open Access Journals (Sweden)

    Abhijit Das

    2013-01-01

    Full Text Available Limb shaking Transient Ischemic Attack is a rare manifestation of carotid-occlusive disease. The symptoms usually present with seizure like activity and often misdiagnosed as focal seizures. Only on careful history the important clinical clues-which may help in differentiating from seizure-are revealed: Lack of Jacksonian march or aura; precipitation by maneuvers that lead to carotid compression. We present the case of an elderly gentleman with recurrent limb shaking transient ischemic attacks that was initially diagnosed as a case of epilepsy. His symptoms responded to optimization of blood pressure. The case report highlights the importance of accurate diagnosis as the treatment of the associated carotid artery occlusion may not only abolish the attacks but also reduce the risk of future stroke.

  14. Limb conservation using non vascularised fibular grafts.

    Science.gov (United States)

    Omololu, B; Ogunlade, S O; Alonge, T O

    2002-01-01

    This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option of an amputation especially where there is no access to microvascular surgery and microvascular bone grafting devices. This is a major problem in the West African subregion hence the need for this article. We present illustrative cases of limb conservation in an adult involved in a high velocity trauma and a child with a destructive osteolytic infection culminating in bone loss. The patients are still been followed up in our surgical outpatient clinics.

  15. Emulating Upper Limb Disorder for Therapy Education

    Directory of Open Access Journals (Sweden)

    Noor Ayuni binti Che Zakaria

    2014-11-01

    Full Text Available Robotics not only contributes to the invention of rehabilitation devices, it can also enhance the quality of medical education. In recent years, the use of patient simulators and part-task trainers in the medical education field has brought meaningful improvements in the training of medical practitioners. Nevertheless, in the context of therapy training for upper limb disorders, trainee therapists still have to engage directly with the patients to gain experience of the rehabilitation of physical diseases. In this work, a high-fidelity part-task trainer that is able to reproduce the stiffness of spasticity and rigidity symptoms of the upper limb, such as those observed in post-stroke patients and Parkinson's disease patients, has been developed. Based on the evaluation carried out by two experienced therapists, the developed part-task trainer is able to simulate different patient cases and help trainee therapists gain pre-clinical experience in a safe and intuitive learning environment.

  16. Lethal neonatal short-limbed dwarfism

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ok Hwa; Yim, Chung Ik; Bahk, Yong Whee [Catholic Medical College, Seoul (Korea, Republic of)

    1986-02-15

    We have detailed our experiences on 6 cases of neonatal lethal short-limbed dwarfism and reviewed the articles. They include, achondrogenesis, thanatophoric dysplasia, asphyxiating thoracic dysplasia, osteogenesis imperfect a congenita, and hypophosphatasia lethals. Five babies were born alive but died soon after birth and one was a stillbirth. The main cause of failure to thrive was respiratory insufficiency. Each case was having quite characteristic radiologic findings, even if the general appearances were similar to the achondroplasts clinically. Precise diagnosis is very important for genetic counselling of the parents and alarm to them the possibility of bone dysplasias to the next offsprings. For this purpose, the radiologists play major role for the correct diagnosis. We stress that when the baby is born with short-limbed dwarfism, whole body radiogram should be taken including lateral view and postmortem radiogram is also very precious.

  17. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  18. Isolated limb perfusion with cytostatic drug leakage.

    Science.gov (United States)

    Zarazua, M; Paredes, P; Gahete-Santiago, F; Rull, R; Blasi, A; Balust, J

    2017-07-25

    Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Neural correlates of evoked phantom limb sensations.

    Science.gov (United States)

    Andoh, J; Diers, M; Milde, C; Frobel, C; Kleinböhl, D; Flor, H

    2017-05-01

    Previous work showed the existence of changes in the topographic organization within the somatosensory cortex (SI) in amputees with phantom limb pain, however, the link between nonpainful phantom sensations such as cramping or tingling or the percept of the limb and cortical changes is less clear. We used functional magnetic resonance imaging (fMRI) in a highly selective group of limb amputees who experienced inducible and reproducible nonpainful phantom sensations. A standardized procedure was used to locate body sites eliciting phantom sensations in each amputee. Selected body sites that could systematically evoke phantom sensations were stimulated using electrical pulses in order to induce phasic phantom sensations. Homologous body parts were also stimulated in a group of matched controls. Activations related to evoked phantom sensations were found bilaterally in SI and the intraparietal sulci (IPS), which significantly correlated with the intensity of evoked phantom sensations. In addition, we found differences in intra- and interhemispheric interaction between amputees and controls during evoked phantom sensations. We assume that phantom sensations might be associated with a functional decoupling between bilateral SI and IPS, possibly resulting from transcallosal reorganization mechanisms following amputation. Copyright © 2017. Published by Elsevier B.V.

  20. OMPS Limb Profiler Instrument Performance Assessment

    Science.gov (United States)

    Jaross, Glen R.; Bhartia, Pawan K.; Chen, Grace; Kowitt, Mark; Haken, Michael; Chen, Zhong; Xu, Philippe; Warner, Jeremy; Kelly, Thomas

    2014-01-01

    Following the successful launch of the Ozone Mapping and Profiler Suite (OMPS) aboard the Suomi National Polar-orbiting Partnership (SNPP) spacecraft, the NASA OMPS Limb team began an evaluation of instrument and data product performance. The focus of this paper is the instrument performance in relation to the original design criteria. Performance that is closer to expectations increases the likelihood that limb scatter measurements by SNPP OMPS and successor instruments can form the basis for accurate long-term monitoring of ozone vertical profiles. The team finds that the Limb instrument operates mostly as designed and basic performance meets or exceeds the original design criteria. Internally scattered stray light and sensor pointing knowledge are two design challenges with the potential to seriously degrade performance. A thorough prelaunch characterization of stray light supports software corrections that are accurate to within 1% in radiances up to 60 km for the wavelengths used in deriving ozone. Residual stray light errors at 1000nm, which is useful in retrievals of stratospheric aerosols, currently exceed 10%. Height registration errors in the range of 1 km to 2 km have been observed that cannot be fully explained by known error sources. An unexpected thermal sensitivity of the sensor also causes wavelengths and pointing to shift each orbit in the northern hemisphere. Spectral shifts of as much as 0.5nm in the ultraviolet and 5 nm in the visible, and up to 0.3 km shifts in registered height, must be corrected in ground processing.

  1. Sports participation of Dutch lower limb amputees.

    Science.gov (United States)

    Bragaru, Mihai; Meulenbelt, Henk E J; Dijkstra, Pieter U; Geertzen, Jan H B; Dekker, Rienk

    2013-12-01

    To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation characteristics, physical limitations, sports participation, skin problems, and prosthesis use. Only data concerning personal and amputation characteristics together with the data concerning sports participation were used for this study. Of the 816 questionnaires received, 780 were suitable for statistical analysis. The mean age of the participants was 59.6 years (SD 14.8), 62% were men and 27% of the amputations was due to vascular diseases or diabetes. Only 15% of all respondents participate in sports at least 5 hours a month. Smoking (odds ratio: 0.55), an age older than 60 (odds ratio: 0.97 per year), and a vascular cause of amputation (odds ratio: 0.42) were negatively associated with sports participation. Less than 15% of the Dutch lower limb amputees participate in sports at least 5 hours per month. Older age, smoking and a vascular cause of amputation have a negative influence on the sports participation of these individuals.

  2. Limb Lengthening in Patients with Achondroplasia.

    Science.gov (United States)

    Park, Kwang-Won; Garcia, Rey-an Niño; Rejuso, Chastity Amor; Choi, Jung-Woo; Song, Hae-Ryong

    2015-11-01

    Although bilateral lower-limb lengthening has been performed on patients with achondroplasia, the outcomes for the tibia and femur in terms of radiographic parameters, clinical results, and complications have not been compared with each other. We proposed 1) to compare the radiological outcomes of femoral and tibial lengthening and 2) to investigate the differences of complications related to lengthening. We retrospectively reviewed 28 patients (average age, 14 years 4 months) with achondroplasia who underwent bilateral limb lengthening between 2004 and 2012. All patients first underwent bilateral tibial lengthening, and at 9-48 months (average, 17.8 months) after this procedure, bilateral femoral lengthening was performed. We analyzed the pixel value ratio (PVR) and characteristics of the callus of the lengthened area on serial radiographs. The external fixation index (EFI) and healing index (HI) were computed to compare tibial and femoral lengthening. The complications related to lengthening were assessed. The average gain in length was 8.4 cm for the femur and 9.8 cm for the tibia. The PVR, EFI, and HI of the tibia were significantly better than those of the femur. Fewer complications were found during the lengthening of the tibia than during the lengthening of the femur. Tibial lengthening had a significantly lower complication rate and a higher callus formation rate than femoral lengthening. Our findings suggest that bilateral limb lengthening (tibia, followed by femur) remains a reasonable option; however, we should be more cautious when performing femoral lengthening in selected patients.

  3. Do the eyes scan dream images during rapid eye movement sleep? Evidence from the rapid eye movement sleep behaviour disorder model.

    Science.gov (United States)

    Leclair-Visonneau, Laurène; Oudiette, Delphine; Gaymard, Bertrand; Leu-Semenescu, Smaranda; Arnulf, Isabelle

    2010-06-01

    Rapid eye movements and complex visual dreams are salient features of human rapid eye movement sleep. However, it remains to be elucidated whether the eyes scan dream images, despite studies that have retrospectively compared the direction of rapid eye movements to the dream recall recorded after having awakened the sleeper. We used the model of rapid eye movement sleep behaviour disorder (when patients enact their dreams by persistence of muscle tone) to determine directly whether the eyes move in the same directions as the head and limbs. In 56 patients with rapid eye movement sleep behaviour disorder and 17 healthy matched controls, the eye movements were monitored by electrooculography in four (right, left, up and down) directions, calibrated with a target and synchronized with video and sleep monitoring. The rapid eye movement sleep behaviour disorder-associated behaviours occurred 2.1 times more frequently during rapid eye movement sleep with than without rapid eye movements, and more often during or after rapid eye movements than before. Rapid eye movement density, index and complexity were similar in patients with rapid eye movement sleep behaviour disorder and controls. When rapid eye movements accompanied goal-oriented motor behaviour during rapid eye movement sleep behaviour disorder (e.g. grabbing a fictive object, hand greetings, climbing a ladder), which happened in 19 sequences, 82% were directed towards the action of the patient (same plane and direction). When restricted to the determinant rapid eye movements, the concordance increased to 90%. Rapid eye movements were absent in 38-42% of behaviours. This directional coherence between limbs, head and eye movements during rapid eye movement sleep behaviour disorder suggests that, when present, rapid eye movements imitate the scanning of the dream scene. Since the rapid eye movements are similar in subjects with and without rapid eye movement sleep behaviour disorder, this concordance can be extended

  4. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

    Science.gov (United States)

    Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

    2012-04-01

    The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  5. Phantom limb related phenomena and their rehabilitation after lower limb amputation.

    Science.gov (United States)

    Casale, R; Alaa, L; Mallick, M; Ring, H

    2009-12-01

    This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.

  6. Gray matter changes following limb amputation with high and low intensities of phantom limb pain.

    Science.gov (United States)

    Preissler, Sandra; Feiler, Johanna; Dietrich, Caroline; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2013-05-01

    Limb amputation and chronic phantom limb pain (PLP) are both associated with neural alterations at all levels of the neuraxis. We investigated gray matter volume of 21 upper limb amputees and 14 healthy control subjects. Results demonstrate that amputation is associated with reduced gray matter in areas in the motor cortex representing the amputated limb. Additionally, patients show an increase in gray matter in brain regions that belong to the dorsal and ventral visual stream. We subdivided the patient group into patients with medium to high PLP (HPLP; N = 11) and those with slight PLP (SPLP; N = 10). HPLP patients showed reduced gray matter in brain areas involved in pain processing. SPLP patients showed a significant gray matter increase in regions of the visual stream. Results indicate that all patients may have an enhanced need for visual control to compensate the lack of sensory feedback of the missing limb. As we found these alterations primarily in the SPLP patient group, successful compensation may have an impact on PLP development. Therefore, we hypothesize that visual adaptation mechanisms may compensate for the lack of sensorimotor feedback and may therefore function as a protection mechanism against high PLP development.

  7. Limb-Enhancer Genie: An accessible resource of accurate enhancer predictions in the developing limb.

    Directory of Open Access Journals (Sweden)

    Remo Monti

    2017-08-01

    Full Text Available Epigenomic mapping of enhancer-associated chromatin modifications facilitates the genome-wide discovery of tissue-specific enhancers in vivo. However, reliance on single chromatin marks leads to high rates of false-positive predictions. More sophisticated, integrative methods have been described, but commonly suffer from limited accessibility to the resulting predictions and reduced biological interpretability. Here we present the Limb-Enhancer Genie (LEG, a collection of highly accurate, genome-wide predictions of enhancers in the developing limb, available through a user-friendly online interface. We predict limb enhancers using a combination of >50 published limb-specific datasets and clusters of evolutionarily conserved transcription factor binding sites, taking advantage of the patterns observed at previously in vivo validated elements. By combining different statistical models, our approach outperforms current state-of-the-art methods and provides interpretable measures of feature importance. Our results indicate that including a previously unappreciated score that quantifies tissue-specific nuclease accessibility significantly improves prediction performance. We demonstrate the utility of our approach through in vivo validation of newly predicted elements. Moreover, we describe general features that can guide the type of datasets to include when predicting tissue-specific enhancers genome-wide, while providing an accessible resource to the general biological community and facilitating the functional interpretation of genetic studies of limb malformations.

  8. Ontogenetic changes in limb bone structural proportions in mountain gorillas (Gorilla beringei beringei).

    Science.gov (United States)

    Ruff, Christopher B; Burgess, M Loring; Bromage, Timothy G; Mudakikwa, Antoine; McFarlin, Shannon C

    2013-12-01

    Behavioral studies indicate that adult mountain gorillas (Gorilla beringei) are the most terrestrial of all nonhuman hominoids, but that infant mountain gorillas are much more arboreal. Here we examine ontogenetic changes in diaphyseal strength and length of the femur, tibia, humerus, radius, and ulna in 30 Virunga mountain gorillas, including 18 immature specimens and 12 adults. Comparisons are also made with 14 adult western lowland gorillas (Gorilla gorilla gorilla), which are known to be more arboreal than adult mountain gorillas. Infant mountain gorillas have significantly stronger forelimbs relative to hind limbs than older juveniles and adults, but are nonsignificantly different from western lowland gorilla adults. The change in inter-limb strength proportions is abrupt at about two years of age, corresponding to the documented transition to committed terrestrial quadrupedalism in mountain gorillas. The one exception is the ulna, which shows a gradual increase in strength relative to the radius and other long bones during development, possibly corresponding to the gradual adoption of stereotypical fully pronated knuckle-walking in older juvenile gorillas. Inter-limb bone length proportions show a contrasting developmental pattern, with hind limb/forelimb length declining rapidly from birth to five months of age, and then showing no consistent change through adulthood. The very early change in length proportions, prior to significant independent locomotion, may be related to the need for relatively long forelimbs for climbing in a large-bodied hominoid. Virunga mountain gorilla older juveniles and adults have equal or longer forelimb relative to hind limb bones than western lowland adults. These findings indicate that both ontogenetically and among closely related species of Gorilla, long bone strength proportions better reflect actual locomotor behavior than bone length proportions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Therapeutic effects of hyaluronidase on acquired lymphedema using a newly developed mouse limb model

    Science.gov (United States)

    Roh, Kangsan; Cho, Sungrae; Park, Jae-hyun; Yoo, Byong Chul; Kim, Won-Ki; Kim, Seok-ki; Park, Kyewon; Kang, Hee; Ku, Jin-mo; Yeom, Chang-Hwan; Lee, Kyunghoon

    2017-01-01

    Acquired lymphedema is one of the most dreaded side effects of cancer treatment, such as surgical treatment or irradiation. However, due to the lack of appropriate animal models, there is no effective therapeutic method to cure acquired lymphedema. To develop a reproducible acquired lymphedema animal model, we devised a mouse hind limb model by removing a superficial inguinal lymph node, a popliteal lymph node, a deep inguinal lymph node, and the femoral lymphatic vessel. We measured the volume of lymphedematous leg and observed the change in level of hyaluronic acid (HA) and lymphangiogenic factors after injecting hyaluronidase. Our model showed the distinguishable swelling and the reliable symptoms compared to previously reported models. In the lymphedematous regions of our model, we confirmed that HA, a major component of extracellular matrix, accumulated to higher levels than in a normal mouse. This lymphedema volume was rapidly reduced by treating hyaluronidase. Following hyaluronidase injection, the lymphedematous region of our model resembled a normal hind limb. Our findings indicated that hyaluronidase promoted lymphangiogenesis on the lymphedematous limb. Based on hyaluronidase treatment in the lymphedematous region, this could potentially be a new therapeutic approach for acquired lymphedema mediated through the modification of the size of HA fragments. Impact statement In this manuscript, the essence of the work described in this manuscript involves the development of (1) a mouse limb model showing acquired lymphedema and (2) a potent therapeutic treatment using hyaluronidase to remedy acquired lymphedema in our model. In order to develop a reproducible acquired lymphedema animal model that reflects the most common symptoms experienced by lymphedema patients, we devised a mouse hind limb model by removing lymph nodes and lymphatics. Our model showed the distinguishable swelling and the reliable symptoms compared to previously reported models. In the

  10. Slower lower limb blood pooling in young women with orthostatic intolerance.

    Science.gov (United States)

    Lindenberger, Marcus; Länne, Toste

    2015-01-01

    What is the central question of this study? Orthostatic stress is mostly caused by venous blood pooling in the lower limbs. Venous distension elicits sympathetic responses, and increased distension speed enhances the cardiovascular response. We examine whether lower limb blood pooling rate during lower body negative pressure is linked to orthostatic intolerance. What is the main finding and its importance? A similar amount of blood was pooled in the lower limb, but at a slower rate in women who developed signs of orthostatic intolerance. The difference in blood pooling rate increased with orthostatic stress and was most prominent at a presyncope-inducing level of lower body negative pressure. The findings have implications for the pathophysiology as well as treatment of orthostatic intolerance. Vasovagal syncope is common in young women, but its aetiology remains elusive. Orthostatic stress-induced lower limb blood pooling is linked with central hypovolaemia and baroreceptor unloading. Venous distension in the arm elicits a sympathetic response, which is enhanced with more rapid distension. Our aim was to study both the amount and the speed of lower limb pooling during orthostatic stress and its effects on compensatory mechanisms to maintain cardiovascular homeostasis in women with orthostatic intolerance. Twenty-seven healthy women, aged 20-27 years, were subjected to a lower body negative pressure (LBNP) of 11-44 mmHg. Five women developed symptoms of vasovagal syncope (orthostatic intolerant) and were compared with the remaining women, who tolerated LBNP well (orthostatic tolerant). Lower limb blood pooling, blood flow and compensatory mobilization of venous capacitance blood were measured. Lower body negative pressure induced equal lower limb blood pooling in both groups, but at a slower rate in orthostatic intolerant women (e.g. time to 50% of total blood pooling, orthostatic intolerant 44 ± 7 s and orthostatic tolerant 26 ± 2 s; P intolerant women (P = 0

  11. Effects of adolescent onset voluntary drinking followed by ethanol vapor exposure on subsequent ethanol consumption during protracted withdrawal in adult Wistar rats.

    Science.gov (United States)

    Criado, Jose R; Ehlers, Cindy L

    2013-01-01

    Epidemiological studies have demonstrated that heavy drinking and alcohol abuse and dependence peak during the transition between late adolescence and early adulthood. The objective of the present study was to determine whether a model of early onset adolescent ethanol drinking exposure that is followed by an ethanol vapor regimen during late adolescence and young adulthood leads to an increase in drinking in adulthood. In this model, initiation of voluntary ethanol drinking in adolescence, using a sweetened solution, was followed by an 8-wk intermittent ethanol vapor regimen in Wistar rats. A limited-access two-bottle choice paradigm was then used to measure intake of a 10% (w/v) ethanol solution. No differences in water intake (g/kg), total fluid intake (ml/kg) and body weight (g) were observed between air-exposed and ethanol-vapor exposed groups during the pre-vapor and post-vapor phases. The 8 weeks of ethanol vapor exposure was found to produce only a modest, but statistically significant, elevation of ethanol intake during the protracted withdrawal period, compared to air-exposed rats. A significant increase in ethanol preference ratio was also observed in ethanol-vapor exposed rats during the sucrose-fading phase, but not during the protracted withdrawal period. The findings from the present study suggest that in addition to alcohol exposure, environmental variables that impact appetitive as well as consumptive behaviors may be important in developing robust drinking effects that model, in animals, the increased risk for alcohol dependence seen in some human adolescents who begin drinking at an early age. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    Science.gov (United States)

    Li, Shengai; Melton, Danielle H; Li, Sheng

    2015-01-01

    Purpose To examine whether there is central sensitization in patients with phantom limb pain (PLP) after traumatic limb amputation. Methods Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST), and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results The novel findings included: 1) electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2) EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. PMID:25945065

  13. Phantom Limbs, Neuroprosthetics, and the Developmental Origins of Embodiment.

    Science.gov (United States)

    Blumberg, Mark S; Dooley, James C

    2017-10-01

    Amputees who wish to rid themselves of a phantom limb must weaken the neural representation of the absent limb. Conversely, amputees who wish to replace a lost limb must assimilate a neuroprosthetic with the existing neural representation. Whether we wish to remove a phantom limb or assimilate a synthetic one, we will benefit from knowing more about the developmental process that enables embodiment. A potentially critical contributor to that process is the spontaneous activity - in the form of limb twitches - that occurs exclusively and abundantly during active (REM) sleep, a particularly prominent state in early development. The sensorimotor circuits activated by twitching limbs, and the developmental context in which activation occurs, could provide a roadmap for creating neuroprosthetics that feel as if they are part of the body. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Upper and lower limb muscle activation is bidirectionally and ipsilaterally coupled.

    Science.gov (United States)

    Huang, Helen J; Ferris, Daniel P

    2009-09-01

    There are neural connections between the upper and lower limbs of humans that enable muscle activation in one limb pair (upper or lower) to modulate muscle activation in the other limb pair (lower or upper, respectively). The aims of this study were to extend previous findings regarding submaximal exercise to maximal effort exercise and determine whether there is an ipsilateral or contralateral bias to the neural coupling during a rhythmic locomotor-like task. We measured upper and lower limb muscle activity, joint kinematics, and limb forces in neurologically intact subjects (n = 16) as they performed recumbent stepping using different combinations of upper and lower limb efforts. We found increased muscle activation in passive lower limbs during active upper limb effort compared with passive upper limb effort. Likewise, increased muscle activation in passive upper limbs occurred during active lower limb effort compared with passive lower limb effort, suggesting a bidirectional effect. Maximal muscle activation in the active lower limbs was not different between conditions with active upper limb effort and conditions with passive upper limb movement. Similarly, maximal muscle activation in the active upper limbs was not different between conditions with active lower limb effort and conditions with passive lower limb movement. Further comparisons revealed that neural coupling was primarily from active upper limb muscles to passive ipsilateral lower limb muscles. These findings indicate that interlimb neural coupling affects muscle recruitment during maximal effort upper and lower limb rhythmic exercise and provides insight into the architecture of the neural coupling.

  15. Asteroid Ida - Limb at Closest Approach

    Science.gov (United States)

    1994-01-01

    The Galileo imaging system captured this picture of the limb of the asteroid 243 Ida about 46 seconds after its closest approach on August 28, 1993, from a range of only 2480 kilometers. It is the highest-resolution image of an asteroid's surface ever captured and shows detail at a scale of about 25 meters per pixel. This image is one frame of a mosaic of 15 frames shuttered near Galileo's closest approach to Ida. Since the exact location of Ida in space was not well-known prior to the Galileo flyby, this mosaic was estimated to have only about a 50 percent chance of capturing Ida. Fortunately, this single frame did successfully image a part of the sunlit side of Ida. The area seen in this frame shows some of the same territory seen in a slightly lower resolution full disk mosaic of Ida returned from the spacecraft in September, 1993, but from a different perspective. Prominent in this view is a 2 kilometer deep 'valley' seen in profile on the limb. This limb profile and the stereoscopic effect between this image and the full disk mosaic will permit detailed refinement of Ida's shape in this region. This high resolution view shows many small craters and some grooves on the surface of Ida, which give clues to understanding the history of this heavily impacted object. The Galileo project, whose primary mission is the exploration of the Jupiter system in 1995-97, is managed for NASA's Office of Space Science by the Jet Propulsion Laboratory.

  16. Lower limb amputations in Trondheim, Norway

    Science.gov (United States)

    2010-01-01

    Background and purpose In the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later. Patients and methods In 2004–07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994–1997. From 1996 through 2006, we registered the activity of the diabetic foot team and we also registered the number of vascular procedures performed on citizens of Trondheim from 1998 through 2006. Results Comparing the two 3-year periods 1994–97 and 2004–07, we observed a decrease in all non-traumatic LLAs. The incidence of diabetic major LLAs per 103 diabetics per year decreased from 4.0 to 2.4, and in patients with peripheral vascular disease we observed a decrease in LLAs from 18 to 12 per 105 inhabitants per year. 5,915 consultations on diabetic subjects were conducted by the diabetic foot team during the period 1996–2006. From 1998 to 2006, the rate of vascular procedures decreased in the non-diabetic population, and was unchanged in diabetic subjects. Interpretation In the population of Trondheim city there appears to have been a reduction in the rate of vascular obstructive lower-limb disease between the two 3-year periods 1994–97 and 2004–07. In our judgment, the decline in diabetic LLA also reflects better care of the diabetic foot. PMID:20860446

  17. Possibilities of prosthetic upper limb fitting in cycling

    OpenAIRE

    Doležalová, Hana

    2011-01-01

    Bachelor thesis give an overview of possible solutions in upper limbs prosthetic fitting which is suitable for cycling. And provide enough information on modifications that should be performed on a bicycle so that it can be used by humans with upper extremity prostheses. It can be an essential guide for anyone looking for a solution that would allow a person with an amputated upper limb again sit on the bike. Keywords: amputation, upper limb prosthesis, prosthetic fitting, cycling

  18. Compressive neuropathy in the upper limb

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

    Full Text Available Entrampment neuropathy or compression neuropathy is a fairly common problem in the upper limb. Carpal tunnel syndrome is the commonest, followed by Cubital tunnel compression or Ulnar Neuropathy at Elbow. There are rarer entities like supinator syndrome and pronator syndrome affecting the Radial and Median nerves respectively. This article seeks to review comprehensively the pathophysiology, Anatomy and treatment of these conditions in a way that is intended for the practicing Hand Surgeon as well as postgraduates in training. It is generally a rewarding exercise to treat these conditions because they generally do well after corrective surgery. Diagnostic guidelines, treatment protocols and surgical technique has been discussed.

  19. Compressive neuropathy in the upper limb

    Science.gov (United States)

    Thatte, Mukund R.; Mansukhani, Khushnuma A.

    2011-01-01

    Entrampment neuropathy or compression neuropathy is a fairly common problem in the upper limb. Carpal tunnel syndrome is the commonest, followed by Cubital tunnel compression or Ulnar Neuropathy at Elbow. There are rarer entities like supinator syndrome and pronator syndrome affecting the Radial and Median nerves respectively. This article seeks to review comprehensively the pathophysiology, Anatomy and treatment of these conditions in a way that is intended for the practicing Hand Surgeon as well as postgraduates in training. It is generally a rewarding exercise to treat these conditions because they generally do well after corrective surgery. Diagnostic guidelines, treatment protocols and surgical technique has been discussed. PMID:22022039

  20. UPPER LIMB FUNCTIONAL ASSESSMENT USING HAPTIC INTERFACE

    Directory of Open Access Journals (Sweden)

    Aleš Bardorfer

    2004-12-01

    Full Text Available A new method for the assessment of the upper limb (UL functional state, using a haptic interface is presented. A haptic interface is used as a measuring device, capable of providing objective, repeatable and quantitative data of the UL motion. A patient is presented with a virtual environment, both graphically via a computer screen and haptically via the Phantom Premium 1.5 haptic interface. The setup allows the patient to explore and feel the virtual environment with three of his/her senses; sight, hearing, and most important, touch. Specially designed virtual environments are used to assess the patient’s UL movement capabilities. The tests range from tracking tasks – to assess the accuracy of movement – tracking tasks with added disturbances in a form of random forces – to assess the patient’s control abilities, a labyrinth test – to assess both speed and accuracy, to the last test for measuring the maximal force capacity of the UL.A new method for the assessment of the upper limb (UL functional state, using a haptic interface is presented. A haptic interface is used as a measuring device, capable of providing objective, repeatable and quantitative data of the UL motion. A patient is presented with a virtual environment, both graphically via a computer screen and haptically via the Phantom Premium 1.5 haptic interface. The setup allows the patient to explore and feel the virtual environment with three of his/her senses; sight, hearing, and most important, touch. Specially designed virtual environments are used to assess the patient’s UL movement capabilities. The tests range from tracking tasks–to assess the accuracy of movement-tracking tasks with added disturbances in a form of random forces-to assess the patient’s control abilities, a labyrinth test-to assess both speed and accuracy, to the last test for measuring the maximal force capacity of the UL.A comprehensive study, using the developed measurement setup within the

  1. The role of limb perfusion studies in the paediatric ischaemic limb

    African Journals Online (AJOL)

    All the studies were recorded on a Philips Axis Dual Head camera, previously known as Picker .... 1 arm, 2 hands. Technical di culties: 4 hands. Fig. 5. Correlation between clinical, scan and surgical findings. Fig. 4. Transmission images of the upper limbs of the same patient as in Figs. 1, 2 and 3. The black arrows indicate ...

  2. Prenatal imaging of distal limb abnormalities using OCT in mice

    Science.gov (United States)

    Larina, Irina V.; Syed, Saba H.; Dickinson, Mary E.; Overbeek, Paul; Larin, Kirill V.

    2012-01-01

    Congenital abnormalities of the limbs are common birth defects. These include missing or extra fingers or toes, abnormal limb length, and abnormalities in patterning of bones, cartilage or muscles. Optical Coherence Tomography (OCT) is a 3-D imaging modality, which can produce high-resolution (~8 μm) images of developing embryos with an imaging depth of a few millimeters. Here we demonstrate the capability of OCT to perform 3D imaging of limb development in normal embryos and a mouse model with congenital abnormalities. Our results suggest that OCT is a promising tool to analyze embryonic limb development in mammalian models of congenital defects.

  3. Alien limb syndrome secondary to multimodal treatment of recurrent oligodendroglioma.

    Science.gov (United States)

    Gallant, Rachel E; Bonney, Phillip A; Sughrue, Michael E; Bharucha, Kersi J; Battiste, James D

    2015-10-01

    We present a 41-year-old man who experienced alien limb syndrome as a complication of treatment for recurrent Grade III oligodendroglioma of the right parietal lobe. Alien limb syndrome is a rare phenomenon in which a limb performs involuntary actions and the affected individual feels a sense of estrangement towards the limb. It occurs most commonly as a result of corticobasal syndrome, though a variety of other etiologies have been reported. It is rarely associated with focal lesions, such as stroke or tumors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. ATHLETE: A Limbed Vehicle for Solar System Exploration

    Science.gov (United States)

    Wilcox, Brian H.

    2012-01-01

    As part of the Human-Robot Systems project funded by NASA, the Jet Propulsion Laboratory has developed a vehicle called ATHLETE: the All-Terrain Hex-Limbed Extra-Terrestrial Explorer. Each vehicle is based on six wheels at the ends of six multi-degree-of-freedom limbs. Because each limb has enough degrees of freedom for use as a general-purpose leg, the wheels can be locked and used as feet to walk out of excessively soft or other extreme terrain. Since the vehicle has this alternative mode of traversing through or at least out of extreme terrain, the wheels and wheel actuators can be sized for nominal terrain. There are substantial mass savings in the wheel and wheel actuators associated with designing for nominal instead of extreme terrain. These mass savings are comparable-to or larger-than the extra mass associated with the articulated limbs. As a result, the entire mobility system, including wheels and limbs, can be about 25% lighter than a conventional mobility chassis. A side benefit of this approach is that each limb has sufficient degrees-of-freedom to use as a general-purpose manipulator (hence the name "limb" instead of "leg"). Our prototype ATHLETE vehicles have quick-disconnect tool adapters on the limbs that allow tools to be drawn out of a "tool belt" and maneuvered by the limb.

  5. Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction.

    Science.gov (United States)

    van der Merwe, Lana; Birkholtz, Franz; Tetsworth, Kevin; Hohmann, Erik

    2016-08-01

    The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between July 2006 and December 2014, with an age range between 18 and 80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53±10years were interviewed. Six patients had a SIP 10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8±11.5 for the physical component, and 57.4±7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers. Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Motor control over the phantom limb in above-elbow amputees and its relationship with phantom limb pain.

    Science.gov (United States)

    Gagné, M; Reilly, K T; Hétu, S; Mercier, C

    2009-08-04

    Recent evidence shows that the primary motor cortex continues to send motor commands when amputees execute phantom movements. These commands are retargeted toward the remaining stump muscles as a result of motor system reorganization. As amputation-induced reorganization in the primary motor cortex has been associated with phantom limb pain we hypothesized that the motor control of the phantom limb would differ between amputees with and without phantom limb pain. Eight above-elbow amputees with or without pain were included in the study. They were asked to produce cyclic movements with their phantom limb (hand, wrist, and elbow movements) while simultaneously reproducing the same movement with the intact limb. The time needed to complete a movement cycle and its amplitude were derived from the kinematics of the intact limb. Electromyographic (EMG) activity from different stump muscles and from the homologous muscles on the intact side was recorded. Different EMG patterns were recorded in the stump muscles depending on the movement produced, showing that different phantom movements are associated with distinct motor commands. Phantom limb pain was associated with some aspects of phantom limb motor control. The time needed to complete a full cycle of a phantom movement was systematically shorter in subjects without phantom limb pain. Also, the amount of EMG modulation recorded in a stump muscle during a phantom hand movement was positively correlated with the intensity of phantom limb pain. Since phantom hand movement-related EMG patterns in above-elbow stump muscles can be considered as a marker of motor system reorganization, this result indirectly supports the hypothesis that amputation-induced plasticity is associated with phantom limb pain severity. The discordance between the (amputated) hand motor command and the feedback from above-elbow muscles might partially explain why subjects exhibiting large EMG modulation during phantom hand movement have more phantom

  7. The Effect of Core and Lower Limb Exercises on Trunk Strength and Lower Limb Stability on Australian Soldiers

    OpenAIRE

    Rolf Sellentin; Rhondda Jones

    2012-01-01

    Study Design: A before and after design in the collection of data and using analyses of variance to examine the changes in each test score. Objectives: The objectives and hypotheses of this study are: (1) Do specific core exercises, incorporating the lower limbs improve lower limb stability and trunk core muscle strength?; (2) Can the Star Excursion Balance Test be used as a measure of ankle and lower limb stability without a history of ankle instability?; (3) Can static core test...

  8. Upper limb impairments associated with spasticity in neurological disorders

    Directory of Open Access Journals (Sweden)

    Mirbagheri Mehdi M

    2007-11-01

    Full Text Available Abstract Background While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms. Methods We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques. Results Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p Conclusion The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.

  9. Hemiplegic limb synergies in stroke patients.

    Science.gov (United States)

    Welmer, Anna-Karin; Holmqvist, Lotta Widén; Sommerfeld, Disa K

    2006-02-01

    To describe the extent to which the voluntary movements of hemiparetic stroke patients are restricted to the hemiplegic limb synergies (which are marked by the inability to master individual joint movements) described by Brunnström. The study also aimed to describe the extent to which the synergies are related to functioning. In a prospective observational study design, 64 consecutive hemiparetic stroke patients were assessed with Brunnström's hemiplegic limb synergies, the modified Ashworth scale for spasticity, the Rivermead mobility index, and the Barthel ADL index. Three months after stroke, 8 of the 64 patients were moving completely or partly within the synergies. All patients whose movements were restricted to the synergies also exhibited spasticity. Hemiparetic patients whose movements were restricted to the synergies had significantly worse functioning scores than hemiparetic patients whose movements were not restricted to the synergies although severe disabilities were seen in both groups. Three months after stroke, the voluntary movements of only 13% of hemiparetic stroke patients were restricted to the synergies. The synergies were associated with spasticity and activity limitations. The use of the synergies might only be suitable for a small fraction of hemiparetic patients-namely, those displaying spasticity.

  10. A RARE CASE OF ACHONDROPLASIA- SHORT LIMB

    Directory of Open Access Journals (Sweden)

    B. Ravichander

    2017-03-01

    Full Text Available BACKGROUND A 6-year-old boy was presented to the paediatric department with shortening of all the limbs and delay in growth. Clinical examinations revealed height less than third percentile along with other abnormalities like frontal bossing, midfacial hypoplasia, flattened nasal bridge, short neck and rhizomelic type of shortening of all the limbs. These clinical features raised the diagnosis towards achondroplasia, which was further supported by radiologic evidence. Achondroplasia is a disorder involving growth of bone. The conversion of cartilage to bone is hampered. The affection is particularly seen in the long bones of arms and legs. The characterising features of this disorder are dwarfism, limitation in range of motion at the elbows, enlarged size of head, small fingers, but with normal intelligence. Other complications like apnoea, obesity, recurrent ear infections and lordosis of the spine are often associated with achondroplasia. The basic defect in achondroplasia lies in mutations of the FGFR3 gene. It is an autosomal dominant disorder.

  11. Altitude Registration of Limb-Scattered Radiation

    Science.gov (United States)

    Moy, Leslie; Bhartia, Pawan K.; Jaross, Glen; Loughman, Robert; Kramarova, Natalya; Chen, Zhong; Taha, Ghassan; Chen, Grace; Xu, Philippe

    2017-01-01

    One of the largest constraints to the retrieval of accurate ozone profiles from UV backscatter limb sounding sensors is altitude registration. Two methods, the Rayleigh scattering attitude sensing (RSAS) and absolute radiance residual method (ARRM), are able to determine altitude registration to the accuracy necessary for long-term ozone monitoring. The methods compare model calculations of radiances to measured radiances and are independent of onboard tracking devices. RSAS determines absolute altitude errors, but, because the method is susceptible to aerosol interference, it is limited to latitudes and time periods with minimal aerosol contamination. ARRM, a new technique introduced in this paper, can be applied across all seasons and altitudes. However, it is only appropriate for relative altitude error estimates. The application of RSAS to Limb Profiler (LP) measurements from the Ozone Mapping and Profiler Suite (OMPS) on board the Suomi NPP (SNPP) satellite indicates tangent height (TH) errors greater than 1 km with an absolute accuracy of +/-200 m. Results using ARRM indicate a approx. 300 to 400m intra-orbital TH change varying seasonally +/-100 m, likely due to either errors in the spacecraft pointing or in the geopotential height (GPH) data that we use in our analysis. ARRM shows a change of approx. 200m over 5 years with a relative accuracy (a long-term accuracy) of 100m outside the polar regions.

  12. Management of ulcers in lymphoedematous limbs

    Directory of Open Access Journals (Sweden)

    Vishnu M Karnasula

    2012-01-01

    Full Text Available Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care.

  13. Limb salvage: When, where, and how?

    Directory of Open Access Journals (Sweden)

    Ajay Puri

    2015-01-01

    Full Text Available From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.

  14. Radiogrammetric analysis of upper limb long bones

    Directory of Open Access Journals (Sweden)

    Stojanović Zlatan

    2011-01-01

    Full Text Available Radiogrammetry is radiological method of bone mineral density quantification. Besides giving an insight in diagnostics and evolution of metabolic bone disorders (osteoporosis, osteomalacia, osteitis deformans- Paget's disease, it can also explain some specific biomechanical characteristics of bone structures. The aim of this study is to evaluate the significance and perspectives of radiogrammetry as a scientific model for further inquiry of skeletal system. The work demonstrates mathematical parameters (Ca-Cortical area, CI- Cortical index, GI- Garn's index, ESI- Exton Smith's index of upper limb long bones (humerus, radius, ulna. Two standard radiological projections of bones were taken: antero-posterior (AP and latero-lateral (LL. Correlation with metacarpal and lower limb bones was also performed. The value of the cortical area of humerus is significantly higher comparing with the two other examined bones (Xmean 2,2443 cm2, p < 0.01. Radial bone has the highest values of the relational mathematical parameters, which implicates its higher strength by volumetric unit concerning humerus and ulna. Despite the development of contemporary osteometric procedures (ultrasound densitometry, dual X-ray absorptiometry, digital X-ray radiogrammetry, the classical radiogrammetry sustains its important role in diagnostics of metabolic bone disorders and it can be successfully used for biomechanical inquiry of skeletal system.

  15. Altitude registration of limb-scattered radiation

    Science.gov (United States)

    Moy, Leslie; Bhartia, Pawan K.; Jaross, Glen; Loughman, Robert; Kramarova, Natalya; Chen, Zhong; Taha, Ghassan; Chen, Grace; Xu, Philippe

    2017-01-01

    One of the largest constraints to the retrieval of accurate ozone profiles from UV backscatter limb sounding sensors is altitude registration. Two methods, the Rayleigh scattering attitude sensing (RSAS) and absolute radiance residual method (ARRM), are able to determine altitude registration to the accuracy necessary for long-term ozone monitoring. The methods compare model calculations of radiances to measured radiances and are independent of onboard tracking devices. RSAS determines absolute altitude errors, but, because the method is susceptible to aerosol interference, it is limited to latitudes and time periods with minimal aerosol contamination. ARRM, a new technique introduced in this paper, can be applied across all seasons and altitudes. However, it is only appropriate for relative altitude error estimates. The application of RSAS to Limb Profiler (LP) measurements from the Ozone Mapping and Profiler Suite (OMPS) on board the Suomi NPP (SNPP) satellite indicates tangent height (TH) errors greater than 1 km with an absolute accuracy of ±200 m. Results using ARRM indicate a ˜ 300 to 400 m intra-orbital TH change varying seasonally ±100 m, likely due to either errors in the spacecraft pointing or in the geopotential height (GPH) data that we use in our analysis. ARRM shows a change of ˜ 200 m over ˜ 5 years with a relative accuracy (a long-term accuracy) of ±100 m outside the polar regions.

  16. Arterial Stiffness in Lower Limb Amputees

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães

    2011-01-01

    Full Text Available Background A high carotid-femoral pulse wave velocity (PWV has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior ® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively. This difference remained even after adjusting for confounding factors. Conclusion A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees.

  17. Arterial Stiffness in Lower Limb Amputees

    Science.gov (United States)

    Magalhães, Pedro; Capingana, Daniel P.; Silva, Amílcar B.T.; Capunge, Inês R.; Gonçalves, Mauer A.A.

    2011-01-01

    Background: A high carotid-femoral pulse wave velocity (PWV) has been related to increased cardiovascular morbidity and mortality, but has not been previously evaluated in amputees. The aim of this study was to compare PWV between amputees and nonamputees. Methods: In this cross-sectional study, data were collected from 60 male lower limb amputees and 86 male age-matched nonamputees. PWV was measured noninvasively using a Complior® device. All participants underwent laboratory investigations and anthropometry. The difference in PWV between amputee and nonamputees was estimated. Multivariate regression was used to adjust for differences between the groups as a result of potential confounders. Results: PWV was higher in amputees than in nonamputees (10.8 ± 1.9 m/sec versus 9.9 ± 1.8 m/sec, P = 0.008, respectively). This difference remained even after adjusting for confounding factors. Conclusion: A higher PWV was demonstrated in lower limb amputees. Routine assessment of PWV may contribute to cardiovascular risk stratification in amputees. PMID:22084616

  18. Effect of limb immobilization on skeletal muscle

    Science.gov (United States)

    Booth, F. W.

    1982-01-01

    Current knowledge and questions remaining concerning the effects of limb immobilization on skeletal muscle is reviewed. The most dramatic of these effects is muscle atrophy, which has been noted in cases of muscles fixed at or below their resting length. Immobilization is also accompanied by a substantial decrease in motoneuronal discharges, which results in the conversion of slow-twitch muscle to muscle with fast-twitch characteristics. Sarcolemma effects include no change or a decrease in resting membrane potential, the appearance of extrajunctional acetylcholine receptors, and no change in acetylcholinesterase activity. Evidence of changes in motoneuron after hyperpolarization characteristics suggests that the muscle inactivity is responsible for neuronal changes, rather than vice versa. The rate of protein loss from atrophying muscles is determined solely by the first-order rate constant for degradation. Various other biochemical and functional changes have been noted, including decreased insulin responsiveness and protein synthesis. The model of limb immobilization may also be useful for related studies of muscle adaptation.

  19. PARTICIPATORY DESIGN OF PEDIATRIC UPPER LIMB PROSTHESES: QUALITATIVE METHODS AND PROTOTYPING.

    Science.gov (United States)

    Sims, Tara; Cranny, Andy; Metcalf, Cheryl; Chappell, Paul; Donovan-Hall, Maggie

    2017-09-06

    The study aims to develop an understanding of the views of children and adolescents, parents, and professionals on upper limb prosthetic devices to develop and improve device design. Previous research has found that children are dissatisfied with prostheses but has relied heavily on parent proxy reports and quantitative measures (such as questionnaires) to explore their views. Thirty-four participants (eight children aged 8-15 years with upper limb difference, nine parents, eight prosthetists, and nine occupational therapists) contributed to the development of new devices through the BRIDGE methodology of participatory design, using focus groups and interviews. The study identified areas for improving prostheses from the perspective of children and adolescents, developed prototypes based on these and gained feedback on the prototypes from the children and other stakeholders (parents and professionals) of paediatric upper limb prostheses. Future device development needs to focus on ease of use, versatility, appearance, and safety. This study has demonstrated that children and adolescents can and should be involved as equal partners in the development of daily living equipment and that rapid prototyping (three-dimensional printing or additive manufacturing), used within a participatory design framework, can be a useful tool for facilitating this.

  20. Sprint kinematics of athletes with lower-limb amputations.

    Science.gov (United States)

    Buckley, J G

    1999-05-01

    To determine and compare the kinematics of the sound and prosthetic limb in five of the world's best unilateral amputee sprinters. Five men, all unilateral lower-limb amputee (one transfemoral, four transtibial) athletes. The individual with transfemoral amputation used a Endolite Hi-activity prosthesis incorporating a CaTech hydraulic swing and stance control unit, a Flex-Foot Modular III, and an ischial containment total contact socket. Those with transtibial amputations used prostheses incorporating a Flex-Foot Modular III and patellar tendon-bearing socket, with silicone sheath liner (Iceross) and lanyard suspension. Case series. Subjects were videotaped sprinting through a performance area. Sagittal plane lower-limb kinematics derived from manual digitization (at 50 Hz) of the video were determined for three sprint trials of the prosthetic and sound limb. Hip, knee, and ankle kinematics of each subject's sound and prosthetic limb were compared to highlight kinematic alterations resulting from the use of individual prostheses. Comparisons were also made with mean data from five able-bodied men who had similar sprinting ability. Sound limb hip and knee kinematics in all subjects with amputation were comparable to those in able-bodied subjects. The prosthetic knee of the transfemoral amputee athlete fully extended early in swing and remained so through stance. In the transtibial amputee athletes, as in able-bodied subjects, a pattern of stance flexion-extension was evident for both limbs. During stance, prosthetic ankle angles of the transtibial amputee subjects were similar to those of the sound side and those of able-bodied subjects. Prosthetic limb kinematics in transtibial amputee subjects were similar to those for the sound limb, and individuals achieved an "up-on-the-toes" gait typical of able-bodied sprinting. Kinematics for the prosthetic limb of the transfemoral amputee subject were more typical of those seen for walking. This resulted in a sprinting

  1. Transcriptomic insights into the genetic basis of mammalian limb diversity.

    Science.gov (United States)

    Maier, Jennifer A; Rivas-Astroza, Marcelo; Deng, Jenny; Dowling, Anna; Oboikovitz, Paige; Cao, Xiaoyi; Behringer, Richard R; Cretekos, Chris J; Rasweiler, John J; Zhong, Sheng; Sears, Karen E

    2017-03-23

    From bat wings to whale flippers, limb diversification has been crucial to the evolutionary success of mammals. We performed the first transcriptome-wide study of limb development in multiple species to explore the hypothesis that mammalian limb diversification has proceeded through the differential expression of conserved shared genes, rather than by major changes to limb patterning. Specifically, we investigated the manner in which the expression of shared genes has evolved within and among mammalian species. We assembled and compared transcriptomes of bat, mouse, opossum, and pig fore- and hind limbs at the ridge, bud, and paddle stages of development. Results suggest that gene expression patterns exhibit larger variation among species during later than earlier stages of limb development, while within species results are more mixed. Consistent with the former, results also suggest that genes expressed at later developmental stages tend to have a younger evolutionary age than genes expressed at earlier stages. A suite of key limb-patterning genes was identified as being differentially expressed among the homologous limbs of all species. However, only a small subset of shared genes is differentially expressed in the fore- and hind limbs of all examined species. Similarly, a small subset of shared genes is differentially expressed within the fore- and hind limb of a single species and among the forelimbs of different species. Taken together, results of this study do not support the existence of a phylotypic period of limb development ending at chondrogenesis, but do support the hypothesis that the hierarchical nature of development translates into increasing variation among species as development progresses.

  2. A comparison of the moment arms of pelvic limb muscles in horses bred for acceleration (Quarter Horse) and endurance (Arab).

    Science.gov (United States)

    Crook, T C; Cruickshank, S E; McGowan, C M; Stubbs, N; Wilson, A M; Hodson-Tole, E; Payne, R C

    2010-07-01

    Selective breeding for performance has resulted in distinct breeds of horse, such as the Quarter Horse (bred for acceleration) and the Arab (bred for endurance). Rapid acceleration, seen during Quarter Horse racing, requires fast powerful muscular contraction and the generation of large joint torques, particularly by the hind limb muscles. This study compared hind limb moment arm lengths in the Quarter Horse and Arab. We hypothesized that Quarter Horse hind limb extensor muscles would have longer moment arms when compared to the Arab, conferring a greater potential for torque generation at the hip, stifle and tarsus during limb extension. Six Quarter Horse and six Arab hind limbs were dissected to determine muscle moment arm lengths for the following muscles: gluteus medius, biceps femoris, semitendinosus, vastus lateralis, gastrocnemius (medialis and lateralis) and tibialis cranialis. The moment arms of biceps femoris (acting at the hip) and gastrocnemius lateralis (acting at the stifle) were significantly longer in the Quarter Horse, although the length of the remaining muscle moment arms were similar in both breeds of horse. All the Quarter Horse muscles were capable of generating greater muscle moments owing to their greater physiological cross-sectional area (PCSA) and therefore greater isometric force potential, which suggests that PCSA is a better determinant of muscle torque than moment arm length in these two breeds of horse. With the exception of gastrocnemius and tibialis cranialis, the observed muscle fascicle length to moment arm ratio (MFL : MA ratio) was greater for the Arab horse muscles. It appears that the Arab muscles have the potential to operate at slower velocities of contraction and hence generate greater force outputs when compared to the Quarter Horse muscles working over a similar range of joint motion; this would indicate that Arab hind limb muscles are optimized to function at maximum economy rather than maximum power output.

  3. Prenatal MRI evaluation of limb-body wall complex

    Energy Technology Data Exchange (ETDEWEB)

    Aguirre-Pascual, Elisa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Hospital Universitario Doce de Octubre, Department of Radiology, Madrid (Spain); Epelman, Monica [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Nemours Children' s Hospital, Department of Medical Imaging, Orlando, FL (United States); Johnson, Ann M.; Chauvin, Nancy A.; Coleman, Beverly G.; Victoria, Teresa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States)

    2014-11-15

    The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. To characterize the prenatal MRI features of limb-body wall complex. We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management. (orig.)

  4. Claudication of the lower limb: an approach to investigation and ...

    African Journals Online (AJOL)

    PTA), peripheral stent or bypass procedure. Intermittent claudication of the lower limbs. The remainder of this article focuses on patients with PAD and. IC. IC is defined as an exertional symptom affecting muscles of the lower limb secondary to ...

  5. Cell to cell signalling during vertebrate limb bud development

    NARCIS (Netherlands)

    Panman, Lia

    2004-01-01

    Communication between cells is essential during embryonic development. The vertebrate limb bud provides us a model to study signalling interactions between cells during patterning of embryonic tissues and organogenesis. In chapter 1 I give an introduction about limb bud development that is focussed

  6. Sex Differences in Limb and Joint Stiffness in Recreational Runners

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan

    2015-09-01

    Full Text Available Purpose. Female runners are known to be at greater risk from chronic running injuries than age-matched males, although the exact mechanisms are often poorly understood. The aim of the current investigation was to determine if female recreational runners exhibit distinct limb and joint stiffness characteristics in relation to their male counterparts. Methods. Fourteen male and fourteen female runners ran over a force platform at 4.0 m · s-1. Lower limb kinematics were collected using an eight-camera optoelectric motion capture system operating at 250 Hz. Measures of limb and joint stiffness were calculated as a function of limb length and joint moments divided by the extent of limb and joint excursion. All stiffness and joint moment parameters were normalized to body mass. Sex differences in normalized limb and knee and ankle joint stiffness were examined statistically using independent samples t tests. Results. The results indicate that normalized limb (male = 0.18 ± 0.07, female = 0.37 ± 0.10 kN · kg · m-1 and knee stiffness (male = 5.59 ± 2.02, female = 7.34 ± 1.78 Nm · kg · rad-1 were significantly greater in female runners. Conclusions. On the basis that normalized knee and limb stiffness were shown to be significantly greater in female runners, the findings from the current investigation may provide further insight into the aetiology of the distinct injury patterns observed between sexes.

  7. Avoidable birth injury complicated with limb gangrene: a reflection of ...

    African Journals Online (AJOL)

    Gangrene of the lower extremities in neonates is a rare event except in traumatic cases. When risk factors for trauma to the limb of the newborn exist, it is important to prevent such injuries and when they are inevitable, appropriate management of injuries should further prevent complications such as limb gangrene.

  8. Surgical Limb Amputation: A Five-Year Experience At Hilltop ...

    African Journals Online (AJOL)

    BACKGROUND: Limb amputation is one of the oldest and commonest surgical procedures known to man. It is performed by the orthopedic, general, vascular and trauma surgeons. At Hilltop Orthopedic Hospital, Enugu, limb amputation is found prevalent, yet most times it is objectionable to the patient. METHOD: A ...

  9. The effect of transradial coronary catheterization on upper limb function

    NARCIS (Netherlands)

    M.A.H. van Leeuwen (Maarten); N.M. van Mieghem (Nicolas); M.J. Lenzen (Mattie); R.W. Selles (Ruud); M.F. Hoefkens (Mirjam F.); F. Zijlstra (Felix); N. van Royen (Niels)

    2015-01-01

    textabstractObjectives The aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery. Background It is currently unknown if upper limb function is affected by transradial (TR) catheterization. Methods Between

  10. Prenatal MRI evaluation of limb-body wall complex.

    Science.gov (United States)

    Aguirre-Pascual, Elisa; Epelman, Monica; Johnson, Ann M; Chauvin, Nancy A; Coleman, Beverly G; Victoria, Teresa

    2014-11-01

    The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. To characterize the prenatal MRI features of limb-body wall complex. We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management.

  11. Micro-lightguide spectrophotometry for tissue perfusion in ischemic limbs

    DEFF Research Database (Denmark)

    Jørgensen, Lise Pyndt; Schroeder, Torben V

    2012-01-01

    To validate micro-lightguide spectrophotometry (O2C) in patients with lower limb ischemia and to compare results with those obtained from toe blood pressure.......To validate micro-lightguide spectrophotometry (O2C) in patients with lower limb ischemia and to compare results with those obtained from toe blood pressure....

  12. Sonography and risk factors for lower limb deep venous thrombosis ...

    African Journals Online (AJOL)

    Background: Lower limb deep venous thrombosis (DVT), and its sequelae (lower limb chronic venous insufficiency and pulmonary embolism) are now well acknowledged as major haematological problems in the world, for which appropriate and accurate means of diagnosis is necessary. Developments in ultrasound have ...

  13. Lower limb deficient children in the Netherlands : epidemiological aspects

    NARCIS (Netherlands)

    Rijnders, LJM; Boonstra, AM; Groothoff, JW; Cornel, MC; Eisma, WH

    information on the characteristics of children with limb deficiencies and amputations in the Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency

  14. Lower limb fractures in adult patients with residua of poliomyelitis ...

    African Journals Online (AJOL)

    Few studies have been published in the literature regarding fractures of limbs in patients with poliomyelitis. We have conducted a retrospective study from 1992 to 2004 in order to present our data on fractures of lower limbs in adult patients with residua of poliomyelitis. During the thirteen-year period under study, only eight ...

  15. Major upper limb amputation after Snake Bite Gangrene | Ajibade ...

    African Journals Online (AJOL)

    Major lower limb amputations following snake bite gangrene have been reported from the savannah belt of Nigeria. In bites delivered to the upper limb, amputations are often of the digits (minor amputations). We report the case of a male farmer who had an above elbow amputation after a snake bite to the hand. Explanation ...

  16. Major limb amputations in El Obeid Hospital, Western Sudan ...

    African Journals Online (AJOL)

    Objectives: To study the causes and pattern of major limb amputations in El Obeid Hospital, Western Sudan. Patients and methods: The records of 50 major limb amputations performed in patients admitted to the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan in two years were retrospectively studied.

  17. The eventual outcome of patients who had lower limb amputations ...

    African Journals Online (AJOL)

    Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: ...

  18. Early protection and compression of residual limbs may improve and accelerate prosthetic fit: a preliminary study.

    Science.gov (United States)

    Duwayri, Yazan; Vallabhaneni, Raghuveer; Kirby, John P; Mueller, Michael J; Volshteyn, Oksana; Geraghty, Patrick J; Sicard, Gregorio A; Curci, John A

    2012-02-01

    The goal of rehabilitation following lower extremity amputation is to restore the highest level of independent function. As much as possible, this includes the functional use of a prosthetic device fitted to the residual limb. Early prosthetic fit depends, in turn, on rapid healing of the amputation site. We hypothesized that compliance with a novel custom-designed amputation protection and compression system (CAPCS) to the residual limb can accelerate and improve the likelihood of successful prosthesis use. We conducted a retrospective study of all patients who were offered CAPCS by certified prosthetists (Hanger Prosthetics and Orthotics, Bethesda, MD) during the period between April 2004 and November 2009. Variables included age, sex, indication for amputation, and compliance with CAPCS. Compliance was defined as consistent observed wearing of the CAPCS as directed. The primary end point was the fitting of a prosthetic device to the amputated limb, with time to prosthetic fit being the secondary outcome. Out of 100 patients who were offered CAPCS (n = 100) during the study period, 76% were considered compliant (n = 76). Sixty five patients (65%) were ultimately fitted with prosthetic limbs. In multivariate analysis, we found that patients who had compliant use of CAPCS were significantly more likely to be successfully fit with prosthesis (72 vs. 42%, p = 0.005). At 100 days post amputation, the cumulative incidence of prosthesis fitting was significantly higher in CAPCS compliant patients (69.7 vs. 22.2%, p = 0.012). Compliant use of a CAPCS following amputation is associated with earlier and more frequent use of a prosthetic. Based on this limited data set, a conclusion can be drawn that the potential exists to significantly improve functional outcomes after amputation, but well-designed prospective studies are needed to confirm this association. Published by Elsevier Inc.

  19. Distinct patterns of desynchronized limb regression in malagasy scincine lizards (squamata, scincidae.

    Directory of Open Access Journals (Sweden)

    Aurélien Miralles

    Full Text Available Scincine lizards in Madagascar form an endemic clade of about 60 species exhibiting a variety of ecomorphological adaptations. Several subclades have adapted to burrowing and convergently regressed their limbs and eyes, resulting in a variety of partial and completely limbless morphologies among extant taxa. However, patterns of limb regression in these taxa have not been studied in detail. Here we fill this gap in knowledge by providing a phylogenetic analysis of DNA sequences of three mitochondrial and four nuclear gene fragments in an extended sampling of Malagasy skinks, and microtomographic analyses of osteology of various burrowing taxa adapted to sand substrate. Based on our data we propose to (i consider Sirenoscincus Sakata & Hikida, 2003, as junior synonym of Voeltzkowia Boettger, 1893; (ii resurrect the genus name Grandidierina Mocquard, 1894, for four species previously included in Voeltzkowia; and (iii consider Androngo Brygoo, 1982, as junior synonym of Pygomeles Grandidier, 1867. By supporting the clade consisting of the limbless Voeltzkowia mira and the forelimb-only taxa V. mobydick and V. yamagishii, our data indicate that full regression of limbs and eyes occurred in parallel twice in the genus Voeltzkowia (as hitherto defined that we consider as a sand-swimming ecomorph: in the Voeltzkowia clade sensu stricto the regression first affected the hindlimbs and subsequently the forelimbs, whereas the Grandidierina clade first regressed the forelimbs and subsequently the hindlimbs following the pattern prevalent in squamates. Timetree reconstructions for the Malagasy Scincidae contain a substantial amount of uncertainty due to the absence of suitable primary fossil calibrations. However, our preliminary reconstructions suggest rapid limb regression in Malagasy scincids with an estimated maximal duration of 6 MYr for a complete regression in Paracontias, and 4 and 8 MYr respectively for complete regression of forelimbs in

  20. Distinct patterns of desynchronized limb regression in malagasy scincine lizards (squamata, scincidae).

    Science.gov (United States)

    Miralles, Aurélien; Hipsley, Christy A; Erens, Jesse; Gehara, Marcelo; Rakotoarison, Andolalao; Glaw, Frank; Müller, Johannes; Vences, Miguel

    2015-01-01

    Scincine lizards in Madagascar form an endemic clade of about 60 species exhibiting a variety of ecomorphological adaptations. Several subclades have adapted to burrowing and convergently regressed their limbs and eyes, resulting in a variety of partial and completely limbless morphologies among extant taxa. However, patterns of limb regression in these taxa have not been studied in detail. Here we fill this gap in knowledge by providing a phylogenetic analysis of DNA sequences of three mitochondrial and four nuclear gene fragments in an extended sampling of Malagasy skinks, and microtomographic analyses of osteology of various burrowing taxa adapted to sand substrate. Based on our data we propose to (i) consider Sirenoscincus Sakata & Hikida, 2003, as junior synonym of Voeltzkowia Boettger, 1893; (ii) resurrect the genus name Grandidierina Mocquard, 1894, for four species previously included in Voeltzkowia; and (iii) consider Androngo Brygoo, 1982, as junior synonym of Pygomeles Grandidier, 1867. By supporting the clade consisting of the limbless Voeltzkowia mira and the forelimb-only taxa V. mobydick and V. yamagishii, our data indicate that full regression of limbs and eyes occurred in parallel twice in the genus Voeltzkowia (as hitherto defined) that we consider as a sand-swimming ecomorph: in the Voeltzkowia clade sensu stricto the regression first affected the hindlimbs and subsequently the forelimbs, whereas the Grandidierina clade first regressed the forelimbs and subsequently the hindlimbs following the pattern prevalent in squamates. Timetree reconstructions for the Malagasy Scincidae contain a substantial amount of uncertainty due to the absence of suitable primary fossil calibrations. However, our preliminary reconstructions suggest rapid limb regression in Malagasy scincids with an estimated maximal duration of 6 MYr for a complete regression in Paracontias, and 4 and 8 MYr respectively for complete regression of forelimbs in Grandidierina and

  1. Distinct Patterns of Desynchronized Limb Regression in Malagasy Scincine Lizards (Squamata, Scincidae)

    Science.gov (United States)

    Miralles, Aurélien; Hipsley, Christy A.; Erens, Jesse; Gehara, Marcelo; Rakotoarison, Andolalao; Glaw, Frank; Müller, Johannes; Vences, Miguel

    2015-01-01

    Scincine lizards in Madagascar form an endemic clade of about 60 species exhibiting a variety of ecomorphological adaptations. Several subclades have adapted to burrowing and convergently regressed their limbs and eyes, resulting in a variety of partial and completely limbless morphologies among extant taxa. However, patterns of limb regression in these taxa have not been studied in detail. Here we fill this gap in knowledge by providing a phylogenetic analysis of DNA sequences of three mitochondrial and four nuclear gene fragments in an extended sampling of Malagasy skinks, and microtomographic analyses of osteology of various burrowing taxa adapted to sand substrate. Based on our data we propose to (i) consider Sirenoscincus Sakata & Hikida, 2003, as junior synonym of Voeltzkowia Boettger, 1893; (ii) resurrect the genus name Grandidierina Mocquard, 1894, for four species previously included in Voeltzkowia; and (iii) consider Androngo Brygoo, 1982, as junior synonym of Pygomeles Grandidier, 1867. By supporting the clade consisting of the limbless Voeltzkowia mira and the forelimb-only taxa V. mobydick and V. yamagishii, our data indicate that full regression of limbs and eyes occurred in parallel twice in the genus Voeltzkowia (as hitherto defined) that we consider as a sand-swimming ecomorph: in the Voeltzkowia clade sensu stricto the regression first affected the hindlimbs and subsequently the forelimbs, whereas the Grandidierina clade first regressed the forelimbs and subsequently the hindlimbs following the pattern prevalent in squamates. Timetree reconstructions for the Malagasy Scincidae contain a substantial amount of uncertainty due to the absence of suitable primary fossil calibrations. However, our preliminary reconstructions suggest rapid limb regression in Malagasy scincids with an estimated maximal duration of 6 MYr for a complete regression in Paracontias, and 4 and 8 MYr respectively for complete regression of forelimbs in Grandidierina and

  2. Assessment of upper limb musculoskeletal pain and posture in workers of packaging units of pharmaceutical industries.

    Science.gov (United States)

    Labbafinejad, Yasser; Danesh, Hossein; Imanizade, Zahra

    2017-01-01

    Work-related musculoskeletal disorders are defined as the disabling or painful injury to the muscles, nerves or tendons that are caused by work or aggravated by it. Some studies confirm the association between working in packaging units in various industries and the pain in the upper limb, but also there are controversies about the possible risk factors among different working populations. The present study aims to define the potential ergonomic risk factors for musculoskeletal pain in the upper limb. The Nordic Musculoskeletal Questionnaire was used for assessment of the musculoskeletal pain. Some other questions about the possible risk factors were included in the questionnaire. In order to assess posture, rapid upper limb assessment (RULA) test was performed by trained ergonomists. The findings of the study reveals that shoulder pain is associated with work history (P-value = 0.01), smoking (P-value = 0.02), the level of education (P-value = 0.04) and age more than 40 years old (P-value = 0.01). Wrist pain was associated with shiftwork (P-value = 0.04) and especially fixed shiftwork (P-value = 0.04) and also age more than 40(P-value = 0.03) and missed days from work with a cut point of 7 days (P-value = 0.03). After regression, only the work history (OR = 14.4 for 10 to 20 years and OR = 32.2 for more than 20 years) and shiftwork (OR = 2.35) remained statistically significant. In this study, RULA was not associated with symptoms in the upper limb in non-heavy working industries so we do not recommend it for screening purposes. The use of decades of working history and shiftwork can be considered for this purpose in the shoulder and wrist pain respectively.

  3. Robotics in Lower-Limb Rehabilitation after Stroke.

    Science.gov (United States)

    Zhang, Xue; Yue, Zan; Wang, Jing

    2017-01-01

    With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots.

  4. Robotics in Lower-Limb Rehabilitation after Stroke

    Directory of Open Access Journals (Sweden)

    Xue Zhang

    2017-01-01

    Full Text Available With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots.

  5. Robotics in Lower-Limb Rehabilitation after Stroke

    Science.gov (United States)

    2017-01-01

    With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, training paradigm, and control strategy of the lower-limb rehabilitation robots in the reviewed literature. A brief review on the gait detection technology of lower-limb rehabilitation robots is also presented. Finally, we discuss the future directions of the lower-limb rehabilitation robots. PMID:28659660

  6. Closing the gap: Avian lineage splits at a young, narrow seaway imply a protracted history of mixed population response.

    Science.gov (United States)

    Trewick, Steve A; Pilkington, Stephen; Shepherd, Lara D; Gibb, Gillian C; Morgan-Richards, Mary

    2017-10-01

    The evolutionary significance of spatial habitat gaps has been well recognized since Alfred Russel Wallace compared the faunas of Bali and Lombok. Gaps between islands influence population structuring of some species, and flightless birds are expected to show strong partitioning even where habitat gaps are narrow. We examined the population structure of the most numerous living flightless land bird in New Zealand, Weka (Gallirallus australis). We surveyed Weka and their feather lice in native and introduced populations using genetic data gathered from DNA sequences of mitochondrial genes and nuclear β-fibrinogen and five microsatellite loci. We found low genetic diversity among extant Weka population samples. Two genetic clusters were evident in the mtDNA from Weka and their lice, but partitioning at nuclear loci was less abrupt. Many formerly recognized subspecies/species were not supported; instead, we infer one subspecies for each of the two main New Zealand islands. Although currently range restricted, North Island Weka have higher mtDNA diversity than the more wide-ranging southern Weka. Mismatch and neutrality statistics indicate North Island Weka experienced rapid and recent population reduction, while South Island Weka display the signature of recent expansion. Similar haplotype data from a widespread flying relative of Weka and other New Zealand birds revealed instances of North Island-South Island partitioning associated with a narrow habitat gap (Cook Strait). However, contrasting patterns indicate priority effects and other ecological factors have a strong influence on spatial exchange at this scale. © 2017 John Wiley & Sons Ltd.

  7. Post-transplant distal limb syndrome

    Directory of Open Access Journals (Sweden)

    María Florencia Borghi Torzillo

    2017-02-01

    Full Text Available The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013 and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course

  8. User experience of lower-limb orthosis.

    Science.gov (United States)

    Yang, Bing-Shiang; Chen, Yen-Wan; Tong, Ji-Rou

    2017-06-09

    If an assistive device is not acceptable to the user, it will not achieve efficacy and would be resource-wasting. This study employed in-depth interviews to understand what users' individual activities of daily living, problems of using orthoses, and considerations for selecting orthoses are. We conducted qualitative interviews with 35 lower-limb orthosis users, and semi-structured interviews were applied in this study. We analyzed the interview data from transcripts, through coding and concepts, to theories based on grounded theory. The results showed that problems of using orthoses are mostly related to activities of daily living of the user and user's expectation. Therefore, in order to enhance its efficacy and use intention, the design and prescribing process of orthoses need to address the problems in the light of activities of daily living and user education.

  9. Lower limb alignment in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Das S

    2005-01-01

    Full Text Available Background: Spasticity leading to tightness of muscle is disabling. Muscular activity is used for balance of motion and joint alignment rather than weight bearing. Change of joint position interferes with passage of ground reaction force leading to muscle fatigue. During ambulation center of mass changes beyond its range due to so many causes including abnormal hip, knee, ankle and foot motion leading to high energy expenditure. Methods: Three hundred and sixty five lower limbs in 220 patients were operated by various methods described for hip, knee and ankle joint. Results: Results were excellent to fair in two hundred cases and poor in twenty cases. Conclusion: When cases taken up for surgery are selected with proper and repeated assessment, appropriate surgical procedures are performed in time then results of surgery are best in comparison with any other modalities of treatment and also achieved in a short time

  10. Radionuclide multicollector lymphography of the limbs

    Energy Technology Data Exchange (ETDEWEB)

    Sveshnikov, A.A.; Chepelenko, G.V.; Mingazova, N.B. (Kurganskij Nauchno-Issledovatel' skij Inst. Ehksperimental' noj i Klinicheskoj ortopedii i Travmatologii (USSR))

    1984-09-01

    A study was made of the lymph flow rate and accumulation-absorption function of the inguinal and popliteal lymph nodes in healthy persons and in patients with leg and forearm bone fractures. The lymph flow rate in the leg of a healthy person is 9.1-10.8 cm/min, much more in the hip 13.7-16.1 cm/min, in the deep collector it was 2-3 times as less. The lymph flow rate in the forearm is equal 5.6-7.9 cm/min, in the shoulder 7.4-10.0 cm/min. After the fracture the lymph flow rate lessened for a short period of time (up to the 21 st day) in the vessels of the medial leg collector but increased in the lateral and deep collectors. In the upper limb the lymph flow rate decreased in the lateral and increased in the medial collectors.

  11. [Psychotherapies for the Treatment of Phantom Limb Pain].

    Science.gov (United States)

    Cárdenas, Katherine; Aranda, Mariana

    The phantom limb pain has been described as a condition in which patients experience a feeling of itching, spasm or pain in a limb or body part that has been previously amputated. Such pain can be induced by a conflict between the representation of the visual and proprioceptive feedback of the previously healthy limb. The phantom limb pain occurs in at least 42 to 90% of amputees. Regular drug treatment of phantom limb pain is almost never effective. A systematic review of the literature was conducted in Medline and Cochrane using the MESH terms "phantom limb pain" and "psychotherapy", published in the last 10 years, in English and Spanish, finding 49 items. After reviewing the abstracts, 25 articles were excluded for not being related to the objective of the research. Additionally cross references of included articles and literature were reviewed. To describe the psychotherapies used in the management of phantom limb pain, their effectiveness and clinical application reported in the literature. The mechanisms underlying phantom limb pain were initially explained, as were the published studies on the usefulness of some psychotherapies such as mirror visual feedback and immersive virtual reality, visual imagery, desensitization and reprocessing eye movements and hypnosis. The phantom limb pain is a complex syndrome that requires pharmacological and psychotherapeutic intervention. The psychotherapies that have been used the most as adjuvants in the treatment of phantom limb pain are mirror visual feedback, desensitization and reprocessing eye movements, imagery and hypnosis. Studies with more representative samples, specifically randomized trials are required. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  12. Lower limb joint replacement in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Clement Nicholas D

    2012-06-01

    Full Text Available Abstract Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov. We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR and total knee replacement (TKR have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.

  13. MR imaging in congenital lower limb deformities

    Energy Technology Data Exchange (ETDEWEB)

    Laor, T. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Jaramillo, D. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Hoffer, F.A. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Kasser, J.R. [Dept. of Orthopedics, Children`s Hospital and Harvard Medical School, Boston, MA (United States)

    1996-06-01

    Treatment for children with cogenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9 years, mean 2.1 years) with longitudinal and transverse deformities of the lower extremities. The lesions imaged were fibular hemimelia (n=5), tibial hemimelia (n=5), and congenital constriction bands (n=3). Each examination was assessed for abnormalities in the osteocartilaginous and extraosseous (articular or periarticular components such as ligaments, tendons, and menisci; the muscles and the arteries) structures. Abnormalities were seen in all patients. Osteocartilaginous abnormalities in the patients with longitudinal deformities included abnormal distal femoral epiphyses, abnormal proximal tribial physes, hypertrophied and dislocated proximal fibular epiphyses, unsuspected fibular and tibial remnants, and absence or coalition of the tarsal bones. No osteocartilaginous abnormalities were seen in the patients with congential constriction bands. Articular abormalities in patients with either form of hemimelia included absent cruciate ligaments and menisci, dislocated or absent cartilaginous patellae, absent patellar tendons, and abnormal collateral ligaments. All but one limb imaged had absent or attenuated muscle groups. Of the nine MR arteriograms performed at the level of the knee, eight were abnormal. The normal popliteal trifurcation was absent or in an abnormal location. We conclude that MR imaging of children with congenital lower extremity deformities shows many osteochondral and extraosseous abnormalities that are not depicted by conventional radiogrpahy. This information can help to plan early surgical intervention and prosthetic rehabilitation. (orig.)

  14. Technologies Assessing Limb Bradykinesia in Parkinson's Disease.

    Science.gov (United States)

    Hasan, Hasan; Athauda, Dilan S; Foltynie, Thomas; Noyce, Alastair J

    2017-01-01

    The MDS-UPDRS (Movement Disorders Society - Unified Parkinson's Disease Rating Scale) is the most widely used scale for rating impairment in PD. Subscores measuring bradykinesia have low reliability that can be subject to rater variability. Novel technological tools can be used to overcome such issues. To systematically explore and describe the available technologies for measuring limb bradykinesia in PD that were published between 2006 and 2016. A systematic literature search using PubMed (MEDLINE), IEEE Xplore, Web of Science, Scopus and Engineering Village (Compendex and Inspec) databases was performed to identify relevant technologies published until 18 October 2016. 47 technologies assessing bradykinesia in PD were identified, 17 of which offered home and clinic-based assessment whilst 30 provided clinic-based assessment only. Of the eligible studies, 7 were validated in a PD patient population only, whilst 40 were tested in both PD and healthy control groups. 19 of the 47 technologies assessed bradykinesia only, whereas 28 assessed other parkinsonian features as well. 33 technologies have been described in additional PD-related studies, whereas 14 are not known to have been tested beyond the pilot phase. Technology based tools offer advantages including objective motor assessment and home monitoring of symptoms, and can be used to assess response to intervention in clinical trials or routine care. This review provides an up-to-date repository and synthesis of the current literature regarding technology used for assessing limb bradykinesia in PD. The review also discusses the current trends with regards to technology and discusses future directions in development.

  15. Limb apraxia and the 'affordance competition hypothesis'

    Directory of Open Access Journals (Sweden)

    Elisabeth eRounis

    2015-07-01

    Full Text Available Limb apraxia, a disorder of higher order motor control, has long been a challenge for clinical assessment and understanding (Leiguarda and Marsden 2000.The deficits originally described in limb apraxia (Liepmann 1908 have been classified by the nature of the errors made by the patients leading to, namely, ideational and ideomotor apraxia. The dual stream hypothesis (Goodale and Milner 1992 has been used to explain these categories: ideational apraxia is thought to relate to a deficit in the concept of a movement (coded in the ventral stream, whereas ideomotor apraxia, is thought to arise from problems in the accurate implementation of movements within the dorsal stream. One of the limitations on understanding apraxia is the failure by the clinical literature to draw on knowledge of the factors determining actions in the environment. Here we emphasize the role of affordance. There is much recent work indicating that our responses to stimuli are strongly influenced by the actions that the objects ‘afford’, based on their physical properties and the intentions of the actor (e.g, Ellis & Tucker, 1998; Humphreys et al., 2010. The concept of affordance, originally suggested by Gibson (1979 has been incorporated in a recent model of interactive behaviour that draws from findings in non-human primates, namely the ‘affordance competition hypothesis’ (Cisek 2007. This postulates that interactive behaviour arises by a process of competition between possible actions elicited by the environment. In this paper we argue that ‘affordance competition’ may play a role in apraxia. We review evidence that at least some aspects of apraxia may reflect an abnormal sensitivity to competition when multiple affordances are present (Riddoch et al., 1998 and/or a poor ability to exert cognitive control over this competition when it occurs. This framework suggests a new way of conceptualising deficits in apraxia which invites further investigations in the field.

  16. Geographic variation in gorilla limb bones.

    Science.gov (United States)

    Jabbour, Rebecca S; Pearman, Tessa L

    2016-06-01

    Gorilla systematics has received increased attention over recent decades from primatologists, conservationists, and paleontologists. Studies of geographic variation in DNA, skulls, and teeth have led to new taxonomic proposals, such as recognition of two gorilla species, Gorilla gorilla (western gorilla) and Gorilla beringei (eastern gorilla). Postcranial differences between mountain gorillas (G. beringei beringei) and western lowland gorillas (G. g. gorilla) have a long history of study, but differences between the limb bones of the eastern and western species have not yet been examined with an emphasis on geographic variation within each species. In addition, proposals for recognition of the Cross River gorilla as Gorilla gorilla diehli and gorillas from Tshiaberimu and Kahuzi as G. b. rex-pymaeorum have not been evaluated in the context of geographic variation in the forelimb and hindlimb skeletons. Forty-three linear measurements were collected from limb bones of 266 adult gorillas representing populations of G. b. beringei, Gorilla beringei graueri, G. g. gorilla, and G. g. diehli in order to investigate geographic diversity. Skeletal elements included the humerus, radius, third metacarpal, third proximal hand phalanx, femur, tibia, calcaneus, first metatarsal, third metatarsal, and third proximal foot phalanx. Comparisons of means and principal components analyses clearly differentiate eastern and western gorillas, indicating that eastern gorillas have absolutely and relatively smaller hands and feet, among other differences. Gorilla subspecies and populations cluster consistently by species, although G. g. diehli may be similar to the eastern gorillas in having small hands and feet. The subspecies of G. beringei are distinguished less strongly and by different variables than the two gorilla species. Populations of G. b. graueri are variable, and Kahuzi and Tshiaberimu specimens do not cluster together. Results support the possible influence of

  17. Disfunção muscular periférica em DPOC: membros inferiores versus membros superiores Peripheral muscle dysfunction in COPD: lower limbs versus upper limbs

    Directory of Open Access Journals (Sweden)

    Eduardo Foschini Miranda

    2011-06-01

    unsupported upper limbs and two mechanisms have been proposed to explain this fact: neuromechanical dysfunction of respiratory muscles; and changes in lung volume during such activities. The neuromechanical dysfunction seen in COPD patients during this type of exercise is related to changes in the breathing pattern, as well as to the simultaneity of afferent and efferent muscle stimuli, resulting in respiratory muscle asynchrony. In addition, the increased ventilation during upper limb exercise in patients with COPD leads to dynamic hyperinflation at different workloads. During lower limb exercises, the strength and endurance of the quadriceps muscle is lower in COPD patients than in healthy subjects. This could by explained by abnormal muscle metabolism (decreased aerobic capacity, dependence on glycolytic metabolism, and rapid accumulation of lactate during exercise. In comparison with lower limb exercises, upper limb exercises result in higher metabolic and ventilatory demands, as well as in a more intense sensation of dyspnea and greater fatigue. Because there are differences between the upper and lower limb muscles in terms of the morphological and functional adaptations in COPD patients, specific protocols for strength training and endurance should be developed and tested for the corresponding muscle groups

  18. Association between phantom limb complex and the level of amputation in lower limb amputee.

    Science.gov (United States)

    Kelle, Bayram; Kozanoğlu, Erkan; Biçer, Ömer Sunkar; Tan, İsmet

    2017-03-01

    The aim of this study was to evaluate the natural course of phantom limb complex without any treatment after lower limb amputation. The study design was consisted of a combination of retrospective review and cross-sectional interview. 101 patients with lower limb amputation were included into the study. Patients were divided into three groups according to the amputation level: i) from hip disarticulation to knee disarticulation (including knee disarticulation) (25 patients, mean age: 55.9, 19 males, 6 females) ii) transtibial amputation (below knee to ankle including ankle disarticulation) (41 patients, mean age: 58.6, 33 males, 8 females) iii) below ankle to toe amputation (35 patients, mean age: 58.7, 26 males, 9 females). The patients were evaluated on both early postoperative period (EPP) and sixth months after the surgery (ASM). The data related amputation including amputation date, level, cause, stump pain (SP), phantom limb pain (PLP), components of PLP, phantom sensation (PS) were recorded based on the information obtained from patients' and hospital files. Statistically significant differences were found for pain intensity (VAS) between groups for SP and PLP at EPP (p < 0.001, p = 0.036; respectively). The mean VAS score in Group I for SP and PLP was higher than other groups. This differences for SP and PLP did not continue at ASM assessment (p = 0.242, p = 0.580; respectively). VAS scores for SP in above knee amputations and VAS scores for PLP in above knee amputations and below ankle amputations were higher at EPP. But these high scores had disappeared over time. Management strategies have to be considered particularly in the early postoperative period in patients who had undergone above knee amputation. Level III Prognostic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  19. Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital.

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    Sin, Eliza I-Lin; Thong, Sze Ying; Poon, Keah-How

    2013-02-01

    Phantom limb sensations (PLS), phantom limb pain (PLP) and stump pain (SP) are well-recognised postamputation phenomena. However, there is a dearth of related epidemiological data in Asian populations. This study was conducted to fill the information gap. Telephone interviews were conducted with patients who underwent lower limb amputations at a tertiary hospital in Singapore. Information was obtained on phantom limb characteristics, perioperative pain and functional assessment. A total of 159 patients underwent amputations over a 31-month period. At the time of the interview, 47 patients had died and 66 were contactable, of whom 49 patients were interviewed. Of these, 31 (63%) patients experienced PLS. 22 patients had postoperative pain, with 9 having both PLP and SP, 3 having PLP alone and 10 having SP alone. Among the 12 patients with PLP, at least 6 (50%) experienced constant or daily pain and 7 (58%) scored their pain as moderate-to-severe. Among those with PLP and/or SP (n = 22), 5 were distressed by the pain, 11 were on analgesics and 3 received medical follow-up. 7 (32%) patients reported functional limitations secondary to PLP or SP. Altogether, 28 (57%) patients were wheelchair or bed bound. The incidence of PLP was 25% in our cohort. Although this is lower than that reported in other studies, it remains significant, as some patients suffered moderate-to-severe pain. The difference in incidence may be due to differences in the ethnic composition and/or indications for amputation in our group. Follow-up and care could improve the outcomes in these patients.

  20. Comparison of upper limb amputees and lower limb amputees: a psychosocial perspective.

    Science.gov (United States)

    Desteli, E E; İmren, Y; Erdoğan, M; Sarısoy, G; Coşgun, S

    2014-12-01

    Amputation of limb is essential in certain conditions; however, it may have significant impact on the patient's psychological condition. The present study investigates psychological responses of upper limb (UL) amputees versus lower limb (LL) amputees regarding prosthetic adjustment, social discomfort, depression, and body image anxiety. Traumatic major amputations of 20 upper and 38 lower extremities of 58 patients who were currently using prosthesis were included. 12 of UL amputations were of dominantly used limb. Seven of the UL amputations, and nine of the LL amputations were female. The Trinity Amputation and Prosthesis Experience Scales was used for adjustment, restriction, and satisfaction. Anxiety and depression levels were assessed using Hospital Anxiety and Depression Scale (HADS). Body image disturbance and social discomfort were assessed with Amputation Body Image Scale-Revised (ABIS-R) and Social Discomfort Score, respectively. 58 individuals with 20 UL and 38 LL amputations were included. Mean age of UL amputees was 44.76 ± 12.26 and 49.1 ± 14.3 years for LL amputees. Mean time of daily prosthesis use was 11.35 ± 4.8 and 11.52 ± 4.7 h, respectively. Mean time since amputation was 35.4 ± 14.3 and 36.05 ± 13.6 months; length of prosthesis use time was 24.8 ± 13.4 and 23.9 ± 15.12 months, respectively. Social adjustment and adjustment to limitation subscales had significantly higher scores in LL amputees (p body image disturbance for UL amputees (p body image anxiety and social discomfort. Epidemiologic and prognostic study, level III.

  1. Manipulated Changes in Limb Mass and Rotational Inertia in Trotting Dogs (Canis lupus familiaris) and Their Effect on Limb Kinematics.

    Science.gov (United States)

    Kilbourne, Brandon M; Carrier, David R

    2016-12-01

    While the mass distribution of limbs is known to influence the metabolic energy consumed during locomotion, it remains unknown how the mass distribution of limbs may influence overall limb kinematics and whether the influence of limb mass distribution on limb kinematics differs between fore- and hindlimbs. To examine limb mass distribution's influence upon fore- and hindlimb kinematics, temporal stride parameters and swing phase joint kinematics were recorded from four dogs trotting on a treadmill with 0.5% and 1.0% body mass added to each limb, forelimbs alone, and hindlimbs alone, as well as with no added mass. Under all loading conditions, stride period did not differ between fore- and hindlimbs; however, forelimbs exhibited greater duty factors and stance durations, whereas hindlimbs exhibited greater swing durations, which may be related to the hindlimb's greater mass. Changes in forelimb joint and hip range of motion (RoM), flexion, and extension were subject to a high amount of kinematic plasticity among dogs. In contrast, for the knee and ankle, distally loading all four limbs or hindlimbs alone substantially increased joint RoM and flexion. Increased flexion of the knee and ankle has the potential to reduce the hindlimb's rotational inertia during swing phase. The differing response of fore- and hindlimbs with regard to joint kinematics is likely due to differences in their mass and mass distribution and differences in the physiological traits of fore- and hindlimb protractors and joint flexors. © 2017 Wiley Periodicals, Inc.

  2. Measuring Upper Limb Capacity in Patients After Stroke : Reliability and Validity of the Stroke Upper Limb Capacity Scale

    NARCIS (Netherlands)

    Houwink, Annemieke; Roorda, Leo D.; Smits, Wendy; Molenaar, Ivo W.; Geurts, Alexander C.

    Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale. Arch Phys Med Rehabil 2011;92:1418-22. Objective: To investigate the interrater reliability and construct validity of the

  3. Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

    Directory of Open Access Journals (Sweden)

    Ibrahima F

    2014-05-01

    Full Text Available Farikou Ibrahima,1,2 Pius Fokam,2 Félicien Faustin Mouafo Tambo11Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, 2Department of Surgery, Douala General Hospital, Douala, CameroonBackground: We present a case of lengthening of a tibia to treat postosteomyelitis pseudarthrosis and limb length discrepancy by the Ilizarov device.Objective: The objective was to treat the pseudarthrosis and correct the consequent limb length discrepancy of 50 mm.Materials and methods: The patient was a 5-year-old boy. Osteotomy of the tibia, excision of fibrosis, and decortications were carried out. After a latency period of 5 days, the lengthening started at a rate of 1 mm per day.Results: The pseudarthrosis healed and the gained correction was 21.73%. The index consolidation was 49 days/cm. Minor complications were reported.Discussion: Osteomyelitis of long bones is a common poverty-related disease in Africa. The disease usually is diagnosed at an advanced stage with complications. In these conditions, treatment is much more difficult. Most surgical procedures treating this condition use the Ilizarov device. The most common reported surgical complications are refractures and recurrence of infection.Conclusion: This technique should be popularized in countries with limited resources because it would be an attractive alternative to the amputations that are sometimes performed.Keywords: Limb length discrepancy (LLD, bone gap, Ilizarov device

  4. Taenia taeniaeformis in rat favors protracted skin lesions caused by Sporothrix schenckii infection: Dectin-1 and IL-17 are dispensable for clearance of this fungus.

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    Xiaohui Zhang

    Full Text Available We occasionally found that cestode Taenia taeniaeformis in rats favored Sporothrix schenckii infection and survival, causing protracted cutaneous lesions. In this study, we compared the pathology and cytokines profile of rats co-infected with the two pathogens and infected with S. schenckii alone to explore underlying mechanisms. In the co-infection group, there was high expression of β-glucan receptor Dectin-1 in the cutaneous lesions and no multinucleated giant cells, but in the S. schenckii infection group the opposite was observed. Cytokines profiles demonstrated an expected finding that IL-4, commonly expressed in helminth and fungus infection, is undetectable in the two infection groups. In the single fungal infection group, cytokines IFN-γ, IL-10 and IL-17 kept increasing in the first few weeks of infection to a peak which was followed by gradual decrease. This study showed that Dectin-1 and IL-17, which were believed to be the major anti-fungus mechanisms, are Th2 independent and dispensable for clearance of S. schenckii infection, suggesting that S. schenckii has a different molecular recognition pattern and evokes anti-infection mechanisms other than Dectin-1 and IL-17.

  5. Dentoskeletal and soft-tissue changes with cervical headgear and mandibular protraction appliance therapy in the treatment of Class II malocclusions.

    Science.gov (United States)

    Siqueira, Danilo Furquim; de Almeira, Renato Rodrigues; Janson, Guilherme; Brandão, Analu Giampietro; Coelho Filho, Carlos Martins

    2007-04-01

    In this study, we cephalometrically compared changes in the dentoskeletal and soft tissues after orthodontic treatment of Class II Division 1 malocclusions between the cervical headgear (CHG) and the mandibular protraction appliance (MPA) followed by fixed appliances. The sample consisted of 50 patients divided into 2 groups of 25 patients each (13 male, 12 female). Group 1 patients were treated with CHG and fixed appliance, and group 2 patients were treated with the MPA and fixed appliances. The patients were matched according to sex, age, treatment time, and initial cephalometric variables. The groups were compared regarding pretreatment stage and treatment changes, with t tests, at P Class II relationship, decreased facial convexity, extrusion and distalization of the maxillary first molar, and extrusion of the mandibular incisors. The MPA group had statistically greater increases in maxillary length, mandibular protrusion, maxillary incisor retrusion, mesial displacement of the mandibular first molars, and protrusion of the lower lip. The changes in Class II malocclusion correction between the CHG and the MPA were that the CHG corrected the Class II malocclusion primarily through greater action on the maxillary skeletal and dentoalveolar structures as compared with the MPA, which corrected the malocclusion through greater action on the mandibular dentoalveolar structures.

  6. Protraction of whole blood and plasma clot lysis in patients with high levels of an inhibitor of tissue-type plasminogen activator.

    Science.gov (United States)

    Brommer, E J; Boks, A L; Koopman, J; Haverkate, F

    1985-08-01

    The influence of the newly discovered, fast-acting inhibitor of tissue-type plasminogen activator (t-PA) on the lysis time of plasma clots was studied by visual observation of lysis of clotted citrated plasma after addition of purified t-PA. To a series of plasma samples with various concentrations of naturally occurring PA-inhibitor purified t-PA was added to a final concentration, which in pooled normal plasma is sufficient to induce clot lysis within a few hours. In those plasma samples with a high free inhibitor level, determined by measuring the recovery of the activity of added purified t-PA, clot lysis was retarded. Whole blood clots were made by clotting freshly collected non-anticoagulated blood with thrombin after admixture of a trace amount of radiolabeled fibrinogen and a fixed amount of t-PA. Lysis rate, read from the appearance of radioactivity in the serum after centrifugation, was significantly lower in clots obtained from subjects with a high free inhibitor level than in those with a low inhibitor level. It is concluded that the PA-inhibitor protracts clot lysis and may be relevant for physiological fibrinolysis.

  7. A critical review of the protracted domestication model for Near-Eastern founder crops: linear regression, long-distance gene flow, archaeological, and archaeobotanical evidence.

    Science.gov (United States)

    Heun, Manfred; Abbo, Shahal; Lev-Yadun, Simcha; Gopher, Avi

    2012-07-01

    The recent review by Fuller et al. (2012a) in this journal is part of a series of papers maintaining that plant domestication in the Near East was a slow process lasting circa 4000 years and occurring independently in different locations across the Fertile Crescent. Their protracted domestication scenario is based entirely on linear regression derived from the percentage of domesticated plant remains at specific archaeological sites and the age of these sites themselves. This paper discusses why estimates like haldanes and darwins cannot be applied to the seven founder crops in the Near East (einkorn and emmer wheat, barley, peas, chickpeas, lentils, and bitter vetch). All of these crops are self-fertilizing plants and for this reason they do not fulfil the requirements for performing calculations of this kind. In addition, the percentage of domesticates at any site may be the result of factors other than those that affect the selection for domesticates growing in the surrounding area. These factors are unlikely to have been similar across prehistoric sites of habitation, societies, and millennia. The conclusion here is that single crop analyses are necessary rather than general reviews drawing on regression analyses based on erroneous assumptions. The fact that all seven of these founder crops are self-fertilizers should be incorporated into a comprehensive domestication scenario for the Near East, as self-fertilization naturally isolates domesticates from their wild progenitors.

  8. Tactile, thermal, and electrical thresholds in patients with and without phantom limb pain after traumatic lower limb amputation

    Directory of Open Access Journals (Sweden)

    Li S

    2015-04-01

    Full Text Available Shengai Li,1,2 Danielle H Melton,1,2 Sheng Li1,2 1Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA; 2Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA Purpose: To examine whether there is central sensitization in patients with phantom limb pain (PLP after traumatic limb amputation. Methods: Seventeen patients after unilateral lower limb amputation secondary to trauma were enrolled. Ten patients had chronic PLP, while the other seven patients had no PLP. Tactile-sensation threshold, cold- and warm-sensation thresholds, cold- and heat-pain thresholds, electrical-sensation threshold (EST, and electrical-pain threshold on the distal residual limb and the symmetrical site on the sound limb were measured in all tested patients. Their thresholds were compared within the PLP and non-PLP group, and between the groups. Results: The novel findings included: 1 electrical-pain threshold was only decreased in the sound limb in the PLP group and there was no difference between two limbs in the non-PLP group, suggesting central sensitization in patients with PLP; and 2 EST was increased on the affected limb as compared to the sound limb within the PLP group, but there were no significant differences in EST between the PLP and non-PLP group. There were in general no significant differences in other tested thresholds within the groups and between groups. Conclusion: Our results demonstrate central sensitization in the patients with PLP after traumatic limb amputation. Keywords: central sensitization, pain threshold, human

  9. Pharmacologic interventions for treating phantom limb pain.

    Science.gov (United States)

    Alviar, Maria Jenelyn M; Hale, Tom; Dungca, Monalisa

    2016-10-14

    This is an updated version of the original Cochrane review published in Issue 12, 2011. Phantom limb pain (PLP) is pain that arises in the missing limb after amputation and can be severe, intractable, and disabling. Various medications have been studied in the treatment of phantom pain. There is currently uncertainty in the optimal pharmacologic management of PLP. This review aimed to summarise the evidence of effectiveness of pharmacologic interventions in treating PLP. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, and Embase for relevant studies. We ran the searches for the original review in September 2011 and subsequent searches for this update up to April 2016. We sought additional studies from clinical trials databases and reference lists of retrieved papers. We included randomised and quasi-randomised trials studying the effectiveness of pharmacologic interventions compared with placebo, another active treatment, or no treatment, in established PLP. We considered the following outcomes: change in pain intensity, function, sleep, depression or mood, quality of life, adverse events, treatment satisfaction, and withdrawals from the study. We independently assessed issues of study quality and extracted efficacy and adverse event data. Due to the wide variability in the studies, we did not perform a meta-analysis for all the interventions and outcomes, but attempted to pool the results of some studies where possible. We prepared a qualitative description and narrative summary of results. We assessed clinical heterogeneity by making qualitative comparisons of the populations, interventions, outcomes/outcome measures, and methods. We added only one new study with 14 participants to this updated review. We included a 14 studies (10 with low risk of bias and 4 with unclear risk of bias overall) with a total of 269 participants. We added another drug class, botulinum neurotoxins (BoNTs), in

  10. Individual differences in response to phantom limb movement therapy.

    Science.gov (United States)

    McAvinue, Laura P; Robertson, Ian H

    2011-01-01

    Phantom limb pain (PLP) is a distressing condition experienced by many amputees. The purpose of this study was to investigate whether motor imagery could be used to treat PLP. Four single case studies were conducted. The participants kept a pain diary in which they recorded the intensity of their PLP during a baseline period, general motor imagery training, phantom limb movement therapy and a follow-up period. Qualitative and quantitative (i.e. interrupted time series) analyses were employed to determine whether phantom limb movement therapy had a significant effect on PLP intensity. Phantom limb movement therapy significantly reduced intensity of PLP in one participant. One participant gained occasional relief by doing phantom limb movement therapy exercises but did not experience an overall reduction in PLP intensity. The third participant did not experience any relief and the fourth participant reported experiencing the re-emergence of an old pain. The results display individual differences in response to phantom limb movement therapy. Individual differences are discussed in the context of motor imagery ability and the phantom limb phenomenon as a multi-dimensional disorder.

  11. Revealing the invisible: the paradox of picturing a phantom limb.

    Science.gov (United States)

    Schott, G D

    2014-03-01

    Illustrations of phantom limbs are intriguing as they depict an invisible perception. But such illustrations are also important: they provide a form of objectivity to phenomena, which particularly in the past, have often stretched credulity. Acknowledging the paradox of using images to reveal an absent though sensate body part, depictions of phantom limbs are discussed from the neurological perspective, starting with medieval pictures that showed the miraculous restoration of limbs, and which possibly represented pictorial metaphors for a phantom limb. Centuries later, phantom limbs-whether resulting from amputation or deafferentation-became illustrated, and some reasons for their illustration are considered. Although often depicted by others, the most precise and perhaps revealing illustrations of these phantoms have been those made when patients guide the artist, or draw the phantom themselves. In the case of phantom pains, the painful component too is sometimes illustrated, again, as with the miraculous, in metaphorical terms. More recently, depictions of phantoms have also been revealing in studies of some underlying mechanisms of phantom phenomena, notably in demonstrating novel patterns of referred sensations after amputation and attributable to cortical plasticity. Mention is made of photographs of phantom hands visualized using a mirror box, such visualization recalling full circle the miraculous restoration of limbs pictured in the past. The nature of the outline of the phantom is included in a discussion of demarcation of an invisible body part, before concluding that images of phantom limbs provide an invaluable background to understanding and studying these remarkable sensory phenomena.

  12. Brachial plexus block in phantom limb pain: a case report.

    Science.gov (United States)

    Preissler, Sandra; Dietrich, Caroline; Meissner, Winfried; Huonker, Ralph; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas

    2011-11-01

    The purpose of this case report is twofold: first, to present evidence of long-lasting relief in a patient suffering from phantom limb pain after pharmacologically blocking his plexus brachialis and, second, to replicate results from a previous study focusing on cortical reorganization and phantom limb pain. Before regional anesthesia, the patient suffered from a phantom hand that cramped and was immovable. We performed a diagnostic axillary blockade of the brachial plexus to differentiate peripheral from more central contributions to phantom limb pain. During blockade of the brachial plexus, the patient reported a reduction of phantom limb pain for the first time following years of suffering and a complete loss of cramping together with muscle relaxation of the phantom hand. Additionally, we found cortical reorganization in the primary somatosensory cortex (re-reorganization). Strikingly, the relaxed phantom limb together with the reduction of phantom limb pain remained preserved even 6 months after blockade of the brachial plexus. A single temporary blockade of the brachial plexus may relieve phantom limb pain and unpleasant phantom feelings (cramping) for an extended period. Wiley Periodicals, Inc.

  13. Capturing the Perceived Phantom Limb through Virtual Reality

    Directory of Open Access Journals (Sweden)

    Christian Rogers

    2016-01-01

    Full Text Available Phantom limb is the sensation amputees may feel when the missing limb is still attached to the body and is still moving as it would if it still existed. Despite there being between 50 and 80% of amputees who report neuropathic pain, also known as phantom limb pain (PLP, there is still little understanding of why PLP occurs. There are no fully effective long-term treatments available. One of the struggles with PLP is the difficulty for amputees to describe the sensations of their phantom limbs. The sensations may be of a limb that is in a position that is impossible for a normal limb to attain. The goal of this project was to treat those with PLP by developing a system to communicate the sensations those with PLP were experiencing accurately and easily through various hand positions using a model arm with a user friendly interface. The system was developed with Maya 3D animation software, the Leap Motion input device, and the Unity game engine. The 3D modeled arm was designed to mimic the phantom sensation being able to go beyond normal joint extensions of regular arms. The purpose in doing so was to obtain a true 3D visualization of the phantom limb.

  14. OMPS Limb Sensor II: Novel Operations to Fix Data Artifacts

    Science.gov (United States)

    Soo, D.; Leitch, J. W.; Brownsberger, K.; Huang, P.; Draper, D. S.; Jaross, G. R.; Knewtson, R.; Lipscy, S.; Rusling, D.; Stutheit, C.

    2014-12-01

    The OMPS Limb sensor flying on the NPP-Suomi mission measures vertically-resolved limb spectral radiance profiles to derive a high spatial resolution ozone profile. The sensor uses both UV and visible light dispersed by a prism and imaged onto a single CCD to make profile measurements of the Earth limb radiance. The measurement challenges include a wide dynamic range in both spectral and spatial directions and demanding stray light requirements, especially for the UV wavelengths. On NPP, the sensor uses two optical gains (bright and dim limb spectral images) and two integration times (Long and Short) to handle the dynamic range of the limb signal. The sensor also contains precisely-positioned spectral filters at the focal plane to control stray light. The multiple image approach creates noise in retrieved profiles at the bright-dim crossover points. The filters are challenging both in fabrication and in alignment. The proposed operational change for the JPSS2 OMPS Limb sensor eliminates the multiple image approach and reduces stray light levels through use of different images for different wavelength channels. Through use of a stepped integration time scheme and on-board image consolidation, the spectral radiance measurements are improved and more pixels are available for downlink within the allotted data rate. We present the operational concept, results of ground testing using the Limb sensor engineering unit and estimates of expected on-orbit performance.

  15. Changes in involved and uninvolved limb function during rehabilitation after anterior cruciate ligament reconstruction: implications for Limb Symmetry Index measures.

    Science.gov (United States)

    Rohman, Eric; Steubs, J Tyler; Tompkins, Marc

    2015-06-01

    Functional testing is used to assess anterior cruciate ligament (ACL) reconstruction rehabilitation, with the goal of symmetric ability. The pattern of change in the uninvolved limb's function during rehabilitation is not established. (1) Involved and uninvolved limb ability increases during rehabilitation, but the uninvolved limb ability increases to a lesser degree. (2) Hop tests will show larger initial asymmetry and will improve the most with rehabilitation. Cohort study; Level of evidence, 3. This was a retrospective case series of 122 patients who underwent ACL reconstruction at our ambulatory surgery center and received multiple postoperative Standard Functional Tests (SFTs) between October 2009 and October 2013. Ten of the 12 individual tests within the SFT battery were analyzed. The patients' earliest and latest SFTs were compared for changes in Limb Symmetry Index (LSI) and absolute function in each limb. We also analyzed the subgroup with SFTs (n = 38) at both 4 and 6 months postoperatively. In all patients with multiple SFTs, involved limb performance increased in all tests except eyes-closed stork. Uninvolved limb performance increased in 4 SFT component tests and decreased in none. LSI significantly improved in 6 tests, all of which also showed involved limb improvement that was significant. Of these 6 tests, 5 showed initial LSI below 90%: single-leg squat, retro step-up, single-leg hop, crossover triple hop, and timed hop. Retro step-up and single-leg hop showed LSI improvements greater than 10 percentage points. In patients with 4- and 6-month data, involved limb performance increased in all tests except single-leg triple hop. Uninvolved limb performance increased in 5 SFT component tests and decreased in none. LSI significantly improved in 4 tests, all of which had initial LSI below 90%, and showed involved limb improvement that was significant. Retro step-up, single-leg hop, and crossover triple hop showed LSI improvements greater than 10

  16. Delayed amputation following trauma increases residual lower limb infection.

    Science.gov (United States)

    Jain, Abhilash; Glass, Graeme E; Ahmadi, Hootan; Mackey, Simon; Simmons, Jon; Hettiaratchy, Shehan; Pearse, Michael; Nanchahal, Jagdeep

    2013-04-01

    Residual limb infection following amputation is a devastating complication, resulting in delayed rehabilitation, repeat surgery, prolonged hospitalisation and poor functional outcome. The aim of this study was to identify variables predicting residual limb infection following non-salvageable lower limb trauma. All cases of non-salvageable lower limb trauma presenting to a specialist centre over 5 years were evaluated from a prospective database and clinical and management variables correlated with the development of deep infection. Forty patients requiring 42 amputations were identified with a mean age of 49 years (±19.9, 1SD). Amputations were performed for 21 Gustilo IIIB injuries, 12 multi-planar degloving injuries, seven IIIC injuries and one open Schatzker 6 fracture. One limb was traumatically amputated at the scene and surgically revised. Amputation level was transtibial in 32, through-knee in one and transfemoral in nine. Median time from injury to amputation was 4 days (range 0-30 days). Amputation following only one debridement and within 5 days resulted in significantly fewer stump infections (p = 0.026 and p = 0.03, respectively, Fisher's exact test). The cumulative probability of infection-free residual limb closure declined steadily from day 5. Multivariate analyses revealed that neither the nature of the injury nor pre-injury patient morbidity independently influenced residual limb infection. Avoiding residual limb infection is critically dependent on prompt amputation of non-salvageable limbs. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Three-dimensional geometric analysis of felid limb bone allometry.

    Directory of Open Access Journals (Sweden)

    Michael Doube

    Full Text Available Studies of bone allometry typically use simple measurements taken in a small number of locations per bone; often the midshaft diameter or joint surface area is compared to body mass or bone length. However, bones must fulfil multiple roles simultaneously with minimum cost to the animal while meeting the structural requirements imposed by behaviour and locomotion, and not exceeding its capacity for adaptation and repair. We use entire bone volumes from the forelimbs and hindlimbs of Felidae (cats to investigate regional complexities in bone allometry.Computed tomographic (CT images (16435 slices in 116 stacks were made of 9 limb bones from each of 13 individuals of 9 feline species ranging in size from domestic cat (Felis catus to tiger (Panthera tigris. Eleven geometric parameters were calculated for every CT slice and scaling exponents calculated at 5% increments along the entire length of each bone. Three-dimensional moments of inertia were calculated for each bone volume, and spherical radii were measured in the glenoid cavity, humeral head and femoral head. Allometry of the midshaft, moments of inertia and joint radii were determined. Allometry was highly variable and related to local bone function, with joint surfaces and muscle attachment sites generally showing stronger positive allometry than the midshaft.Examining whole bones revealed that bone allometry is strongly affected by regional variations in bone function, presumably through mechanical effects on bone modelling. Bone's phenotypic plasticity may be an advantage during rapid evolutionary divergence by allowing exploitation of the full size range that a morphotype can occupy. Felids show bone allometry rather than postural change across their size range, unlike similar-sized animals.

  18. INCIDENCE OF NEC ROTIZING FASCITIS IN LOWER LIMB CELLLULITIS

    Directory of Open Access Journals (Sweden)

    Oruganti

    2015-10-01

    Full Text Available BACKGROUND: Necrotizing fasciitis (NF is a rare, life - threatening, mixed, synergistic gangrenous bacterial infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous tissue, and superficial fascia. Necrotizing Fasciitis needs e arly diagnosis, immediate extensive surgical debridement, antimicrobial treatment and nutritional support. AIM: This study aims at early detection of Necrotizing Fasciitis by tissue biopsy to enable appropriate management. MATERIALS AND METHODS: Total 29 p atients were included in study taking inclusion and exclusion criteria. To aid in establishment of clinical diagnosis, tissue biopsy from skin and deep soft tissue was taken from the suspected area with induration, erythema or necrosis to confirm histologi cal diagnosis. RESULTS: The incidence of Necrotizing Fasciitis is seen highest in age group 41 to 60 years. Male to Female ratio is 22:7. Most common predisposing factor is minor trauma (44.83% followed by snake bites (24.14%. Average duration between on set of symptoms and first surgery is 3.7days. Klebsiella was the most common microorganism grown on the aerobic culture media. Diabetes (37.93% is the common co - morbid condition came across in this study. Duration of hospital stay is approximately 8 to 6 1 days with an average around 29 days. Mortality rate is 13.8%. CONCLUSION : Necrotizing Fasciitis is a fatal disease and its early recognition is crucial for the outcome. Repeating procedures are often needed in order to check for evidence of progressive t issue necrosis and to remove the source of systemic toxins. It demands decision making, if limb can be salvaged and proceed as required. Mortality is high

  19. Three-dimensional geometric analysis of felid limb bone allometry.

    Science.gov (United States)

    Doube, Michael; Wiktorowicz-Conroy, Alexis; Conroy, Alexis Wiktorowicz; Christiansen, Per; Hutchinson, John R; Shefelbine, Sandra

    2009-01-01

    Studies of bone allometry typically use simple measurements taken in a small number of locations per bone; often the midshaft diameter or joint surface area is compared to body mass or bone length. However, bones must fulfil multiple roles simultaneously with minimum cost to the animal while meeting the structural requirements imposed by behaviour and locomotion, and not exceeding its capacity for adaptation and repair. We use entire bone volumes from the forelimbs and hindlimbs of Felidae (cats) to investigate regional complexities in bone allometry. Computed tomographic (CT) images (16435 slices in 116 stacks) were made of 9 limb bones from each of 13 individuals of 9 feline species ranging in size from domestic cat (Felis catus) to tiger (Panthera tigris). Eleven geometric parameters were calculated for every CT slice and scaling exponents calculated at 5% increments along the entire length of each bone. Three-dimensional moments of inertia were calculated for each bone volume, and spherical radii were measured in the glenoid cavity, humeral head and femoral head. Allometry of the midshaft, moments of inertia and joint radii were determined. Allometry was highly variable and related to local bone function, with joint surfaces and muscle attachment sites generally showing stronger positive allometry than the midshaft. Examining whole bones revealed that bone allometry is strongly affected by regional variations in bone function, presumably through mechanical effects on bone modelling. Bone's phenotypic plasticity may be an advantage during rapid evolutionary divergence by allowing exploitation of the full size range that a morphotype can occupy. Felids show bone allometry rather than postural change across their size range, unlike similar-sized animals.

  20. Weight Change Trajectories After Incident Lower-Limb Amputation.

    Science.gov (United States)

    Bouldin, Erin D; Thompson, Mary Lou; Boyko, Edward J; Morgenroth, David C; Littman, Alyson J

    2016-01-01

    To characterize weight change after amputation by identifying typical weight trajectories in men with incident lower-limb amputation (LLA) and describing characteristics associated with each trajectory. Retrospective cohort study and analyzed using group-based trajectory modeling. Administrative data. Veterans who were men (N=759), living in the Northwest United States, and who had an incident toe, foot, or leg amputation between 1997 and 2008 and at least 18 months of amputation-free survival thereafter. Not applicable. Postamputation weight and body mass index change. The mean weight at baseline was 91.6±24 kg (202±53 lb), and average follow-up was 2.4 years. We identified 4 trajectory groups for weight change: weight loss (13%), stable weight (47%), slow weight gain (33%), and rapid weight gain (7%). Men with a toe or foot amputation most frequently were assigned to the stable weight group (58%), whereas men with transtibial or transfemoral amputations were most commonly assigned to the slow weight gain group (42% each). Men who died during follow-up were more likely to be assigned to the weight loss group (24%) than men who did not die (11%). We identified distinct weight change trajectories that represent heterogeneity in weight change after LLA. An improved understanding of factors predictive of weight gain or loss in people with LLA may help better target rehabilitation and prosthetic prescription. Additional research is needed to fully understand the relation between weight change and health status after amputation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Rapid Prototyping and its Application in Dentistry

    Directory of Open Access Journals (Sweden)

    V. N. V. Madhav

    2013-01-01

    Full Text Available Medical implants and biological models have three main characteristics: low volume, complex shape, and can be customized. These characteristics suit very well with Rapid Prototyping (RP and Rapid Manufacturing (RM processes. RP/RM processes are fabricated part layer- by-layer until complete shape finished from 3D model. Biocompatible materials, such as Titanium and Titanium alloy, Zirconium, Cobalt Chromium, PEEK, etc, are used for fabrication process. Reverse Engineering (RE technology greatly affects RP/RM processes. RE is used to capture or scan image of the limb, cranium, tooth, and other biological objects. Three common methods to get the image are 3D laser scanning, Computer Tomography (CT, and Magnetic Resonance Imaging (MRI. Main RP/RM techniques used in Dentistry are Stereotype Lithography Apparatus (SLA, Fused Deposition Modeling (FDM, Selective Laser Sintering (SLS, and ink jet printing. This article reviews the changing scenario of technology in dentistry with special emphasis on Rapid Prototyping and its various applications in Dentistry.

  2. Comparison of 2-limb versus 3-limb electrodiagnostic studies in the evaluation of chronic inflammatory demyelinating polyneuropathy.

    Science.gov (United States)

    Vo, Mary L; Hanineva, Aneliya; Chin, Russell L; Carey, Bridget T; Latov, Norman; Langsdorf, Jennifer A

    2015-04-01

    European Federation of Neurological Societies/Peripheral Nerve Society electrodiagnostic (EDx) criteria for the definite diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) require the presence of demyelinating findings (DF) in at least 2 nerves. Data are lacking, however, regarding the optimal number of nerves to test. We retrospectively reviewed EDx data from 53 patients with CIDP and compared the number of DF found on 2- and 3-limb testing. A median of 3 (range 2-5) DF were found on 2-limb testing compared with 5 (range 4-7) DF when 3 limbs were evaluated. Two-limb EDx studies were sufficient to diagnose definite CIDP in 92.3% of typical, 84.2% of asymmetric, and 66.7% of distal phenotypes. Testing a third limb increased diagnostic certainty in 11 patients (20.8%) to definite CIDP. Three-limb testing may increase diagnostic sensitivity of definite CIDP, especially in patients with atypical phenotypes. Larger prospective studies are needed to better assess the benefit of performing 3-limb EDx studies. © 2014 Wiley Periodicals, Inc.

  3. Effects of Robot-Assisted Therapy for the Upper Limb After Stroke.

    Science.gov (United States)

    Veerbeek, Janne M; Langbroek-Amersfoort, Anneli C; van Wegen, Erwin E H; Meskers, Carel G M; Kwakkel, Gert

    2017-02-01

    Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and

  4. Cancer cachexia decreases specific force and accelerates fatigue in limb muscle

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, B.M. [1225 Center Drive, HPNP Building Room 1142, Department of Physical Therapy, University of Florida, Gainesville, FL 32610 (United States); Frye, G.S.; Ahn, B.; Ferreira, L.F. [1864 Stadium Road, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32610 (United States); Judge, A.R., E-mail: arjudge@phhp.ufl.edu [1225 Center Drive, HPNP Building Room 1142, Department of Physical Therapy, University of Florida, Gainesville, FL 32610 (United States)

    2013-06-07

    Highlights: •C-26 cancer cachexia causes a significant decrease in limb muscle absolute force. •C-26 cancer cachexia causes a significant decrease in limb muscle specific force. •C-26 cancer cachexia decreases fatigue resistance in the soleus muscle. •C-26 cancer cachexia prolongs time to peak twitch tension in limb muscle. •C-26 cancer cachexia prolongs one half twitch relaxation time in limb muscle. -- Abstract: Cancer cachexia is a complex metabolic syndrome that is characterized by the loss of skeletal muscle mass and weakness, which compromises physical function, reduces quality of life, and ultimately can lead to mortality. Experimental models of cancer cachexia have recapitulated this skeletal muscle atrophy and consequent decline in muscle force generating capacity. However, more recently, we provided evidence that during severe cancer cachexia muscle weakness in the diaphragm muscle cannot be entirely accounted for by the muscle atrophy. This indicates that muscle weakness is not just a consequence of muscle atrophy but that there is also significant contractile dysfunction. The current study aimed to determine whether contractile dysfunction is also present in limb muscles during severe Colon-26 (C26) carcinoma cachexia by studying the glycolytic extensor digitorum longus (EDL) muscle and the oxidative soleus muscle, which has an activity pattern that more closely resembles the diaphragm. Severe C-26 cancer cachexia caused significant muscle fiber atrophy and a reduction in maximum absolute force in both the EDL and soleus muscles. However, normalization to muscle cross sectional area further demonstrated a 13% decrease in maximum isometric specific force in the EDL and an even greater decrease (17%) in maximum isometric specific force in the soleus. Time to peak tension and half relaxation time were also significantly slowed in both the EDL and the solei from C-26 mice compared to controls. Since, in addition to postural control, the oxidative

  5. Rapid Prototyping Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The ARDEC Rapid Prototyping (RP) Laboratory was established in December 1992 to provide low cost RP capabilities to the ARDEC engineering community. The Stratasys,...

  6. Limb salvage treatment vs. amputation in sarcoma

    Directory of Open Access Journals (Sweden)

    Motamedi M

    1993-05-01

    Full Text Available Many years ago the treatment of sarcoma was radiotherapy up to 2000-4000 rad. This treatment was very complicated, due to producing neoplasm after radiotherapy. By this method of treatment of osteosarcoma, the rate of survival became about 20% (two years. The second method of treatment was chemotherapy for a period of 2-5 weeks that amputation was performed afterwards. By chemotherapy, the rate of being alive reached up to 25-27% (five years. Right now, the best treatment for sarcoma is limb salvage. In our report, the chance of being alive in chondrosarcoma was about four years. This was nearly the same as that of the other institutes in the world especially in America, Europe, and Japan. The rate of recurrence was also more than that from different parts of the world. The survival rate in osteosarcomatic patients was about two years less for males the females, and it was more in tall people than short ones. The survival rate of the patients with giant cell tumor was more than osteosarcoma up to five years, and it has no recurrence or metastasis

  7. Geophysical validation of SCIAMACHY Limb Ozone Profiles

    Directory of Open Access Journals (Sweden)

    E. J. Brinksma

    2006-01-01

    Full Text Available We discuss the quality of the two available SCIAMACHY limb ozone profile products. They were retrieved with the University of Bremen IFE's algorithm version 1.61 (hereafter IFE, and the official ESA offline algorithm (hereafter OL versions 2.4 and 2.5. The ozone profiles were compared to a suite of correlative measurements from ground-based lidar and microwave, sondes, SAGE II and SAGE III (Stratospheric Aerosol and Gas Experiment. To correct for the expected Envisat pointing errors, which have not been corrected implicitly in either of the algorithms, we applied a constant altitude shift of -1.5 km to the SCIAMACHY ozone profiles. The IFE ozone profile data between 16 and 40 km are biased low by 3-6%. The average difference profiles have a typical standard deviation of 10% between 20 and 35 km. We show that more than 20% of the SCIAMACHY official ESA offline (OL ozone profiles version 2.4 and 2.5 have unrealistic ozone values, most of these are north of 15° S. The remaining OL profiles compare well to correlative instruments above 24 km. Between 20 and 24 km, they underestimate ozone by 15±5%.

  8. Biomechanics of lower limb haemophilic arthropathy.

    Science.gov (United States)

    Stephensen, David; Drechsler, Wendy I; Scott, Oona M

    2012-09-01

    Intermittent joint bleeding and potential arthropathy remain a concern for patients and those responsible for haemophilic care. Monitoring the status of haemophilic joints is a current challenge. Evaluation of bone and soft tissue with radiological imaging together with clinical joint scoring is often used to monitor haemophilic arthropathy and may not be sufficiently sensitive to early changes in joint morphology. Recently an interest in the biomechanical status of haemophilic joints has emerged. Biomechanics is defined as the interdiscipline that describes, analyses and assesses movement in relation to biological and physical principles. This review considers the biomechanical evaluation of haemophilic joint status of the lower limb with particular reference to the evaluation of muscle atrophy, muscle strength, range of motion and gait as well as the relationship to haemophilic arthropathy. In raising the need for increased clinical awareness, this review highlights the need to establish test-retest and inter-rater reliability and ensuring that comparative studies are undertaken with age-matched unaffected peer groups. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Phantom limb pain: cortical plasticity and novel therapeutic approaches.

    Science.gov (United States)

    Flor, H; Birbaumer, N

    2000-10-01

    Phantom limb pain is still a very frequent consequence of peripheral deafferentation or amputation of a limb. Recent findings from animal and neuroimaging studies suggest that phantom limb pain might be a central phenomenon, related to changes in the cortical, thalamic and spinal representation of the painful limb, and might be a type of somatosensory pain memory. Based on these assumptions, new treatment approaches focus on sensory discrimination training or motor cortex stimulation in an effort to influence cortical reorganization. Prevention of perpetuation of a somatosensory pain memory might also be possible through pharmacological agents such as N-methyl-D-aspartate antagonists and gamma-aminobutyric acid agonists, substances that have been shown to influence and prevent cortical reorganization.

  10. A survey on robotic devices for upper limb rehabilitation

    National Research Council Canada - National Science Library

    Maciejasz, Paweł; Eschweiler, Jörg; Gerlach-Hahn, Kurt; Jansen-Troy, Arne; Leonhardt, Steffen

    2014-01-01

    .... The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing...

  11. Major limb amputations: a tertiary hospital experience in northwestern Tanzania

    National Research Council Canada - National Science Library

    Chalya, Phillipo L; Mabula, Joseph B; Dass, Ramesh M; Ngayomela, Isdori H; Chandika, Alphonce B; Mbelenge, Nkinda; Gilyoma, Japhet M

    2012-01-01

    Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially...

  12. Abnormal facial appearance, body asymmetry, limb deformities, and internal malformations

    NARCIS (Netherlands)

    Oudesluijs, Grétel; Simon, Marleen E. H.; Burggraaf, Rianne H. J.; Waterham, Hans R.; Hennekam, Raoul C. M.

    2012-01-01

    We describe a newborn girl with multiple congenital anomalies and abnormal phenotype comprising underdeveloped corpus callosum with ventriculomegaly, chorioretinal atrophy, pulmonary arterial hypertension, annular pancreas, horseshoe kidney, asymmetric limb and chest anomalies, spinal segmentation

  13. UARS Microwave Limb Sounder (MLS) Level 3AL V001

    Data.gov (United States)

    National Aeronautics and Space Administration — The Microwave Limb Sounder (MLS) Level 3AL data product consists of daily, 4 degree increment latitude-ordered vertical profiles of temperature, geopotential height,...

  14. UARS Microwave Limb Sounder (MLS) Level 3AT V001

    Data.gov (United States)

    National Aeronautics and Space Administration — The Microwave Limb Sounder (MLS) Level 3AT data product consists of daily, 65.536 second interval time-ordered vertical profiles of temperature, geopotential height,...

  15. [Tests of hand functionality in upper limb amputation with prosthesis].

    Science.gov (United States)

    Bazzini, G; Orlandini, D; Moscato, T A; Nicita, D; Panigazzi, M

    2007-01-01

    The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.

  16. Maxillary Protraction With Intermaxillary Elastics to Miniplates Versus Bone-Anchored Face-Mask Therapy in Cleft Lip and Palate Patients.

    Science.gov (United States)

    Jahanbin, Arezoo; Kazemian, Mozhgan; Eslami, Neda; Pouya, Iman Saeedi

    2016-07-01

    Cleft lip and palate patients usually have deficient maxilla due to postsurgical scars. The aim this study was to compare the effectiveness of miniplates-anchored face-mask therapy versus intermaxillary elastics to miniplates for maxillary traction in cleft lip and palate patients. This clinical trial included 11 prepubertal patients with cleft lip and palate. Initially, a w-arch expander was cemented and activated 3 mm per month to overcorrect the crossbite. Then, the patients were divided into 2 groups: mini-plate-anchored face-mask (n = 5): 2 miniplates were placed in the maxilla and the patients were instructed to wear a face-mask for 12 to 14 hours/per day. Intermaxillary elastics to miniplates (n = 6): 2 miniplates were inserted in the maxilla; 1 on each side and 2 miniplates were placed in the anterior mandible on both sides. Intermaxillary elastics with a force of 250 g per side were attached to the hooks. Cephalometric parameters before treatment (T1) and after achieving positive overjet (T2) were compared between the 2 groups. Fisher exact, paired, and independent t tests were used for statistical comparison. At T1 or T2 there was not a significant difference between the 2 groups in the skeletal, dental, and soft tissue variables. According to results of our preliminary study, intermaxillary elastics to miniplates might have a promising effect as an alternative for face mask therapy in maxillary protraction of cleft lip and palate patients.

  17. The fastest runner on artificial legs: different limbs, similar function?

    Science.gov (United States)

    Weyand, Peter G; Bundle, Matthew W; McGowan, Craig P; Grabowski, Alena; Brown, Mary Beth; Kram, Rodger; Herr, Hugh

    2009-09-01

    The recent competitive successes of a bilateral, transtibial amputee sprint runner who races with modern running prostheses has triggered an international controversy regarding the relative function provided by his artificial limbs. Here, we conducted three tests of functional similarity between this amputee sprinter and competitive male runners with intact limbs: the metabolic cost of running, sprinting endurance, and running mechanics. Metabolic and mechanical data, respectively, were acquired via indirect calorimetry and ground reaction force measurements during constant-speed, level treadmill running. First, we found that the mean gross metabolic cost of transport of our amputee sprint subject (174.9 ml O(2)*kg(-1)*km(-1); speeds: 2.5-4.1 m/s) was only 3.8% lower than mean values for intact-limb elite distance runners and 6.7% lower than for subelite distance runners but 17% lower than for intact-limb 400-m specialists [210.6 (SD 13.2) ml O(2)*kg(-1)*km(-1)]. Second, the speeds that our amputee sprinter maintained for six all-out, constant-speed trials to failure (speeds: 6.6-10.8 m/s; durations: 2-90 s) were within 2.2 (SD 0.6)% of those predicted for intact-limb sprinters. Third, at sprinting speeds of 8.0, 9.0, and 10.0 m/s, our amputee subject had longer foot-ground contact times [+14.7 (SD 4.2)%], shorter aerial [-26.4 (SD 9.9)%] and swing times [-15.2 (SD 6.9)%], and lower stance-averaged vertical forces [-19.3 (SD 3.1)%] than intact-limb sprinters [top speeds = 10.8 vs. 10.8 (SD 0.6) m/s]. We conclude that running on modern, lower-limb sprinting prostheses appears to be physiologically similar but mechanically different from running with intact limbs.

  18. Robotics in Lower-Limb Rehabilitation after Stroke

    OpenAIRE

    Xue Zhang; Zan Yue; Jing Wang

    2017-01-01

    With the increase in the elderly, stroke has become a common disease, often leading to motor dysfunction and even permanent disability. Lower-limb rehabilitation robots can help patients to carry out reasonable and effective training to improve the motor function of paralyzed extremity. In this paper, the developments of lower-limb rehabilitation robots in the past decades are reviewed. Specifically, we provide a classification, a comparison, and a design overview of the driving modes, traini...

  19. Musculoskeletal anatomical changes that accompany limb reduction in lizards.

    Science.gov (United States)

    Abdala, Virginia; Grizante, Mariana B; Diogo, Rui; Molnar, Julia; Kohlsdorf, Tiana

    2015-11-01

    Muscles, bones, and tendons in the adult tetrapod limb are intimately integrated, both spatially and functionally. However, muscle and bone evolution do not always occur hand in hand. We asked, how does the loss of limb bones affect limb muscle anatomy, and do these effects vary among different lineages? To answer these questions, we compared limb muscular and skeletal anatomy among gymnophthalmid lizards, which exhibit a remarkable variation in limb morphology and different grades of digit and limb reduction. We mapped the characters onto a phylogeny of the group to assess the likelihood that they were acquired independently. Our results reveal patterns of reduction of muscle and bone elements that did not always coincide and examples of both, convergent and lineage-specific non-pentadactyl musculoskeletal morphologies. Among lineages in which non-pentadactyly evolved independently, the degree of convergence seems to depend on the number of digits still present. Most tetradactyl and tridactyl limbs exhibited profound differences in pattern and degree of muscle loss/reduction, and recognizable morphological convergence occurred only in extremely reduced morphologies (e.g., spike-like appendix). We also found examples of muscles that persisted although the bones to which they plesiomorphically attach had been lost, and examples of muscles that had been lost although their normal bony attachments persisted. Our results demonstrate that muscle anatomy in reduced limbs cannot be predicted from bone anatomy alone, meaning that filling the gap between osteological and myological data is an important step toward understanding this recurrent phenomenon in the evolution of tetrapods. © 2015 Wiley Periodicals, Inc.

  20. Malawer limb salvage surgery for the treatment of scapular chondrosarcoma.

    Science.gov (United States)

    Chang, Fei; Liu, Guang-Yao; Zhang, Qiao; Lin, Gang; Huang, Hong; Duan, De-Sheng; Wang, Jin-Cheng

    2014-06-30

    Chondrosarcoma is a common malignant bone tumor, which accounts for 20% of all malignant bone tumors. It often occurs in the long bones, but the incidence of scapular chondrosarcoma is rare. Here, we describe a case of a large chondrosarcoma occurring in the scapula which was treated with Malawer limb salvage surgery. The patient retained considerable limb function after complete removal of the tumor tissue as assessed at the follow-up visit two years and ten months following surgery.

  1. Upper limb malformations in DiGeorge syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Cormier-Daire, V.; Iserin, L.; Sidi, D. [and others

    1995-03-13

    We report on upper limb anomalies in two children with a complete DiGeorge sequence: conotruncal defects, hypocalcemia, thymic aplasia, and facial anomalies. One child had preaxial polydactyly, and the other had club hands with hypoplastic first metacarpal. In both patients, molecular analysis documented a 22q11 deletion. To our knowledge, limb anomalies have rarely been reported in DiGeorge syndrome, and they illustrate the variable clinical expression of chromosome 22q11 deletions. 13 refs., 2 figs.

  2. Research Priorities in Limb and Task-Specific Dystonias

    Directory of Open Access Journals (Sweden)

    Sarah Pirio Richardson

    2017-05-01

    Full Text Available Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including

  3. Features of manifestation and progression for critical lower limb ischemia in subjects with abdominal aortic calcification: a pilot study

    Directory of Open Access Journals (Sweden)

    V. A. Zelinskiy

    2017-11-01

    Full Text Available Aim. The study was designed to assess the specific features of manifestation and progression for critical low limb ischemia in patients with abdominal aortic calcification. Methods. The total of 151 patients with low limb critical ischemia due to peripheral arterial disease were enrolled to the study cohort: 79 patients (study group with abdominal aortic calcification and 72 patients (control group without any signs of abdominal aortic wall calcification. Abdominal aortic calcification was detected by CT-imaging. The patients with diabetes mellitus and with chronic renal insufficiency were excluded from the study cohort. Results. Critical lower limb ischemia in subjects with abdominal aortic calcification manifested itself in the following features: predominant localization of lesions in the aorto-iliac position (68.4% vs. 33.3% in patients without abdominal aortic calcification; р<0.05, rapid progression of lower limb ischemia (its prevalence in the study group was 77.7% vs. 37.3% in the control group; р<0.01, expressed hypercoagulation combined with a decrease in the level of natural anticoagulants concentration (mean activity of antithrombin III in individuals with abdominal aortic calcification was 56.5±10.4% vs. 98.7±16.4% in patients without abdominal aortic calcification; р<0.001. Conclusion. The study findings have shown that critical lower limb ischemia in subjects with abdominal aortic calcification has specific futures of manifestation and clinical course that need to be considered when choosing the best treatment strategy.Received 24 April 2017. Revised 7 June 2017. Accepted 19 June 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  4. [Evaluation of upper limb load intensity based on biomechanical methods].

    Science.gov (United States)

    Li, H; Li, F; Yan, Q; Wang, Z; Wang, C H

    2017-06-20

    Objective: To establish a model for evaluating the upper limb load intensity of workers based on biomechanical methods, and to verify its effectiveness. Methods: 15 male volunteers participated in lifting test of 3 kinds of external force load in March 2015. Volunteers' operating postures, forces, and subjective load intensities were collected. The biomechanical models of lifting operation were established with the input of operating postures and forces, and to output joint torque of shoulder, elbow and wrist. The simulation results were normalized by the maximum torque of each joint, and the relative joint torque was obtained. Then the upper limb load intensity evaluation model, which related with relative joint torque of shoulder, elbow and wrist, was established based on analytic hierarchy process. In order to validate the validity of the model, the assessment results of the model and the subjective load intensities of the volunteers were contrasted. Results: The weight of shoulder joint (0.56) was larger than the weights of elbow and wrist (0.27 and 0.17) in the influence factors of the upper limb load. Pearson correlation analysis showed that the upper limb load intensities of the model were significantly correlated with the subjective load intensities of volunteers ( r =0.863, P 0.05) . Conclusion: The evaluation model of the upper limb load intensity based on biomechanical methods could be used for predicting and evaluating the upper limb load intensities of workers.

  5. Lower limb movement variability in patients with peripheral arterial disease.

    Science.gov (United States)

    Crowther, Robert G; Spinks, Warwick L; Leicht, Anthony S; Quigley, Frank; Golledge, Jonathan

    2008-10-01

    Peripheral arterial disease is a chronic obstructive disease of the arteries of the lower limb caused by atherosclerosis. The resultant decrease in blood flow can result in symptoms of pain in the lower limb on exercise known as intermittent claudication. Exercise induced pain is experienced in the calves, thigh or buttocks restricting activities of daily living and thus reducing quality of life. This study investigated lower limb movement variability in individuals with peripheral arterial disease-intermittent claudication (n=28) compared to individuals without peripheral arterial disease-intermittent claudication (control, n=25). A further aim was to examine the efficacy of various techniques used to describe single joint movement variability. All participants underwent two-dimensional angular kinematics analysis of the lower limb during normal walking. Single joint movement variability was measured using linear (spanning set and coefficient of variation) techniques. Between group differences were examined by one-way ANOVA. The peripheral arterial disease-intermittent claudication participants displayed significantly higher levels of lower limb movement variability in all joints when assessed using the coefficient of variation technique. There were no significant between group differences using the spanning set technique. Individuals with peripheral arterial disease-intermittent claudication have higher levels of lower limb movement variability and reduced walking speed compared to healthy age and mass matched controls. This variability may be an adaptation to the gradual onset of ischaemic pain in this population.

  6. Tropospheric ozone from SCIAMACHY limb-nadir-measurements

    Energy Technology Data Exchange (ETDEWEB)

    Boetel, Stefan; Ebojie, Felix; Ladstaetter-Weissenmayer, Annette; Savigny, Christian von; Burrows, John P. [Institute of Environmental Physics, University of Bremen, Bremen (Germany)

    2011-07-01

    SCIAMACHY (Scanning Imaging Absorption Spectrometer for Atmospheric Chartography) launched in March 2002 measures sunlight, transmitted, reflected and scattered by the earth atmosphere or surface (240 nm-2380 nm). SCIAMACHY measurements yield the amounts and distribution of O{sub 3}, BrO, OClO, ClO, SO{sub 2}, H{sub 2}CO, NO{sub 2}, CO, CO{sub 2}, CH{sub 4}, H{sub 2}O, N{sub 2}O, p, T, aerosol, radiation, cloud cover and cloud top height in limb as well as nadir mode. With it's collocated limb and nadir measurements limb-nadir-matching can be used to determine tropospheric ozone columns from SCIAMACHY limb and nadir measurements. A comparison of tropospheric ozone columns determined from ozone-sonde measurements with tropospheric ozone columns determined from SCIAMACHY using limb-nadir-matching in various latitude bands. The variability of using limb-nadir-matching to determine global distributions of tropospheric ozone is investigated.

  7. LIMB Demonstration Project Extension and Coolside Demonstration. [Final report

    Energy Technology Data Exchange (ETDEWEB)

    Goots, T.R.; DePero, M.J.; Nolan, P.S.

    1992-11-10

    This report presents results from the limestone Injection Multistage Burner (LIMB) Demonstration Project Extension. LIMB is a furnace sorbent injection technology designed for the reduction of sulfur dioxide (SO{sub 2}) and nitrogen oxides (NO{sub x}) emissions from coal-fired utility boilers. The testing was conducted on the 105 Mwe, coal-fired, Unit 4 boiler at Ohio Edison`s Edgewater Station in Lorain, Ohio. In addition to the LIMB Extension activities, the overall project included demonstration of the Coolside process for S0{sub 2} removal for which a separate report has been issued. The primary purpose of the DOE LIMB Extension testing, was to demonstrate the generic applicability of LIMB technology. The program sought to characterize the S0{sub 2} emissions that result when various calcium-based sorbents are injected into the furnace, while burning coals having sulfur content ranging from 1.6 to 3.8 weight percent. The four sorbents used included calcitic limestone, dolomitic hydrated lime, calcitic hydrated lime, and calcitic hydrated lime with a small amount of added calcium lignosulfonate. The results include those obtained for the various coal/sorbent combinations and the effects of the LIMB process on boiler and plant operations.

  8. The Effectiveness of Intravenous Morphine Infusion as Preemptive Analgesia in Preventing Phantom Limb Pain Following Lower Limb Amputation

    Directory of Open Access Journals (Sweden)

    KC Chong

    2010-11-01

    Full Text Available hantom limb pain may reduce ambulation and mobility in amputees, resulting in diminished quality of life. We conducted a prospective study to compare the perioperative analgesic use of intravenous morphine infusion in 27 patients (Group A and intramuscular diclofenac sodium in 28 patients (Group B in patients undergoing lower limb amputation. All patients underwent amputation under spinal anaesthesia and reported a Modified Verbal Numerical Pain Score of less than two prior to the procedure. Presence of phantom pain was assessed on the first, second, third and seventh day as well as at the third month and sixth month post-operatively. Twelve (44 % patients from group A and 21 patients (75 % from group B developed phantom limb pain following amputation, a statistically significant difference between groups (p<0.05. We conclude that intravenous morphine infusion is more effective than intramuscular diclofenac sodium in preventing the occurrence of phantom limb pain following amputation.

  9. Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

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    Haitham H. Khalil

    2008-01-01

    Full Text Available Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005, 5 men and 2 women were managed. Median age was 21 years (range 15–49. The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases or a delayed extended VRAM flap (2 cases. Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

  10. Neoadjuvant chemotherapy combined with limb salvage surgery in patients with limb osteosarcoma of Enneking stage II: a retrospective study

    Directory of Open Access Journals (Sweden)

    Yuan G

    2017-05-01

    Full Text Available Guangke Yuan,1,2 Jingming Chen,2 Dongjin Wu,1 Chunzheng Gao1 1Department of Orthopedics, The Second Hospital of Shandong University, Jinan, 2Department of Orthopedics, Yidu Central Hospital of Weifang, Weifang, Shandong, People’s Republic of China Objective: To explore the effect of neoadjuvant chemotherapy combined with limb salvage surgery in patients with limb osteosarcoma of Enneking stage II. Patients and methods: Medical records of 98 patients who met the inclusion criteria were retrospectively analyzed. Of these patients, 56 cases who received neoadjuvant chemotherapy combined with limb salvage surgery were listed as group A, while another 42 patients who received limb salvage surgery combined with adjuvant chemotherapy were listed as group B. The recurrence and metastasis rate, survival rate, limb function and incidence of adverse reactions were compared between the two groups. Results: All 98 patients completed the treatment in this study. Baseline characteristics showed no significant differences between group A and group B, including age, gender, tumor location, maximum tumor diameter and Enneking stage (all P>0.05. The total metastasis and recurrence rate of group A was significantly lower than that of group B (25.0% vs 47.6%, χ2=5.419, P=0.020. The Kaplan–Meier method showed that progression-free survival (PFS (log-rank χ2=4.014, P=0.045 and overall survival (OS (log-rank χ2=3.859, P=0.049 of group A were both significantly higher than those of group B. There was no significant difference in the incidence of grades III–IV adverse reactions between the two groups (all P>0.05. The excellent and good rate of limb function in group A was significantly higher than that in group B (83.9% vs 66.7%, χ2=3.982, P=0.046. Conclusion: Neoadjuvant chemotherapy combined with limb salvage surgery for patients with Enneking stage IIA or IIB limb osteosarcoma patients has better efficacy and can significantly improve limb function of

  11. Spatial planning deficits in limb apraxia.

    Science.gov (United States)

    Clark, M A; Merians, A S; Kothari, A; Poizner, H; Macauley, B; Gonzalez Rothi, L J; Heilman, K M

    1994-10-01

    Geschwind (1975) proposed a disconnection model in which an apraxic subject is unable to carry out movements to command because the left hemisphere that comprehended the verbal command is disconnected from the right premotor and motor areas which controls the left hand. An alternate model, however, proposes that apraxia results from destruction of spatiotemporal representations of learned movement stored in the left hemisphere (Heilman, 1979). The disconnection hypothesis would predict that apraxic subjects should be able to correctly imitate gestures and correctly use actual tools since these tasks do not require language. The movement representation model predicts that imitation and actual tool use would also be impaired. Motion analyses were performed on the trajectories of repetitive 'slicing' gestures made in a series of conditions in which contextual cues were introduced in a graded fashion. Four cue conditions were presented: no cues (verbal command), object present, tool present and both object and tool present. Positions of the hand, wrist, elbow, and shoulder were digitized from neighbouring views, reconstructed in three dimensions and analysed with respect to specific spatiotemporal features of the trajectories. Three subjects with limb apraxia, who had lesions that included left parietal cortex, and four neurologically intact subjects participated. The apraxic subjects showed disturbances in planning the movement of the hand in space across the cue conditions. For example, they showed deficits in the plane of motion, the shape of the trajectory and in the coupling of hand speed and trajectory shape even when given full contextual cues. These data support the hypothesis that apraxia can result from the destruction of spatiotemporal representations of learned movement, rather than from a disconnection between the receptive language areas in the left hemisphere and the contralateral motor cortices.

  12. Bioimpedance profiling of the limbs: Update

    Science.gov (United States)

    Ward, L. C.; Essex, T.; Bartlett, M.; Kilbreath, S.; Brookes, D.

    2010-04-01

    Bioelectrical impedance spectroscopy (BIS) is now commonly used to assess breast cancer-related lymphoedema. Typically, the ratio of impedances of the two arms, determined at zero frequency (Z0), is used as a quantitative index of the presence of excess lymph. Measurement uses skin electrodes spanning the whole limb. However, lymphoedema may be highly localised and may involve changes other than simple fluid accumulation, e.g. increased fat and fibrosis, that also give rise to changes in impedance-related parameters such as capacitance. We have previously reported (13th ICEBI, Graz, 2007) a prototype mobile electrode probe that replaces the distal sense electrode which, when moved proximally along the arm, provides an impedance profile. We report here the further development of this technology to incorporate real-time measurement of impedance integrated with a digital measuring wheel. This allows exact synchronisation of impedance with position on the arm. A commercial BIS instrument (ImpediMed SFB7) was modified to collect impedance (R and Xc) data every msec and the mean impedance computed for each 10-mm slice. The apparent resistivity values for arm tissue were used to calculate slice volumes. These computed volumes were compared to equivalent slice volumes from perometry and DXA. The system is being further validated by correlating slice impedance parameters with lean tissue volume determined by pQCT (StraTec XCT 3000), for multiple positions along the arm. Ultimately, it is hoped that such measurements will not only allow localised tissue volume measurement but will also provide information of tissue composition in conditions such as lymphoedema.

  13. Trade-offs in relative limb length among Peruvian children: extending the thrifty phenotype hypothesis to limb proportions.

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    Emma Pomeroy

    Full Text Available BACKGROUND AND METHODS: Both the concept of 'brain-sparing' growth and associations between relative lower limb length, childhood environment and adult disease risk are well established. Furthermore, tibia length is suggested to be particularly plastic under conditions of environmental stress. The mechanisms responsible are uncertain, but three hypotheses may be relevant. The 'thrifty phenotype' assumes that some components of growth are selectively sacrificed to preserve more critical outcomes, like the brain. The 'distal blood flow' hypothesis assumes that blood nutrients decline with distance from the heart, and hence may affect limbs in relation to basic body geometry. Temperature adaptation predicts a gradient of decreased size along the limbs reflecting decreasing tissue temperature/blood flow. We examined these questions by comparing the size of body segments among Peruvian children born and raised in differentially stressful environments. In a cross-sectional sample of children aged 6 months to 14 years (n = 447 we measured head circumference, head-trunk height, total upper and lower limb lengths, and zeugopod (ulna and tibia and autopod (hand and foot lengths. RESULTS: Highland children (exposed to greater stress had significantly shorter limbs and zeugopod and autopod elements than lowland children, while differences in head-trunk height were smaller. Zeugopod elements appeared most sensitive to environmental conditions, as they were relatively shorter among highland children than their respective autopod elements. DISCUSSION: The results suggest that functional traits (hand, foot, and head may be partially protected at the expense of the tibia and ulna. The results do not fit the predictions of the distal blood flow and temperature adaptation models as explanations for relative limb segment growth under stress conditions. Rather, our data support the extension of the thrifty phenotype hypothesis to limb growth, and suggest that

  14. Suppression of morphogenesis in embryonic mouse limbs exposed in vitro to excess gravity

    Science.gov (United States)

    Duke, Jackie C.

    1983-01-01

    The effect of excess gravity on in vitro mammalian limb chondrogenesis is studied. Limb buds from mice of various gestational stages were exposed to excess gravity (2.6G) using a culture centrifuge. Both forelimbs and hind limbs were cultured, and the development of various limb elements was scored after four to six days. The 2.6G force significantly depressed the development of limb elements when applied during the teratogen-sensitive period of chondrogenesis.

  15. [Mirror, mirror of the wall: mirror therapy in the treatment of phantom limbs and phantom limb pain].

    Science.gov (United States)

    Casale, Roberto; Furnari, Anna; Lamberti, Raul Coelho; Kouloulas, Efthimios; Hagenberg, Annegret; Mallik, Maryam

    2015-01-01

    Phantom limb and phantom limb pain control are pivotal points in the sequence of intervention to bring the amputee to functional autonomy. The alterations of perception and sensation, the pain of the residual limb and the phantom limb are therefore aspects of amputation that should be taken into account in the "prise en charge" of these patients. Within the more advanced physical therapies to control phantom and phantom limb pain there is the use of mirrors (mirror therapy). This article willfocus on its use and on the possible side effects induced by the lack of patient selection and a conflict of body schema restoration through mirror therapy with concurrent prosthetic training and trauma acceptance. Advice on the need to select patients before treatment decisions, with regard to their psychological as well as clinical profile (including time since amputation and clinical setting), and the need to be aware of the possible adverse effects matching different and somehow conflicting therapeutic approaches, are put forward. Thus a coordinated sequence of diagnostic, prognostic and therapeutic procedures carried out by an interdisciplinary rehabilitation team that works globally on all patients' problems is fundamental in the management of amputees and phantom limb pain. Further studies and the development of a multidisciplinary network to study this and other applications of mirror therapy are needed.

  16. Limb ossification in the Paleozoic branchiosaurid Apateon (Temnospondyli) and the early evolution of preaxial dominance in tetrapod limb development.

    Science.gov (United States)

    Fröbisch, Nadia B; Carroll, Robert L; Schoch, Rainer R

    2007-01-01

    Despite the wide range of shapes and sizes that accompany a vast variety of functions, the development of tetrapod limbs follows a conservative pattern of de novo condensation, branching, and segmentation. Development of the zeugopodium and digital arch typically occurs in a posterior to anterior sequence, referred to as postaxial dominance, with a digital sequence of 4-3-5-2-1. The only exception to this pattern in all of living Tetrapoda can be found in salamanders, which display a preaxial dominance in limb development, a de novo condensation of a basale commune (distal carpal/tarsal 1+2) and a precoccial development of digits I and II. These divergent patterns have puzzled researchers for over a century leading to various explanatory hypotheses. Despite many advances in research on tetrapod limb development, the divergent evolution of these two pathways and its causes are still not understood. Based on an extensive ontogenetic series we investigated the pattern of limb development of the 300 Ma old branchiosaurid amphibian Apateon. This revealed a preaxial dominance in limb development that was previously believed to be unique and derived for modern salamanders. The Branchiosauridae are favored as close relatives of extant salamanders in most phylogenetic hypotheses of the highly controversial origins and relationships of extant amphibians. The findings provide new insights into the evolution of developmental pathways in tetrapod limb development, the relationships of modern amphibians with possible Paleozoic antecedents, and their initial timing of divergence.

  17. Major limb amputations: A tertiary hospital experience in northwestern Tanzania

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-05-01

    Full Text Available Abstract Background Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Methods This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. Results A total of 162 patients were entered into the study. Their ages ranged between 2–78 years (mean 28.30 ± 13.72 days. Males outnumbered females by a ratio of 2:1. The majority of patients (76.5% had primary or no formal education. One hundred and twelve (69.1% patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality

  18. Obesity and lower limb venous disease - The epidemic of phlebesity.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Singhal, Rishi; Smith, Neil; Bradbury, Andrew W

    2017-05-01

    Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately

  19. Major limb amputations: a tertiary hospital experience in northwestern Tanzania.

    Science.gov (United States)

    Chalya, Phillipo L; Mabula, Joseph B; Dass, Ramesh M; Ngayomela, Isdori H; Chandika, Alphonce B; Mbelenge, Nkinda; Gilyoma, Japhet M

    2012-05-11

    Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. This was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software. A total of 162 patients were entered into the study. Their ages ranged between 2-78 years (mean 28.30 ± 13.72 days). Males outnumbered females by a ratio of 2:1. The majority of patients (76.5%) had primary or no formal education. One hundred and twelve (69.1%) patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality rate was 16.7%. Complications of diabetic foot ulcers and trauma

  20. IL-6 trans-Signaling-Dependent Rapid Development of Cytotoxic CD8+ T Cell Function

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    Jan P. Böttcher

    2014-09-01

    Full Text Available Immune control of infections with viruses or intracellular bacteria relies on cytotoxic CD8+ T cells that use granzyme B (GzmB for elimination of infected cells. During inflammation, mature antigen-presenting dendritic cells instruct naive T cells within lymphoid organs to develop into effector T cells. Here, we report a mechanistically distinct and more rapid process of effector T cell development occurring within 18 hr. Such rapid acquisition of effector T cell function occurred through cross-presenting liver sinusoidal endothelial cells (LSECs in the absence of innate immune stimulation and known costimulatory signaling. Rather, interleukin-6 (IL-6 trans-signaling was required and sufficient for rapid induction of GzmB expression in CD8+ T cells. Such LSEC-stimulated GzmB-expressing CD8+ T cells further responded to inflammatory cytokines, eliciting increased and protracted effector functions. Our findings identify a role for IL-6 trans-signaling in rapid generation of effector function in CD8+ T cells that may be beneficial for vaccination strategies.

  1. Rapid Airplane Parametric Input Design (RAPID)

    Science.gov (United States)

    Smith, Robert E.

    1995-01-01

    RAPID is a methodology and software system to define a class of airplane configurations and directly evaluate surface grids, volume grids, and grid sensitivity on and about the configurations. A distinguishing characteristic which separates RAPID from other airplane surface modellers is that the output grids and grid sensitivity are directly applicable in CFD analysis. A small set of design parameters and grid control parameters govern the process which is incorporated into interactive software for 'real time' visual analysis and into batch software for the application of optimization technology. The computed surface grids and volume grids are suitable for a wide range of Computational Fluid Dynamics (CFD) simulation. The general airplane configuration has wing, fuselage, horizontal tail, and vertical tail components. The double-delta wing and tail components are manifested by solving a fourth order partial differential equation (PDE) subject to Dirichlet and Neumann boundary conditions. The design parameters are incorporated into the boundary conditions and therefore govern the shapes of the surfaces. The PDE solution yields a smooth transition between boundaries. Surface grids suitable for CFD calculation are created by establishing an H-type topology about the configuration and incorporating grid spacing functions in the PDE equation for the lifting components and the fuselage definition equations. User specified grid parameters govern the location and degree of grid concentration. A two-block volume grid about a configuration is calculated using the Control Point Form (CPF) technique. The interactive software, which runs on Silicon Graphics IRIS workstations, allows design parameters to be continuously varied and the resulting surface grid to be observed in real time. The batch software computes both the surface and volume grids and also computes the sensitivity of the output grid with respect to the input design parameters by applying the precompiler tool

  2. Ontogenetic scaling patterns and functional anatomy of the pelvic limb musculature in emus (Dromaius novaehollandiae

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    Luis P. Lamas

    2014-12-01

    Full Text Available Emus (Dromaius novaehollandiae are exclusively terrestrial, bipedal and cursorial ratites with some similar biomechanical characteristics to humans. Their growth rates are impressive, as their body mass increases eighty-fold from hatching to adulthood whilst maintaining the same mode of locomotion throughout life. These ontogenetic characteristics stimulate biomechanical questions about the strategies that allow emus to cope with their rapid growth and locomotion, which can be partly addressed via scaling (allometric analysis of morphology. In this study we have collected pelvic limb anatomical data (muscle architecture, tendon length, tendon mass and bone lengths and calculated muscle physiological cross sectional area (PCSA and average tendon cross sectional area from emus across three ontogenetic stages (n = 17, body masses from 3.6 to 42 kg. The data were analysed by reduced major axis regression to determine how these biomechanically relevant aspects of morphology scaled with body mass. Muscle mass and PCSA showed a marked trend towards positive allometry (26 and 27 out of 34 muscles respectively and fascicle length showed a more mixed scaling pattern. The long tendons of the main digital flexors scaled with positive allometry for all characteristics whilst other tendons demonstrated a less clear scaling pattern. Finally, the two longer bones of the limb (tibiotarsus and tarsometatarsus also exhibited positive allometry for length, and two others (femur and first phalanx of digit III had trends towards isometry. These results indicate that emus experience a relative increase in their muscle force-generating capacities, as well as potentially increasing the force-sustaining capacities of their tendons, as they grow. Furthermore, we have clarified anatomical descriptions and provided illustrations of the pelvic limb muscle–tendon units in emus.

  3. Limb-size proportions in Australopithecus afarensis and Australopithecus africanus.

    Science.gov (United States)

    Green, David J; Gordon, Adam D; Richmond, Brian G

    2007-02-01

    Previous analyses have suggested that Australopithecus africanus possessed more apelike limb proportions than Australopithecus afarensis. However, due to the errors involved in estimating limb length and body size, support for this conclusion has been limited. In this study, we use a new Monte Carlo method to (1) test the hypothesis that A. africanus had greater upper:lower limb-size proportions than A. afarensis and (2) assess the statistical significance of interspecific differences among these taxa, extant apes, and humans. Our Monte Carlo method imposes sampling constraints that reduce extant ape and human postcranial measurements to sample sizes comparable to the fossil samples. Next, composite ratios of fore- and hindlimb geometric means are calculated for resampled measurements from the fossils and comparative taxa. Mean composite ratios are statistically indistinguishable (alpha=0.05) from the actual ratios of extant individuals, indicating that this method conserves each sample's central tendency. When applied to the fossil samples, upper:lower limb-size proportions in A. afarensis are similar to those of humans (p=0.878) and are significantly different from all great ape proportions (pAustralopithecus africanus is more similar to the apes (p> or =0.180) and significantly different from humans and A. afarensis (pafricanus possessed more apelike limb-size proportions than A. afarensis, suggesting that A. africanus either evolved from a more postcranially primitive ancestor than A. afarensis or that the more apelike limb-size proportions of A. africanus were secondarily derived from an A. afarensis-like ancestor. Among the extant taxa, limb-size proportions correspond with observed levels of forelimb- and hindlimb-dominated positional behaviors. In conjunction with detailed anatomical features linked to arboreality, these results suggest that arboreal posture and locomotion may have been more important components of the A. africanus behavioral repertoire

  4. Rapid shallow breathing

    Science.gov (United States)

    ... the smallest air passages of the lungs in children ( bronchiolitis ) Pneumonia or other lung infection Transient tachypnea of the newborn Anxiety and panic Other serious lung disease Home Care Rapid, shallow breathing should not be treated at home. It is ...

  5. Rapid Strep Test

    Science.gov (United States)

    ... worse than normal. Your first thoughts turn to strep throat. A rapid strep test in your doctor’s office ... your suspicions.Viruses cause most sore throats. However, strep throat is an infection caused by the Group A ...

  6. Visual Feedback of the Non-Moving Limb Improves Active Joint-Position Sense of the Impaired Limb in Spastic Hemiparetic Cerebral Palsy

    Science.gov (United States)

    Smorenburg, Ana R. P.; Ledebt, Annick; Deconinck, Frederik J. A.; Savelsbergh, Geert J. P.

    2011-01-01

    This study examined the active joint-position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and the effect of static visual feedback and static mirror visual feedback, of the non-moving limb, on the joint-position sense. Participants were asked to match the position of one upper limb with that of the contralateral limb. The task…

  7. A New Limb Movement Detector Enabling People with Multiple Disabilities to Control Environmental Stimulation through Limb Swing with a Gyration Air Mouse

    Science.gov (United States)

    Shih, Ching-Hsiang; Chang, Man-Ling; Shih, Ching-Tien

    2010-01-01

    This study assessed whether two persons with multiple disabilities would be able to control environmental stimulation using limb swing with a gyration air mouse and a newly developed limb movement detection program (LMDP, i.e., a new software program that turns a gyration air mouse into a precise limb movement detector). The study was performed…

  8. RAPID3? Aptly named!

    Science.gov (United States)

    Berthelot, J-M

    2014-01-01

    The RAPID3 score is the sum of three 0-10 patient self-report scores: pain, functional impairment on MDHAQ, and patient global estimate. It requires 5 seconds for scoring and can be used in all rheumatologic conditions, although it has mostly been used in rheumatoid arthritis where cutoffs for low disease activity (12/30) have been set. A RAPID3 score of ≤ 3/30 with 1 or 0 swollen joints (RAPID3 ≤ 3 + ≤ SJ1) provides remission criteria comparable to Boolean, SDAI, CDAI, and DAS28 remission criteria, in far less time than a formal joint count. RAPID3 performs as well as the DAS28 in separating active drugs from placebos in clinical trials. RAPID3 also predicts subsequent structural disease progression. RAPID3 can be determined at short intervals at home, allowing the determination of the area under the curve of disease activity between two visits and flare detection. However, RAPID3 should not be seen as a substitute for DAS28 and face to face visits in routine care. Monitoring patient status with only self-report information without a rheumatologist's advice (including joints and physical examination, and consideration of imaging and laboratory tests) may indeed be as undesirable for most patients than joint examination without a patient questionnaire. Conversely, combining the RAPID3 and the DAS28 may consist in faster or more sensitive confirmation that a medication is effective. Similarly, better enquiring of most important concerns of patients (pain, functional status and overall opinion on their disorder) should reinforces patients' confidence in their rheumatologist and treatments.

  9. Synaesthesia in phantom limbs induced with mirrors.

    Science.gov (United States)

    Ramachandran, V S; Rogers-Ramachandran, D

    1996-04-22

    Although there is a vast clinical literature on phantom limbs, there have been no experimental studies on the effects of visual input on phantom sensations. We introduce an inexpensive new device--a 'virtual reality box'--to resurrect the phantom visually to study inter-sensory effects. A mirror is placed vertically on the table so that the mirror reflection of the patient's intact had is 'superimposed' on the felt position of the phantom. We used this procedure on ten patients and found the following results. 1. In six patients, when the normal hand was moved, so that the phantom was perceived to move in the mirror, it was also felt to move; i.e. kinesthetic sensations emerged in the phantom. In D.S. this effect occurred even though he had never experienced any movements in the phantom for ten years before we tested him. He found the return of sensations very enjoyable. 2. Repeated practice led to a permanent 'disappearance' of the phantom arm in patient D.S. and the hand became telescoped into the stump near the shoulder. 3. Using an optical trick, impossible postures--e.g. extreme hyperextension of the fingers--could be induced visually in the phantom. In one case this was felt as a transient 'painful tug' in the phantom. 4. Five patients experienced involuntary painful 'clenching spasms' in the phantom hand and in four of them the spasms were relieved when the mirror was used to facilitate 'opening' of the phantom hand; opening was not possible without the mirror. 5. In three patients, touching the normal hand evoked precisely localized touch sensations in the phantom. Interestingly, the referral was especially pronounced when the patients actually 'saw' their phantom being touched in the mirror. Indeed, in a fourth patient (R.L.) the referral occurred only if he saw his phantom being touched: a curious form of synaesthesia. These experiments lend themselves readily to imaging studies using PET and fMRI. Taken collectively, they suggest that there is a

  10. A fast code for channel limb radiances with gas absorption and scattering in a spherical atmosphere

    Science.gov (United States)

    Eluszkiewicz, Janusz; Uymin, Gennady; Flittner, David; Cady-Pereira, Karen; Mlawer, Eli; Henderson, John; Moncet, Jean-Luc; Nehrkorn, Thomas; Wolff, Michael

    2017-05-01

    We present a radiative transfer code capable of accurately and rapidly computing channel limb radiances in the presence of gaseous absorption and scattering in a spherical atmosphere. The code has been prototyped for the Mars Climate Sounder measuring limb radiances in the thermal part of the spectrum (200-900 cm-1) where absorption by carbon dioxide and water vapor and absorption and scattering by dust and water ice particles are important. The code relies on three main components: 1) The Gauss Seidel Spherical Radiative Transfer Model (GSSRTM) for scattering, 2) The Planetary Line-By-Line Radiative Transfer Model (P-LBLRTM) for gas opacity, and 3) The Optimal Spectral Sampling (OSS) for selecting a limited number of spectral points to simulate channel radiances and thus achieving a substantial increase in speed. The accuracy of the code has been evaluated against brute-force line-by-line calculations performed on the NASA Pleiades supercomputer, with satisfactory results. Additional improvements in both accuracy and speed are attainable through incremental changes to the basic approach presented in this paper, which would further support the use of this code for real-time retrievals and data assimilation. Both newly developed codes, GSSRTM/OSS for MCS and P-LBLRTM, are available for additional testing and user feedback.

  11. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees.

    Science.gov (United States)

    Grijalva-Eternod, Carlos S; Wells, Jonathan C K; Cortina-Borja, Mario; Salse-Ubach, Nuria; Tondeur, Mélody C; Dolan, Carmen; Meziani, Chafik; Wilkinson, Caroline; Spiegel, Paul; Seal, Andrew J

    2012-01-01

    Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6-59 mo) and 1,781 women (15-49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden-affected (24.7%). The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under

  12. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees.

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    Carlos S Grijalva-Eternod

    Full Text Available BACKGROUND: Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. METHODS AND FINDINGS: We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference in 1,608 children (6-59 mo and 1,781 women (15-49 y. We estimated the prevalence of global acute malnutrition (GAM, stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2% and overweight (38.8% in women affected a higher proportion of households than did GAM (7.0%, stunting (19.5%, or underweight (13.3% in children. Overall, households classified as overweight (31.5% were most common, followed by undernourished (25.8%, and then double burden-affected (24.7%. CONCLUSIONS: The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity

  13. The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees

    Science.gov (United States)

    Grijalva-Eternod, Carlos S.; Wells, Jonathan C. K.; Cortina-Borja, Mario; Salse-Ubach, Nuria; Tondeur, Mélody C.; Dolan, Carmen; Meziani, Chafik; Wilkinson, Caroline; Spiegel, Paul; Seal, Andrew J.

    2012-01-01

    Background Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. Methods and Findings We implemented a stratified nutrition survey in October–November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6–59 mo) and 1,781 women (15–49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden–affected (24.7%). Conclusions The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention

  14. Critical Limb Ischemia in Association with Charcot Neuroarthropathy: Complex Endovascular Therapy for Limb Salvage

    Energy Technology Data Exchange (ETDEWEB)

    Palena, Luis Mariano, E-mail: marianopalena@hotmail.com [Policlinico Abano Terme, Interventional Radiology Unit (Italy); Brocco, Enrico [Policlinico Abano Terme, Diabetic Foot Department, Foot and Ankle Clinic (Italy); Manzi, Marco [Policlinico Abano Terme, Interventional Radiology Unit (Italy)

    2013-05-09

    Charcot neuroarthropathy is a low-incidence complication of diabetic foot and is associated with ankle and hind foot deformity. Patients who have not developed deep ulcers are managed with offloading and supportive bracing or orthopedic arthrodesis. In patients who have developed ulcers and severe ankle instability and deformity, below-the-knee amputation is often indicated, especially when deformity and cutaneous involvement result in osteomyelitis. Ischemic association has not been described but can be present as a part of peripheral arterial disease in the diabetic population. In this extreme and advanced stage of combined neuroischemic diabetic foot disease, revascularization strategies can support surgical and orthopedic therapy, thus preventing osteomyelitis and leading to limb and foot salvage.

  15. Disinhibition of upper limb motor area by voluntary contraction of the lower limb muscle.

    Science.gov (United States)

    Tazoe, Toshiki; Endoh, Takashi; Nakajima, Tsuyoshi; Sakamoto, Masanori; Komiyama, Tomoyoshi

    2007-03-01

    It is well known that monosynaptic spinal reflexes and motor evoked potentials following transcranial magnetic stimulation (TMS) are reinforced during phasic and intensive voluntary contraction in the remote segment (remote effect). However, the remote effect on the cortical silent period (CSP) is less known. The purpose of the present study is to determine to what extent the CSP in the intrinsic hand muscle following TMS is modified by voluntary ankle dorsiflexion and to elucidate the origin of the modulation of CSP by the remote effect. CSP was recorded in the right first dorsal interosseous while subjects performed phasic dorsiflexion in the ipsilateral side under self-paced and reaction-time conditions. Modulation of the peripherally-induced silent period (PSP) induced by electrical stimulation of the ulnar nerve was also investigated under the same conditions. In addition, modulation of the CSP was investigated during ischemic nerve block of the lower limb and during application of vibration to the tibialis anterior tendon. The duration of CSP was significantly shortened by phasic dorsiflexion, and the extent of shortening was proportional to dorsiflexion force. Shortening of the CSP duration was also observed during tonic dorsiflexion. In contrast, the PSP duration following ulnar nerve stimulation was not altered during phasic dorsiflexion. Furthermore, the remote effect on the CSP duration was seen during ischemic nerve block of the lower limb and the pre-movement period in the reaction-time paradigm, but shortening of the CSP was not observed during tendon vibration. These findings suggest that phasic muscle contraction in the remote segment results in a decrease in intracortical inhibitory pathways to the corticospinal tract innervating the muscle involved in reflex testing and that the remote effect on the CSP is predominantly cortical in origin.

  16. Elasticity changes in the large arteries of human limbs in response to cycle ergometry performed with upper and lower limbs.

    Science.gov (United States)

    Mazhbich, B I; Roifman, M D

    1989-01-01

    At rest and after cycle ergometry the elastic properties of the large arteries of limbs of healthy men were examined using an original non-invasive quantitative oscillometric method. It has been shown that in response to muscle work performed with the legs there is a decrease of the effective inner radius, and an increase of the characteristic impedance modulus and bulk modulus and of the elastic resistance of the intact and relaxed wall in the large arteries in the upper limbs. All these changes testify to an increase of vascular tension in the upper limbs. In response to work performed with the hands, there is an increase of the effective inner radius of large arteries of the upper limbs, a large increase of the pulsatile blood volume increment of the intact vessels and a decrease of the characteristic impedance modulus, of the bulk modulus and of the elastic resistance of the intact arterial wall. These changes indicate a decrease of the vascular tension of these arteries. In response to work performed either with the legs or with the hands a decrease of the effective inner radius of large arteries and an increase of the elastic resistance of the relaxed arterial wall were observed in the lower limbs, all these changes indicating relatively small changes in tone of these vessels. It is concluded that the wall tension of large arteries supplying blood to the muscles of non-working limbs is increased. Vascular tension changes in the arteries in working limbs are accounted for by the superimposition of centrally originating vasoconstriction with local vasodilatation, which also affects large arteries.

  17. The perception of phantom limbs. The D. O. Hebb lecture.

    Science.gov (United States)

    Ramachandran, V S; Hirstein, W

    1998-09-01

    Almost everyone who has a limb amputated will experience a phantom limb--the vivid impression that the limb is not only still present, but in some cases, painful. There is now a wealth of empirical evidence demonstrating changes in cortical topography in primates following deafferentation or amputation, and this review will attempt to relate these in a systematic way to the clinical phenomenology of phantom limbs. With the advent of non-invasive imaging techniques such as MEG (magnetoencephalogram) and functional MRI, topographical reorganization can also be demonstrated in humans, so that it is now possible to track perceptual changes and changes in cortical topography in individual patients. We suggest, therefore, that these patients provide a valuable opportunity not only for exploring neural plasticity in the adult human brain but also for understanding the relationship between the activity of sensory neurons and conscious experience. We conclude with a theory of phantom limbs, some striking demonstrations of phantoms induced in normal subjects, and some remarks about the relevance of these phenomena to the question of how the brain constructs a 'body image.'

  18. Progressive thinning of visual motion area in lower limb amputees

    Directory of Open Access Journals (Sweden)

    Guangyao eJiang

    2016-03-01

    Full Text Available Accumulating evidence has indicated that amputation or deafferentation of a limb induces functional or structural reorganization in the visual areas. However, the extent of the visual areas involved after lower limb amputation remains uncertain. In this investigation, we studied 48 adult patients with unilateral lower limb amputation and 48 matched healthy controls using T1-weighted magnetic resonance imaging. Template-based regions of interest analysis was implemented to detect the changes of cortical thickness in the specific visual areas. Compared with normal controls, amputees exhibited significantly lower thickness in the V5/middle temporal (V5/MT+ visual area, as well as a trend of cortical thinning in the V3d. There was no significant difference in the other visual areas between the two groups. In addition, no significant difference of cortical thickness was found between patients with amputation at different levels. Across all amputees, correlation analyses revealed that the cortical thickness of the V5/MT+ was negatively correlated to the time since amputation. In conclusion, our findings indicate that the amputation of unilateral lower limb could induce changes in the motor-related visual cortex, and provide an update on the plasticity of the human brain after limb injury.

  19. Estimation of stature using lower limb measurements in Sudanese Arabs.

    Science.gov (United States)

    Ahmed, Altayeb Abdalla

    2013-07-01

    The estimation of stature from body parts is one of the most vital parts of personal identification in medico-legal autopsies, especially when mutilated and amputated limbs or body parts are found. The aim of this study was to assess the reliability and accuracy of using lower limb measurements for stature estimations. The stature, tibial length, bimalleolar breadth, foot length and foot breadth of 160 right-handed Sudanese Arab subjects, 80 men and 80 women (25-30 years old), were measured. The reliability of measurement acquisition was tested prior to the primary data collection. The data were analysed using basic univariate analysis and linear and multiple regression analyses. The results showed acceptable standards of measurement errors and reliability. Sex differences were significant for all of the measurements. There was a positive correlation coefficient between lower-limb dimensions and stature (P-value stature prediction accuracy ranged from ± 2.75-5.40 cm, which is comparable to the established skeletal standards for the lower limbs. This study provides new forensic standards for stature estimation using the lower limb measurements of Sudanese Arabs. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  20. Regeneration of limb joints in the axolotl (Ambystoma mexicanum.

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    Jangwoo Lee

    Full Text Available In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints.

  1. Skeletal muscle responses to lower limb suspension in humans

    Science.gov (United States)

    Hather, Bruce M.; Adams, Gregory R.; Tesch, Per A.; Dudley, Gary A.

    1992-01-01

    The morphological responses of human skeletal muscle to unweighting were assessed by analyzing multiple transaxial magnetic resonance (MR) images of both lower limbs and skeletal muscle biopsies of the unweighted lower limb before and after six weeks of unilaterial (left) lower limb suspension (ULLS). Results indicated that, as a results of 6 weeks of unweighting (by the subjects walking on crutches using only one limb), the cross sectional area (CSA) of the thigh muscle of the unweighted left limb decreased 12 percent, while the CSA of the right thigh muscle did not change. The decrease was due to a twofold greater response of the knee extensors than the knee flexors. The pre- and post-ULLS biopsies of the left vastus lateralis showed a 14 percent decrease in average fiber CSA due to unweighting. The number of capillaries surrounding the different fiber types was unchanged after ULLS. Results showed that the adaptive responses of human skeletal muscle to unweighting are qualitatively, but not quantitatively, similar to those of lower mammals and not necessarily dependent on the fiber-type composition.

  2. Optimal walking speed following changes in limb geometry.

    Science.gov (United States)

    Leurs, Françoise; Ivanenko, Yuri P; Bengoetxea, Ana; Cebolla, Ana-Maria; Dan, Bernard; Lacquaniti, Francesco; Cheron, Guy A

    2011-07-01

    The principle of dynamic similarity states that the optimal walking speeds of geometrically similar animals are independent of size when speed is normalized to the dimensionless Froude number (Fr). Furthermore, various studies have shown similar dimensionless optimal speed (Fr ∼0.25) for animals with quite different limb geometries. Here, we wondered whether the optimal walking speed of humans depends solely on total limb length or whether limb segment proportions play an essential role. If optimal walking speed solely depends on the limb length then, when subjects walk on stilts, they should consume less metabolic energy at a faster optimal speed than when they walk without stilts. To test this prediction, we compared kinematics, electromyographic activity and oxygen consumption in adults walking on a treadmill at different speeds with and without articulated stilts that artificially elongated the shank segment by 40 cm. Walking on stilts involved a non-linear reorganization of kinematic and electromyography patterns. In particular, we found a significant increase in the alternating activity of proximal flexors-extensors during the swing phase, despite significantly shorter normalized stride lengths. The minimal metabolic cost per unit distance walked with stilts occurred at roughly the same absolute speed, corresponding to a lower Fr number (Fr ∼0.17) than in normal walking (Fr ∼0.25). These findings are consistent with an important role of limb geometry optimization and kinematic coordination strategies in minimizing the energy expenditure of human walking.

  3. A computational clonal analysis of the developing mouse limb bud.

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    Luciano Marcon

    Full Text Available A comprehensive spatio-temporal description of the tissue movements underlying organogenesis would be an extremely useful resource to developmental biology. Clonal analysis and fate mappings are popular experiments to study tissue movement during morphogenesis. Such experiments allow cell populations to be labeled at an early stage of development and to follow their spatial evolution over time. However, disentangling the cumulative effects of the multiple events responsible for the expansion of the labeled cell population is not always straightforward. To overcome this problem, we develop a novel computational method that combines accurate quantification of 2D limb bud morphologies and growth modeling to analyze mouse clonal data of early limb development. Firstly, we explore various tissue movements that match experimental limb bud shape changes. Secondly, by comparing computational clones with newly generated mouse clonal data we are able to choose and characterize the tissue movement map that better matches experimental data. Our computational analysis produces for the first time a two dimensional model of limb growth based on experimental data that can be used to better characterize limb tissue movement in space and time. The model shows that the distribution and shapes of clones can be described as a combination of anisotropic growth with isotropic cell mixing, without the need for lineage compartmentalization along the AP and PD axis. Lastly, we show that this comprehensive description can be used to reassess spatio-temporal gene regulations taking tissue movement into account and to investigate PD patterning hypothesis.

  4. Regeneration of Limb Joints in the Axolotl (Ambystoma mexicanum)

    Science.gov (United States)

    Lee, Jangwoo; Gardiner, David M.

    2012-01-01

    In spite of numerous investigations of regenerating salamander limbs, little attention has been paid to the details of how joints are reformed. An understanding of the process and mechanisms of joint regeneration in this model system for tetrapod limb regeneration would provide insights into developing novel therapies for inducing joint regeneration in humans. To this end, we have used the axolotl (Mexican Salamander) model of limb regeneration to describe the morphology and the expression patterns of marker genes during joint regeneration in response to limb amputation. These data are consistent with the hypothesis that the mechanisms of joint formation whether it be development or regeneration are conserved. We also have determined that defects in the epiphyseal region of both forelimbs and hind limbs in the axolotl are regenerated only when the defect is small. As is the case with defects in the diaphysis, there is a critical size above which the endogenous regenerative response is not sufficient to regenerate the joint. This non-regenerative response in an animal that has the ability to regenerate perfectly provides the opportunity to screen for the signaling pathways to induce regeneration of articular cartilage and joints. PMID:23185640

  5. Hair patterns of the lower limb in Central Indian males.

    Science.gov (United States)

    Chaurasia, B D

    1977-08-01

    The distribution of hair of the right lower limb has been studied in a random sample of 220 healthy Central Indian males 17 to 45 years of age. The common hair patterns observed are the proximal phalangeal hair in all toes in 55.45%, the middle phalangeal hair in the third toe in 8.18%, the tibial on the dorsum of foot in 69.55%, and the pedo-cruro-femoral in the lower limb in 70.00% subjects. Comparison of these findings with those of the right upper limb shows that hairiness of the two limbs is correlated, that the dorsum of foot is less hairy than the dorsum of hand, and that the third and second toes are comparable with the fourth and third fingers, respectively, as regards their middle phalangeal hair. Comparison with the available literature shows that the Central Indian males resemble the Whites in having greater frequency of middle phalangeal hair than those of the Negroes, that the dorsum of feet of this population is less hairy than the White and more hairy than the Negroes, and that the general hairiness of the lower limb is more or less equal in the three groups of persons.

  6. Agency over Phantom Limb Enhanced by Short-Term Mirror Therapy.

    Science.gov (United States)

    Imaizumi, Shu; Asai, Tomohisa; Koyama, Shinichi

    2017-01-01

    Most amputees experience phantom limb, whereby they feel that the amputated limb is still present. In some cases, these experiences include pain that can be alleviated by "mirror therapy." Mirror therapy consists of superimposing a mirrored image of the moving intact limb onto the phantom limb. This therapy provides a closed loop between the motor command to the amputated limb and its predicted visual feedback. This loop is also involved in the sense of agency, a feeling of controlling one's own body. However, it is unclear how mirror therapy is related to the sense of agency over a phantom limb. Using mirror therapy, we investigated phantom limb pain and the senses of agency and ownership (i.e., a feeling of having one's own body) of the phantom limb. Nine upper-limb amputees, five of whom reported recent phantom limb pain, underwent a single 15-min trial of mirror therapy. Before and after the trial, the participants completed a questionnaire regarding agency, ownership, and pain related to their phantom limb. They reported that the sense of agency over the phantom limb increased following the mirror therapy trial, while the ownership slightly increased but not as much as did the agency. The reported pain did not change; that is, it was comparably mild before and after the trial. These results suggest that short-term mirror therapy can, at least transiently, selectively enhance the sense of agency over a phantom limb, but may not alleviate phantom limb pain.

  7. NEUREX: a tutorial expert system for the diagnosis of neurogenic diseases of the lower limbs.

    Science.gov (United States)

    Starita, A; Majidi, D; Giordano, A; Battaglia, M; Cioni, R

    1995-02-01

    Specialist tutors have to transfer two types of knowledge to doctors who are specialising in a particular clinic: public declarative knowledge, including facts, notions, principles in that particular field; and their own private procedural knowledge acquired in years of direct experience. Embodying this knowledge into an expert system means that this information can be shared more rapidly, and tutoring is easier. This paper presents a tutorial expert system for neurological clinics which can emulate the diagnostic process of an expert neurologist for neurogenic diseases of the lower limbs, assist users in planning the optimal sequence of NG and EMG tests, interpret the results of these tests, and help users to achieve the most suitable diagnosis.

  8. Late-onset Pompe disease with phenotype of the limb-girdle muscular dystrophy

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    S. A. Kurbatov

    2015-01-01

    Full Text Available Pompe disease, also known as type II glycogenosis, is a rare autosomal recessive disease. Two main types include early-onset Pompe disease – severe, rapidly progressive multisystem deficency, manifestating on the first year of life, and late-onset Pompe disease (LOPD, with the age of onset ranging from the first year till late adulthood. Both types are caused by the deficiency of lysosomal acid-α-glucosidase due to the mutations in GAA gene, leading to an excessive storage of glycogen in body cells. LOPD is a slowly progressive disease with a primary lesion of a skeletal, respiratory and cardiac muscles, affected in different grade, and moderately elevated сreatine kinase. It is often difficult to perform differential diagnosis with a large group of hereditary and non-hereditary myopathies. We present a case report of LOPD with signs of limb-girdle muscular dystrophy.

  9. A passively safe cable driven upper limb rehabilitation exoskeleton.

    Science.gov (United States)

    Chen, Yanyan; Fan, Jizhuang; Zhu, Yanhe; Zhao, Jie; Cai, Hegao

    2015-01-01

    When using upper limb exoskeletons that assist the movement of physically weak people, safety should be the most important index. In this paper, a passively safe, cable-driven upper limb exoskeleton with parallel actuated joints, which perfectly mimics human motions, is proposed. Compared with the existing upper limb exoskeletons which are mostly designed only considering the realization of functional properties, and having poor wearabity, a passively safe prototype for motion assistance based on human anatomy structure has been developed in our design. This design is based on the prior exoskeleton structure with the adoption of a gravity balanced device. The gravity balanced mechanism was confirmed in theory and simulation, showing it has a positive effect on balance.

  10. Development of Phantom Limb Pain after Femoral Nerve Block

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    Sadiah Siddiqui

    2014-01-01

    Full Text Available Historically, phantom limb pain (PLP develops in 50–80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment.

  11. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    Science.gov (United States)

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  12. Limb salvage treatment for congenital deficiency of the tibia.

    Science.gov (United States)

    Wada, Akifusa; Fujii, Toshio; Takamura, Kazuyuki; Yanagida, Haruhisa; Urano, Noriko; Yamaguchi, Toru

    2006-01-01

    Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

  13. Munchausen syndrome revealed by subcutaneous limb emphysema: a case report.

    Science.gov (United States)

    Koufagued, Kaldadak; Chafry, Bouchaib; Benyass, Youssef; Abissegue, Yves; Benchebba, Driss; Bouabid, Salim; Belkacem, Chagar

    2015-08-18

    Limb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient. We report the case of an 18-year-old Moroccan woman patient who presented to our hospital with a subcutaneous emphysema of the shoulder girdle and the right arm, caused by our patient. Treatment was aggressive, with a wide surgical debridement, parenteral antibiotic therapy and hyperbaric oxygen therapy. The results have been favorable. The correlation of anamnestic data and clinical and para-clinical exams were essential for the diagnosis of Munchausen syndrome in this case. In this regard, we report a rare case of subcutaneous limb emphysema secondary to Munchausen syndrome.

  14. Restorative surgery of combined injuries of neurovascular structures of limbs

    Directory of Open Access Journals (Sweden)

    I. V. Pertsov

    2015-02-01

    Full Text Available Combined damage of neurovascular structures is complicate pathology and require repeated surgical interventions and often lead to permanent disability. Aim. To define the features of restorative surgical treatment of traumatic injuries of limbs neurovascular structures and to study the effect of regional hemodynamics on the nerve function restore. Methods and results. In 98 patients with combined trauma of the neurovascular structures microcirculation indicators were established with laser Doppler flowmetry and determine the degree of restoration of nerve function. Conclusion. Strong direct correlation between the degree of restoration of nerve function and microcirculation was detected, the correlation coefficient was +0.72 at t = 3,16 p<0,05. Careful surgical restoration of blood flow helps to improve microcirculation in the limbs, makes positive impact on the recovery of limb function.

  15. Sports and recreation for persons with limb deficiency.

    Science.gov (United States)

    Webster, J B; Levy, C E; Bryant, P R; Prusakowski, P E

    2001-03-01

    Opportunities for persons with limb deficiency to participate in sport and recreational activities have increased dramatically over the past 20 years. Various factors have contributed to this phenomenon, including an increased public interest in sports and fitness as well as improvements in disability awareness. An even more essential element has been a consumer-driven demand for advances in prosthetic technology and design. Whether the activity is a music performance, a friendly round of golf, or a high-level track-and-field competition, the benefits of participation in sports and recreation are numerous both at the individual and at the societal level. This article provides an overview of the development and scope of sport and recreational opportunities available to persons with limb deficiency. In addition, specific prosthetic considerations for several common sport and recreational activities are presented in a case-discussion format. To review the development and scope of sport and recreational opportunities available to persons with limb deficiency.

  16. Lower limb salvage in Gustillo Type III-b distal tibial fracture with a ...

    African Journals Online (AJOL)

    Background: Reconstruction of crushed distal tibia is a challenging ordeal to a plastic surgeon which involved a protracted course of management. Free flaps are often the only viable option to provide a soft tissue cover over exposed and fractured bone. Patient and Result: We present a case of 32 years old male with ...

  17. Atypical supernumerary phantom limb and phantom limb pain in a patient with spinal cord injury: case report.

    Science.gov (United States)

    Choi, Ja Young; Kim, Hyo In; Lee, Kil Chan; Han, Zee-A

    2013-12-01

    Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

  18. Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

    Science.gov (United States)

    Choi, Ja Young; Kim, Hyo In; Lee, Kil Chan

    2013-01-01

    Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury. PMID:24466528

  19. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome.

    Science.gov (United States)

    Iriarte, Jorge; Murie-Fernandez, Manuel; Toledo, Estefania; Urrestarazu, Elena; Alegre, Manuel; Viteri, Cesar; Salvador, Javier; Baptista, Peter; Alcaide, Belen; Artieda, Julio

    2009-08-01

    Periodic limb movements (PLM) and obstructive sleep apnea syndrome (OSAS) are two frequent sleep disorders which often occur in the same patient. The goal of this study was to know the influence of the presence of PLM in the sleep architecture in patients with and without OSAS. Two hundred twenty consecutive patients (69 women and 151 men) participated in this transversal study. They were patients with clinical suspicion of dysomnia, including snoring, OSAS, and PLM. All of them underwent a full polysomnography and were interviewed using questionnaires about the sleep quality. The sleep parameters (percentage of sleep stages, rapid eye movement latency, sleep efficiency, awakenings, PLM presence, apnea-hypopnea index) were calculated and compared between groups. Descriptive statistics and nonparametric distribution techniques were used for the analysis. Patients with PLM when compared with patients with OSAS had lower sleep efficiency and less rapid eye movement percentage. The presence of PLM in patients with sleep apnea was less relevant being responsible only for an increase in the rapid eye movement latency and a decrease in the duration of the three to four sleep stages. However, the presence of OSAS was related to a better sleep efficiency (patients with PLM plus OSAS had a better sleep efficiency than patients with only PLM). PLM alters the structure of sleep. In patients with sleep apnea, the presence of PLM is less relevant.

  20. Toe amputation: a predictor of future limb loss?

    Science.gov (United States)

    Griffin, Kathryn J; Rashid, Tawqeer S; Bailey, Marc A; Bird, Sarah A; Bridge, Katherine; Scott, Julian D A

    2012-01-01

    Digital toe amputation is a relatively minor surgical procedure but there is a historical view that it is the "first stage in a predictable clinical course" leading to eventual limb loss. There is a paucity of contemporaneous data on the long-term outcomes of patients undergoing toe amputation. We aim to study the experience from our institution, focussing on the risk factors for progression to future limb loss, by conducting a retrospective review of our practice. Sixty-three patients undergoing toe amputation within our institution were identified and the clinical notes retrospectively reviewed. A database of vascular risk factors and co-morbidity was constructed and correlation with future limb loss was analysed with Chi-squared testing and a logistic regression model. Sixty-three patients with a mean age of 69 (IQR 62-76.5) years were identified. Thirty-five (55.6%) of these patients went on to have a further surgical amputation; 22 major amputations (16 below-knee and 6 above-knee amputations) and 23 minor amputations were performed in total. Forty three (68.3%) patients had diabetes and 31 (49.2%) patients had one or more revascularisation procedures undertaken. There was a significant correlation between patients who did not have diabetes and future limb loss (Chi-squared=4.31, p=0.038), however no other identified risk factor predicted the need for major amputation. Toe amputation is a significant predictor of future limb loss. Our study identified that patients with diabetes are significantly less likely to progress to further limb loss than those with the disease. We hypothesise that this difference is due to the more intensive, multi-disciplinary foot care follow-up that diabetic patients receive. These results highlight the significance of toe amputation and contribute to the evidence for a more intensive out-patient service for these high risk patients. Copyright © 2012 Elsevier Inc. All rights reserved.