WorldWideScience

Sample records for wrist diagnostic performance

  1. Diagnostic performance of three-dimensional MR maximum intensity projection for the assessment of synovitis of the hand and wrist in rheumatoid arthritis: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Xubin, E-mail: lixb@bjmu.edu.cn [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China); Liu, Xia; Du, Xiangke [Department of Radiology, Peking University People' s Hospital, Beijing 100044 (China); Ye, Zhaoxiang [Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Reseaech Center for Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060 (China)

    2014-05-15

    Purpose: To evaluate the diagnostic performance of three-dimensional (3D) MR maximum intensity projection (MIP) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis (RA) compared to 3D contrast-enhanced magnetic resonance imaging (CE-MRI). Materials and methods: Twenty-five patients with RA underwent MR examinations. 3D MR MIP images were derived from the enhanced images. MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist. The diagnostic sensitivity, specificity and accuracy of 3D MIP were, respectively, calculated with the reference standard 3D CE-MRI. Results: In all subjects, 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image. Synovitis demonstrated high signal intensity on MIP images. The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images (k = 0.87) and CE-MR images (k = 0.91), respectively. 3D MIP demonstrated a sensitivity, specificity and accuracy of 91.07%, 98.57% and 96.0%, respectively, for the detection of synonitis. Conclusion: 3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA, which has potential value of clinical practice.

  2. Force transmission through the wrist during performance of push-ups on a hyperextended and a neutral wrist.

    Science.gov (United States)

    Polovinets, Olga; Wolf, Alon; Wollstein, Ronit

    2017-07-03

    Cross-sectional cohort. Push-ups are used ubiquitously to evaluate and strengthen the upper body. They are usually performed in 1 of 2 main ways: with the wrist in hyperextension and with the wrist in a neutral position. The purpose of our study was to compare the dynamic forces in the wrist during the 2 push-up styles. Fourteen volunteers performed push-ups in 2 different patterns: on a hyperextended wrist and a neutral wrist (NW). Two force plates and a motion capture system were used to measure the ground reaction forces (GRFs) and the kinematics of the upper extremity during push-ups. Kinematic and kinetic analyses were performed using Matlab software (Mathworks, Natick, MA). The GRF vector was distributed differently during the different types of push-ups. For both methods, the total GRF carried by the upper dominant extremity was larger than those of the nondominant extremity. In the NW configuration, the GRF vector was more uniform throughout the push-up in the vertical direction. The horizontal distance between the capitate bone location and the GRF origin was smaller in hyperextension. The forces traveled more dorsally over a wider area and more ulnarly in the hyperextended wrist. Forces are transmitted differently through the wrist in the 2 methods. Push-ups on an NW are likely safer because ligaments may be preferentially loaded in hyperextension. Further study may delineate the differences in the anatomic location of force transmission and the long-term clinical effect on the wrist. This study supports the performance of push-ups on a wrist in neutral flexion extension; both to enable patients after surgery or injury to strengthen the upper body and prevent injury and long-term wear in the wrist. The knowledge gained from this study may assist in outlining guidelines for push-up performance. Diagnostic level 2a. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  3. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    Energy Technology Data Exchange (ETDEWEB)

    De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: massimo.defilippo@unipr.it; Pogliacomi, Francesco [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Bertellini, Annalisa [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Araoz, Philip A. [Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (United States); Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Corradi, Maurizio; Costantino, Cosimo [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Zompatori, Maurizio [Department of Radiological and Histopathological Sciences, Policlinic S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna (Italy)

    2010-04-15

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  4. Design of a Magnetic Resonance-Safe Haptic Wrist Manipulator for Movement Disorder Diagnostics

    NARCIS (Netherlands)

    Bode, Dyon; Mugge, Winfred; Schouten, Alfred C.; van Rootselaar, Anne-Fleur; Bour, Lo J.; van der Helm, Frans C. T.; Lammertse, Piet

    2017-01-01

    Tremor, characterized by involuntary and rhythmical movements, is the most common movement disorder. Tremor can have peripheral and central oscillatory components which properly assessed may improve diagnostics. A magnetic resonance (MR)-safe haptic wrist manipulator enables simultaneous measurement

  5. Wrist kinematic coupling and performance during functional tasks: effects of constrained motion.

    Science.gov (United States)

    Garg, Rohit; Kraszewski, Andrew P; Stoecklein, Holbrook H; Syrkin, Grisha; Hillstrom, Howard J; Backus, Sherry; Lenhoff, Mark L; Wolff, Aviva L; Crisco, Joseph J; Wolfe, Scott W

    2014-04-01

    To quantify the coupled motion of the wrist during selected functional tasks and to determine the effects of constraining this coupled motion using a radial-ulnar deviation blocking splint on performance of these tasks. Ten healthy, right-handed men performed 15 trials during selected functional tasks with and without a splint, blocking radial and ulnar deviation. The following tasks were performed: dart throwing, hammering, basketball free-throw, overhand baseball and football throwing, clubbing, and pouring. Kinematic coupling parameters (coupling, kinematic path length, flexion-extension range of motion, radial-ulnar deviation range of motion, flexion-extension offset, and radial-ulnar deviation offset) and performance were determined for each functional task. A generalized estimation equation model was used to determine whether each kinematic coupling parameter was significantly different across tasks. A repeated-measures generalized estimation equation model was used to test for differences in performance and kinematic coupling parameters between the free and splinted conditions. Wrist motion exhibited linear coupling between flexion-extension and radial-ulnar deviation, demonstrated by R(2) values from 0.70 to 0.99. Average wrist coupling and kinematic path lengths were significantly different among tasks. Coupling means and kinematic path lengths were different between free and splinted conditions across all tasks other than pouring. Performance was different between wrist conditions for dart throwing, hammering, basketball shooting, and pouring. Wrist kinematic coupling parameters are task specific in healthy individuals. Functional performance is decreased when wrist coupling is constrained by an external splint. Surgical procedures that restrict wrist coupling may have a detrimental effect on functional performance as defined in the study. Patients may benefit from surgical reconstructive procedures and wrist rehabilitation protocols designed to restore

  6. Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists.

    Directory of Open Access Journals (Sweden)

    Jakob Neubauer

    Full Text Available To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT and to radiography equivalent dose cone beam computed tomography (RED-CBCT for wrist fractures.As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100 were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care, RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004. No significant differences were detected concerning the modalities' specificities (with values between P = .98. Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001.The diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

  7. Wrist arthroscopy

    Science.gov (United States)

    Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... you will have regional anesthesia. Your arm and wrist area will be numbed so that you do ...

  8. Diagnostic value of "bedside ultrasonography" and the "water bath technique" in distal forearm, wrist, and hand bone fractures.

    Science.gov (United States)

    Javadzadeh, Hamid Reza; Davoudi, Amir; Davoudi, Farnoush; Ghane, Mohammad Reza; Khajepoor, Hojatolla; Goodarzi, Hasan; Faraji, Mehrdad; Mahmoudi, Sadrollah; Shariat, Somayeh Sadat; Emami Meybodi, Kazem

    2014-02-01

    Bedside ultrasonography (BUS) has been widely used in many emergency evaluations, but the technique was not thoroughly evaluated for use in adult fractures. The water bath technique (WBT) is a modality which overcomes some important limitations of using BUS in extremity fractures. The study aims to evaluate and compare diagnostic values of BUS and WBT. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), and accuracy of BUS and WBT were calculated and compared by the McNemar chi-square test. BUS had the highest sensitivity, specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of BUS were seen in phalangeal and wrist injuries, respectively. The WBT examination had the highest sensitivity in phalangeal injuries and the highest specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR- of the WBT examination were seen in phalangeal and wrist injuries, respectively. The McNemar χ (2) values for the comparison of BUS and WBT indicate that the two techniques provide statistically different results. The ultrasound revealed excellent diagnostic values which make it a favorable alternative in evaluating upper extremity fractures in adults. The WBT provides even better results.

  9. MR Imaging of Wrist Ligaments.

    Science.gov (United States)

    Ringler, Michael D; Murthy, Naveen S

    2015-08-01

    This article discusses the normal anatomy and pathologic appearances of the intrinsic and extrinsic wrist ligaments using MR Imaging. Technological advances in surface coil design and higher magnetic field strengths have improved radiologists' ability to consistently visualize these small ligaments in their entirety. Wrist ligament anatomy, in the context of proper physiologic function, is emphasized, including common normal variants, and their appearances on MR imaging. The spectrum of disorders, incorporating overlapping appearances of senescent degenerative changes, and destabilizing ligament tears, is outlined. The diagnostic performance of MR imaging to date for various ligament abnormalities is discussed, along with significant limitations. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists.

    Science.gov (United States)

    Neubauer, Jakob; Benndorf, Matthias; Reidelbach, Carolin; Krauß, Tobias; Lampert, Florian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Fiebich, Martin; Goerke, Sebastian M

    2016-01-01

    To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures. As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT. Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = radiography (P radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

  11. Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study.

    Science.gov (United States)

    Masia, Lorenzo; Casadio, Maura; Giannoni, Psiche; Sandini, Giulio; Morasso, Pietro

    2009-12-07

    In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life). Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion) of the different DoFs (degrees of Freedom). The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE), Abduction/Adduction (AA) and Pronation/Supination (PS). Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns. Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the beginning and at the end of the test therapy

  12. Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

    Directory of Open Access Journals (Sweden)

    Sandini Giulio

    2009-12-01

    Full Text Available Abstract Background In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life. Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion of the different DoFs (degrees of Freedom. Methods The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE, Abduction/Adduction (AA and Pronation/Supination (PS. Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns. Results Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the

  13. Development and performance of a new prosthesis system using ultrasonic sensor for wrist movements: a preliminary study.

    Science.gov (United States)

    Abd Razak, Nasrul Anuar; Abu Osman, Noor Azuan; Gholizadeh, Hossein; Ali, Sadeeq

    2014-04-23

    The design and performance of a new development prosthesis system known as biomechatronics wrist prosthesis is presented in this paper. The prosthesis system was implemented by replacing the Bowden tension cable of body powered prosthesis system using two ultrasonic sensors, two servo motors and microcontroller inside the prosthesis hand for transradial user. The system components and hand prototypes involve the anthropometry, CAD design and prototyping, biomechatronics engineering together with the prosthetics. The modeler construction of the system develop allows the ultrasonic sensors that are placed on the shoulder to generate the wrist movement of the prosthesis. The kinematics of wrist movement, which are the pronation/supination and flexion/extension were tested using the motion analysis and general motion of human hand were compared. The study also evaluated the require degree of detection for the input of the ultrasonic sensor to generate the wrist movements. The values collected by the vicon motion analysis for biomechatronics prosthesis system were reliable to do the common tasks in daily life. The degree of the head needed to bend to give the full input wave was about 45°-55° of rotation or about 14 cm-16 cm. The biomechatronics wrist prosthesis gave higher degree of rotation to do the daily tasks but did not achieve the maximum degree of rotation. The new development of using sensor and actuator in generating the wrist movements will be interesting for used list in medicine, robotics technology, rehabilitations, prosthetics and orthotics.

  14. Wrist Sprains

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Sprains Email to a friend * required fields From * ... most common ligament to be injured in the wrist is the scapho-lunate ligament (see Figure 2). ...

  15. Wrist ultrasound examination – scanning technique and ultrasound anatomy. Part 2: Ventral wrist

    Directory of Open Access Journals (Sweden)

    Cyprian Olchowy

    2017-06-01

    Full Text Available Ultrasound imaging of the musculoskeletal system is an important element of the diagnostic and therapeutic protocol. Clinical decisions, including those regarding surgical procedures, are often based solely on ultrasound imaging. However, detailed knowledge on the anatomy and a correct scanning technique are crucial for an accurate diagnosis. Modern ultrasonographic equipment allows obtaining detailed anatomical images of muscle tendons, ligaments, nerves and vessels of the carpal area. Ventral wrist ultrasound is one of the most common diagnostic procedures in patients with suspected carpal tunnel syndrome. Ventral wrist evaluation is also often performed in patients with wrist pain of unclear etiology, rheumatic diseases, wrist injuries or symptoms of ulnar neuropathy. The aim of this paper is to present ultrasound images with corresponding anatomical schemes. The technique of ultrasound examination of the ventral wrist along with practical guidance to help obtain highly diagnostic images is also discussed. The present paper is the second part of an article devoted to ultrasound anatomy and wrist ultrasound technique – the part discussing the dorsal side of the wrist was published in the Journal of Ultrasonography, Vol. 15, No 61. The following anatomical structures should be visualized during an ultrasound examination of the ventral wrist, both in the carpal tunnel as well as proximally and distally to it: four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, flexor pollicis longus, flexor carpi radialis tendon, median nerve and flexor retinaculum; in the carpal tunnel as well as proximally and distally to it: the ulnar nerve, ulnar artery and veins; the tendon of the flexor carpi ulnaris muscle; carpal joints.

  16. Opportunistic Osteoporosis Screening - Gleaning Additional Information from Diagnostic Wrist CT Scans.

    Science.gov (United States)

    Schreiber, Joseph J; Gausden, Elizabeth B; Anderson, Paul A; Carlson, Michelle G; Weiland, Andrew J

    2015-07-01

    Although screening for and treating osteoporosis can prevent subsequent fractures, the rates of such interventions are low following a distal radial fracture. One potential method for identifying metabolic bone disease is via Hounsfield unit (HU) measurements from diagnostic computed tomography (CT) scans. We hypothesized that HU values of the distal aspect of the radius could be used to assess local bone quality and would be predictive of distal radial fracture risk, thereby allowing the identification of patients in need of further management. Measurements of bone mineral density (BMD) were made for 100 patients on the basis of HU values of cancellous portions of the distal aspect of the radius, the ulnar head, and the capitate. The HU values in twenty-five male and twenty-five female patients with an acute distal radial fracture documented on CT were compared with those of age and sex-matched control patients who had a CT scan obtained for other indications. Among the control patients, HU values decreased as age increased. When assessed on the basis of sex, both male and female patients with a distal radial fracture had significantly lower regional BMD compared with nonfracture control patients. A distal radial HU value of 218 for females and 246 for males optimized sensitivity and specificity; values below this threshold were associated with an increased risk of distal radial fracture. HU measurements can be obtained from any diagnostic CT scan using modern software programs and can be obtained by physicians in the office setting with minimal effort and at no additional cost or radiation exposure to the patient. Regardless of imaging indications, we suggest that patients with HU values below the identified thresholds be considered for further metabolic bone disease work-up, such as additional imaging, laboratory assessments, the initiation of osteoporosis treatment, or appropriate referral. Copyright © 2015 by The Journal of Bone and Joint Surgery

  17. [Operative differential therapy of rheumatic wrists].

    Science.gov (United States)

    Dinges, H; Fürst, M; Rüther, H; Schill, S

    2007-09-01

    The wrists are affected in the long-term in 90% of people with rheumatism and are often (42%) the first manifestation of a destructive disease. The functionality of the wrist and the whole hand is of great importance because in many cases loss of function of the wrists leads to severe limitations. Local and operative treatment of the wrist in rheumatoid arthritis (RA) is one of the main duties in rheuma-orthopaedics. For operative treatment there is a finely tuned differential therapeutic spectrum available. The diagnostic indications take the local and total pattern of affection, the current systemic therapy as well as patient wishes and patient compliance into consideration. In the early stages according to LDE (Larsen, Dale, Eek), soft tissues operations such as articulo-tenosynovectomy (ATS) are most commonly carried out. In further advanced stages osseus stabilisation must often be performed. At this point a smooth transition from partial arthrodesis to complete fixation is possible. After initial euphoria, arthroplasty of the wrist is being increasingly less used for operative treatment due to the unconvincing long-term results and high complication rate. With reference to the good long-term results of all operative procedures, in particular early ATS with respect to pain, function and protection of tendons, after failure of medicinal treatment and persistence of inflammatory activity in the wrist, patients should be transferred to an experienced rheuma-orthopaedic surgeon.

  18. Wrist osteoarthritis.

    Science.gov (United States)

    Laulan, J; Marteau, E; Bacle, G

    2015-02-01

    Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Evaluation of flat, angled, and vertical computer mice and their effects on wrist posture, pointing performance, and preference.

    Science.gov (United States)

    Odell, Dan; Johnson, Peter

    2015-01-01

    Modern computer users use the mouse almost three times as much as the keyboard. As exposure rates are high, improving upper extremity posture while using a computer mouse is desirable due to the fact that posture is one risk factor for injury. Previous studies have found posture benefits associated with using alternative mouse designs, but at the cost of performance and preference. To develop new computer mouse shapes, evaluate them versus benchmarks, and determine whether there are differences in wrist posture, pointing performance, and subjective measures. Three concept mice were designed and evaluated relative to two existing benchmark models: a traditional flat mouse, and an alternative upright mouse. Using a repeated measures design, twelve subjects performed a standardized point-and-click task with each mouse. Pointing performance and wrist posture was measured, along with perceived fatigue ratings and subjective preferences pre and post use. All of the concept mice were shown to reduce forearm pronation relative to the traditional flat mouse. There were no differences in pointing performance between the traditional flat mouse and the concept mice. In contrast, the fully vertical mouse reduced pronation but had the poorest pointing performance. Perceived fatigue and subjective preferences were consistently better for one concept mouse. Increasing mouse height and angling the mouse topcase can improve wrist posture without negatively affecting performance.

  20. The Optimal Speed for Cortical Activation of Passive Wrist Movements Performed by a Rehabilitation Robot: A Functional NIRS Study.

    Science.gov (United States)

    Bae, Sung Jin; Jang, Sung Ho; Seo, Jeong Pyo; Chang, Pyung Hun

    2017-01-01

    Objectives: To advance development of rehabilitation robots, the conditions to induce appropriate brain activation during rehabilitation performed by robots should be optimized, based on the concept of brain plasticity. In this study, we examined differences in cortical activation according to the speed of passive wrist movements performed by a rehabilitation robot. Methods: Twenty three normal subjects participated in this study. Passive movements of the right wrist were performed by the wrist rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5 Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity accompanying the passive movements performed by a robot. The relative changes in oxy-hemoglobin (HbO) were measured in two regions of interest (ROI): the primary sensory-motor cortex (SM1) and premotor area (PMA). Results: In the left SM1 the HbO value was significantly higher at 0.5 Hz, compared with movements performed at 0.25 Hz and 0.75 Hz (p 0.05). In the group analysis, the left SM1 was activated during passive movements at three speeds (uncorrected p rehabilitation robot. Therefore, our results might provide useful data for more effective and empirically-based robot rehabilitation therapy.

  1. The Optimal Speed for Cortical Activation of Passive Wrist Movements Performed by a Rehabilitation Robot: A Functional NIRS Study

    Directory of Open Access Journals (Sweden)

    Pyung Hun Chang

    2017-04-01

    Full Text Available Objectives: To advance development of rehabilitation robots, the conditions to induce appropriate brain activation during rehabilitation performed by robots should be optimized, based on the concept of brain plasticity. In this study, we examined differences in cortical activation according to the speed of passive wrist movements performed by a rehabilitation robot.Methods: Twenty three normal subjects participated in this study. Passive movements of the right wrist were performed by the wrist rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5 Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity accompanying the passive movements performed by a robot. The relative changes in oxy-hemoglobin (HbO were measured in two regions of interest (ROI: the primary sensory-motor cortex (SM1 and premotor area (PMA.Results: In the left SM1 the HbO value was significantly higher at 0.5 Hz, compared with movements performed at 0.25 Hz and 0.75 Hz (p < 0.05, while no significant differences were observed in the left PMA (p > 0.05. In the group analysis, the left SM1 was activated during passive movements at three speeds (uncorrected p < 0.05 and the greatest activation in the SM1 was observed at 0.5 Hz.Conclusions: In conclusion, the contralateral SM1 showed the greatest activation by a moderate speed (0.5 Hz rather than slow (0.25 Hz and fast (0.75 Hz speed. Our results suggest an ideal speed for execution of the wrist rehabilitation robot. Therefore, our results might provide useful data for more effective and empirically-based robot rehabilitation therapy.

  2. The post-arthro-CT of the wrist clinical evaluation

    CERN Document Server

    Scheurecker, G

    2001-01-01

    To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: in 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: the following detection rates were observed (AG and AS positive/AG...

  3. Wrist Pain

    Science.gov (United States)

    ... wrist. These can include football, bowling, golf, gymnastics, snowboarding and tennis. Repetitive work. Almost any activity that ... guards for high-risk activities, such as football, snowboarding and rollerblading. Pay attention to ergonomics. If you ...

  4. Wrist Actigraphy

    OpenAIRE

    Martin, Jennifer L.; Hakim, Alex D.

    2011-01-01

    To record sleep, actigraph devices are worn on the wrist and record movements that can be used to estimate sleep parameters with specialized algorithms in computer software programs. With the recent establishment of a Current Procedural Terminology code for wrist actigraphy, this technology is being used increasingly in clinical settings as actigraphy has the advantage of providing objective information on sleep habits in the patient’s natural sleep environment. Actigraphy has been well valid...

  5. Estimating Heart Rate, Energy Expenditure, and Physical Performance With a Wrist Photoplethysmographic Device During Running.

    Science.gov (United States)

    Parak, Jakub; Uuskoski, Maria; Machek, Jan; Korhonen, Ilkka

    2017-07-25

    Wearable sensors enable long-term monitoring of health and wellbeing indicators. An objective evaluation of sensors' accuracy is important, especially for their use in health care. The aim of this study was to use a wrist-worn optical heart rate (OHR) device to estimate heart rate (HR), energy expenditure (EE), and maximal oxygen intake capacity (VO2Max) during running and to evaluate the accuracy of the estimated parameters (HR, EE, and VO2Max) against golden reference methods. A total of 24 healthy volunteers, of whom 11 were female, with a mean age of 36.2 years (SD 8.2 years) participated in a submaximal self-paced outdoor running test and maximal voluntary exercise test in a sports laboratory. OHR was monitored with a PulseOn wrist-worn photoplethysmographic device and the running speed with a phone GPS sensor. A physiological model based on HR, running speed, and personal characteristics (age, gender, weight, and height) was used to estimate EE during the maximal voluntary exercise test and VO2Max during the submaximal outdoor running test. ECG-based HR and respiratory gas analysis based estimates were used as golden references. OHR was able to measure HR during running with a 1.9% mean absolute percentage error (MAPE). VO2Max estimated during the submaximal outdoor running test was closely similar to the sports laboratory estimate (MAPE 5.2%). The energy expenditure estimate (n=23) was quite accurate when HR was above the aerobic threshold (MAPE 6.7%), but MAPE increased to 16.5% during a lighter intensity of exercise. The results suggest that wrist-worn OHR may accurately estimate HR during running up to maximal HR. When combined with physiological modeling, wrist-worn OHR may be used for an estimation of EE, especially during higher intensity running, and VO2Max, even during submaximal self-paced outdoor recreational running.

  6. Diagnostic criteria for sarcopenia and physical performance

    NARCIS (Netherlands)

    Bijlsma, A.Y.; Meskers, C.G.M.; van den Eshof, N.; Westendorp, R.G.; Sipila, S.; Stenroth, L.; Sillanpaa, E.; McPhee, J.S.; Jones, D.A.; Narici, M.V.; Gapeyeva, H.; Paasuke, M.; Voit, T.; Barnouin, Y.; Hogrel, J.Y.; Butler-Browne, G.; Maier, A.B.

    2014-01-01

    Relative and absolute muscle mass and muscle strength are used as diagnostic criteria for sarcopenia.We aimed to assess which diagnostic criteria are most associated with physical performance in 180 young (18-30 years) and 281 healthy old participants (69-81 years) of the European study MYOAGE.

  7. Diagnostic performance of screening methods for urinary ...

    African Journals Online (AJOL)

    E-mail: akinfati@yahoo.com. Journal of Community Medicine and Primary Health Care. June 2005; 17(1): 24-27. Abstract. Background: Indirect diagnostic methods in urinary schistosomiasis are widely used for screening high-risk populations in endemic areas. Their diagnostic performances, however, vary. The objective of.

  8. [Standardisation of the MRI and US images evaluation in the diagnostics of rheumatoid arthritis within the wrist and metacarpophalangeal joints].

    Science.gov (United States)

    Kapuścińska, Katarzyna; Urbanik, Andrzej; Wojciechowski, Wadim; Podsiadło, Lilianna; Grochowska, Anna; Nardzewska-Szczepanik, Monika

    2010-01-01

    In Rheumatoid arthritis (RA) it is very important to recognize pathologic condition and to start proper treatment as early as possible to lessen its consequences. Currently, magnetic resonance imaging and ultrasonography are the best imaging modalities because they depict early stages of this disease and allows to control response to treatment. MRI depicts also bone oedema, which is a strong predictor of further progression. The process of standardization is needed in assessing both MR and US pictures. Standardization allows to compared both examinations of the same patient in different time and examinations of different patients. An aim of this article is to present: MR protocols of hand and wrist MR examinations for rheumatologic demand and standards of results, according to worldwide OMERAC RAMRIS 2002 and supplemented by tenosynovitis system; proposals for US examination of hands in rheumatoid patients.

  9. Wrist rhythm during wrist joint motion evaluated by dynamic radiography.

    Science.gov (United States)

    Kawashima, Hiroki; Tada, Kaoru; Suganuma, Seigo; Tsuchiya, Hiroyuki; Sanada, Shigeru

    2014-01-01

    We hypothesized that wrist joint motion involves a "wrist rhythm" similar to the scapulohumeral rhythm. Therefore, we used a flat-panel detector to evaluate the ratio of radiolunate and capitolunate joint motions during wrist joint motion by dynamic radiography. The subjects were 20 healthy men. Dynamic imaging of the wrist joint was performed during active exercise for a total of ten seconds. In this study, we defined the radiocarpal (RL angle) and midcarpal joint angle (CL angle) as the wrist joint angle in the obtained images and measured the variation of these angles. The average curve was plotted and regression lines calculated from the average curve. The ratio was calculated from the slopes of the regression lines of the RL CL angles. These findings indicated that the ratio of the RL and CL angle motions was approximately 1:4 during palmar flexion and approximately 2:1 during dorsiflexion.

  10. High Performance Modeling of Novel Diagnostics Configuration

    Science.gov (United States)

    Smith, Dalton; Gibson, John; Lodes, Rylie; Malcolm, Hayden; Nakamoto, Teagan; Parrack, Kristina; Trujillo, Christopher; Wilde, Zak; Los Alamos Laboratories Q-6 Students Team

    2017-06-01

    A novel diagnostics method to measure the Hayes Electric Effect was tested and verified against computerized models. Where standard PVDF diagnostics utilize piezoelectric materials to measure detonation pressure through strain-induced electrical signals, the PVDF was used in a novel technique by also detecting the detonation's induced electric field. The ALE-3D Hydro Codes predicted the performance by calculating detonation velocities, pressures, and arrival times. These theoretical results then validated the experimental use of the PVDF repurposed to specifically track the Hayes Electric Effect. Los Alamos National Laboratories Q-6.

  11. Wrist Injuries in Elderly Women

    DEFF Research Database (Denmark)

    Wrange, Erik Kristian Maurice; Brix, Lau

    Keywords Extremities, Musculoskeletal bone, Trauma, Conventional radiography, MR, Outcomes analysis, Acute, Osteoporosis Aims and objectives The purpose of this study was to compare diagnostic X-rays and MRI of the injured wrist in female patients aged 50 years or more. Methods and materials Fift...

  12. Total wrist arthrodesis with wrist fusion rod in patients with rheumatoid arthritis.

    Science.gov (United States)

    Onuma, Kenji; Shintani, Ryosuke; Fujimaki, Hisako; Sukegawa, Koji; Kenmoku, Tomonori; Uchida, Kentaro; Takahira, Naonobu; Takaso, Masashi

    2015-01-01

    This study aims to retrospectively review the short-term surgical outcome of wrist fusion using wrist fusion rod (WFR). Six wrists of four female patients (mean age 56 years; range 51 to 62 years) with advanced stage rheumatoid arthritis of Larsen IV or V were performed total wrist fusion using WFR. Clinical outcome was assessed using a numeric rating scale of pain satisfaction level. Bony fusion, correction of palmar subluxation and ulnar deviation, rod bending angle, wrist fusion angle, and complications were assessed from radiographs. All wrists achieved painless wrist stability with bony fusion of the radiocarpal joint. Both the palmar subluxation and ulnar deviation were corrected in all patients. Two radiographic complications were observed: rod fracture in one patient and a radiolucent line in proximal metacarpal bone in another patient. Both complications might have occurred as a result of instability of the third carpometacarpal joint, but neither influenced clinical outcome. Wrist fusion angle was smaller than rod bending angle at final observation. Wrist fusion using WFR is an option for the treatment of advanced stage rheumatoid arthritis of wrist. According to our experience, the stability of third carpometacarpal joint should be assessed before surgery, and this joint should be fused if required. The bending angle of the intramedullary rod does not directly form the wrist fusion angle in contrast to the case with a dorsal wrist fusion plate.

  13. New Diagnostics to Assess Model Performance

    Science.gov (United States)

    Koh, Tieh-Yong

    2013-04-01

    The comparison of model performance between the tropics and the mid-latitudes is particularly problematic for observables like temperature and humidity: in the tropics, these observables have little variation and so may give an apparent impression that model predictions are often close to observations; on the contrary, they vary widely in mid-latitudes and so the discrepancy between model predictions and observations might be unnecessarily over-emphasized. We have developed a suite of mathematically rigorous diagnostics that measures normalized errors accounting for the observed and modeled variability of the observables themselves. Another issue in evaluating model performance is the relative importance of getting the variance of an observable right versus getting the modeled variation to be in phase with the observed. The correlation-similarity diagram was designed to analyse the pattern error of a model by breaking it down into contributions from amplitude and phase errors. A final and important question pertains to the generalization of scalar diagnostics to analyse vector observables like wind. In particular, measures of variance and correlation must be properly derived to avoid the mistake of ignoring the covariance between north-south and east-west winds (hence wrongly assuming that the north-south and east-west directions form a privileged vector basis for error analysis). There is also a need to quantify systematic preferences in the direction of vector wind errors, which we make possible by means of an error anisotropy diagram. Although the suite of diagnostics is mentioned with reference to model verification here, it is generally applicable to quantify differences between two datasets (e.g. from two observation platforms). Reference publication: Koh, T. Y. et al. (2012), J. Geophys. Res., 117, D13109, doi:10.1029/2011JD017103. also available at http://www.ntu.edu.sg/home/kohty

  14. Hand and Wrist Tumors

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Hand Tumors and Wrist Tumors Email to a friend * ... are seen commonly. CAUSES Common Types of Wrist Hand Tumors Ganglion Cysts (Figure 1): This is the ...

  15. Wrist sprain - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000568.htm Wrist sprain - aftercare To use the sharing features on ... that hold bones together. When you sprain your wrist, you have pulled or torn one or more ...

  16. Wrist anatomy (image)

    Science.gov (United States)

    ... a compartment called the carpal tunnel in the wrist. The ligaments that transverse the nerve are not ... flexible. If there is any swelling within the wrist compartment excessive pressure can be put on structures ...

  17. Wrist Arthroscopy under Portal Site Local Anesthesia (PSLA) without Tourniquet.

    Science.gov (United States)

    Ong, Michael T Y; Ho, P C; Wong, Clara W Y; Cheng, Sally H S; Tse, Wing-Lim

    2012-11-01

    Purpose wrist arthroscopy is typically performed under general or regional anesthesia with the aid of a tourniquet to maintain a bloodless field. We have been using portal site local anesthesia (PSLA) for wrist arthroscopy without a tourniquet since 1998. The aim of the study was to assess the efficacy, safety, and complications of PSLA and whether this can be recommended for routine wrist arthroscopy. Method We conducted a retrospective study, identifying 111 consecutive cases of wrist arthroscopies performed from January 2007 to December 2009. All cases were performed under PSLA. The effectiveness of PSLA was assessed by analyzing whether the procedure required adjuvant forms of anesthesia. The subjective effectiveness was assessed via phone questionnaires. Results Sixty-eight male and 43 female patients were identified. The average age was 43.2 (range 16-77). The indications included chronic wrist pain of unknown origin (30), posttraumatic arthritis (27), rheumatoid arthritis (5), ganglion (30), triangular fibrocartilage complex (TFCC) injury (14), infectious (1), and carpal instability (4). The average duration of the procedures was 73 minutes (range 20-255 minutes). Therapeutic procedures were performed in all 111 cases in addition to a routine diagnostic assessment. These included arthroscopic debridement (82) synovectomy (6), ganglionectomy (30), TFCC repair (3), TFCC debridement (11), radial styloidectomy (2), wafer procedure (4), thermal shrinkage (2), distal scaphoidectomy (1), and synovial biopsy (4). All procedures could be completed uneventfully. Most patients tolerated the procedure well throughout the operation, and the satisfaction level was high. No complication was encountered. Discussions We concluded that PSLA technique is a feasible mode of anesthesia in selected patients. Level IV.

  18. Physical Performance Characteristics of Military Aircraft Maintenance Personnel Resistant to Work-Related Musculoskeletal Disorders of the Hand and Wrist

    Science.gov (United States)

    2006-01-01

    tendonitis, carpal tunnel syndrome , and arthritis are included in the category of WMSDs. Risk factors such as repetition, vibration, awkward positions...work. For example, WMSDs such as carpal tunnel syndrome , wrist injuries and repetitive motion injuries resulted in 32, 17, and 22 days absence from work...inflammatory disorders include tendonitis, trigger finger, and tenosynovitis. Nerve compression conditions include carpal tunnel syndrome and ulnar

  19. The immediate effects of tension of counterforce forearm brace on neuromuscular performance of wrist extensor muscles in subjects with lateral humeral epicondylosis.

    Science.gov (United States)

    Ng, G Y F; Chan, H L

    2004-02-01

    Within-subject repeated-measures study. To examine the immediate effects of counterforce forearm brace on isokinetic strenght stretch reflex, passive stretching pain threshold of the wrist extensors, and proprioception of the wrist in subjects with lateral humeral epicondylosis for different strap tensions of a forearm brace. Counterforce forearm bracing has been used for treating lateral humeral epicondylosis, but the effect of brace tension has not been well reported. Fifteen subjects diagnosed with lateral humeral epicondylosis on their dominant arm were tested under 4 randomized conditions: (1) no brace, (2) brace with minimal tension, (3) brace with 25-N tension, and (4) brace with 50-N tension. The tests included isokinetic wrist extensors strength, passive stretching force in wrist flexion to elicit pain in the wrist extensors, wrist proprioception, and stretch reflex latency of the extensor carpi ulnari. A repeated-measures MANOVA was used to analyze the data and significant results were further analyzed with post hoc linear contrasts (alpha = .05). Among the 4 conditions, significant differences were found in wrist proprioception P = .032) and pain threshold to passive stretching of the wrist extensors (P = .05), but were not found in wrist extension isokinetic strength and stretch reflex latency of the extensor carpi ulnaris. A forearm counterforce brace, as applied in this study, affects wrist joint proprioception and increases the pain threshold to passive stretching of the wrist extensors in subjects with lateral humeral epicondylosis, but it has no effect on wrist extensor strength and stretch reflex latency of the extensor carpi ulnaris.

  20. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple.

    Science.gov (United States)

    Gitto, Salvatore; Messina, Carmelo; Mauri, Giovanni; Aliprandi, Alberto; Sardanelli, Francesco; Sconfienza, Luca Maria

    2017-02-01

    Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Design and characterization of the OpenWrist: A robotic wrist exoskeleton for coordinated hand-wrist rehabilitation.

    Science.gov (United States)

    Pezent, Evan; Rose, Chad G; Deshpande, Ashish D; O'Malley, Marcia K

    2017-07-01

    Robotic devices have been clinically verified for use in long duration and high intensity rehabilitation needed for motor recovery after neurological injury. Targeted and coordinated hand and wrist therapy, often overlooked in rehabilitation robotics, is required to regain the ability to perform activities of daily living. To this end, a new coupled hand-wrist exoskeleton has been designed. This paper details the design of the wrist module and several human-related considerations made to maximize its potential as a coordinated hand-wrist device. The serial wrist mechanism has been engineered to facilitate donning and doffing for impaired subjects and to insure compatibility with the hand module in virtual and assisted grasping tasks. Several other practical requirements have also been addressed, including device ergonomics, clinician-friendliness, and ambidextrous reconfigurability. The wrist module's capabilities as a rehabilitation device are quantified experimentally in terms of functional workspace and dynamic properties. Specifically, the device possesses favorable performance in terms of range of motion, torque output, friction, and closed-loop position bandwidth when compared with existing devices. The presented wrist module's performance and operational considerations support its use in a wide range of future clinical investigations.

  2. Evaluation of the diagnostic performance and operational ...

    African Journals Online (AJOL)

    Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. 6. Université de Ouagadougou, Laboratoire de Bactériologie-Virologie. Abstract. Background and objective: Little information is available on the rapid diagnostic testing for syphilis in Burkina Faso. The objectives of the study were (i) to assess the sensitivity ...

  3. Education in wrist arthroscopy

    NARCIS (Netherlands)

    Obdeijn, M.C.

    2014-01-01

    The subject of this thesis is an initiative for improving the education of residents in surgical skills and knowledge by using the current technical possibilities. The choice of wrist arthroscopy was driven by the fact that novel techniques have recently been developed within hand and wrist surgery

  4. Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Demehri, Shadpour; Hafezi-Nejad, Nima; Morelli, John N.; Thakur, Uma; Eng, John [Johns Hopkins University, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Lifchez, Scott D.; Shores, Jaimie T. [Johns Hopkins University, Department of Plastic and Reconstructive Surgery, Baltimore, MD (United States); Means, Kenneth R. [MedStar Union Memorial Hospital, The Curtis National Hand Center, Baltimore, MD (United States)

    2016-04-15

    Using four-dimensional CT scan (4DCT), we aimed at showing the kinematics of scapholunate (SL) interval in asymptomatic wrists in comparison with symptomatic contralateral wrists with inconclusive radiographic findings. This is an IRB approved, HIPPA compliant, retrospective study. Patients suspected of SL interosseous ligament (SLIL) injuries were referred for further evaluation of chronic wrist pain (>3 months). Twelve wrists (11 subjects) with chronic symptoms and inconclusive plain radiographs and 10 asymptomatic wrists (in 10 different subjects) were scanned using 4DCT. The minimum SL interval was measured during three wrist motions: relaxed-to-clenched fist, flexion-to-extension, and radial-to-ulnar-deviation. Changes were recorded using double-oblique multiplanar reformation technique. We extracted the normal limits of the SL interval as measured by dynamic CT scanning during active motion in asymptomatic wrists. In asymptomatic wrists, the average SL interval was observed to be smaller than 1 mm during all motions. In symptomatic wrists, during exams performed with clenched fist (SL interval (mean ± SD) = 2.53 ± 1.19 mm), extension (2.54 ± 1.48 mm) or ulnar deviation (2.06 ± 1.12 mm), the average SL interval was more than 2 mm. In contrast to symptomatic wrists, no significant change in SL interval measurements was detected during wrist motions in asymptomatic wrists. There was a mild to moderate correlation between SL interval change and presence/absence of symptoms (point-biserial correlation coefficients: 0.29-0.55). In patients with wrist pain suspicious for SLIL injury and inconclusive radiographs, SL interval increase can be detected with 4DCT in the symptomatic wrist compared to the asymptomatic wrist. (orig.)

  5. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction

    Energy Technology Data Exchange (ETDEWEB)

    Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Kantonsspital Luzern, Roentgeninstitut/Nuklearmedizin, Luzern (Switzerland); Steurer-Dober, Isabelle; Huellner, Martin W.; Sol Perez Lago, Maria del; Veit-Haibach, Patrick; Tornquist, Katharina [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Silva, Angela J. da [Advanced Molecular Imaging, Philips Healthcare, San Jose, CA (United States); Bodmer, Elvira; Wartburg, Urs von; Hug, Urs [Lucerne Cantonal Hospital, Division of Hand and Plastic Surgery, Lucerne (Switzerland)

    2014-03-15

    To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq {sup 99m}Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up. The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82 %) and 25 of 28 wrists (89 %), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81 %), SL ligament in 22 of 27 wrists (81 %) and LT ligament in 23 of 27 wrists (85 %). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75 %). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14 %) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11 %). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100 % and reached 96 % (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93 %, 100 % and 100 %, and 93 %, 93 % and 93

  6. Application of the Blobo bluetooth ball in wrist rehabilitation training.

    Science.gov (United States)

    Hsieh, Wei-Min; Hwang, Yuh-Shyan; Chen, Shih-Ching; Tan, Sun-Yen; Chen, Chih-Chen; Chen, Yu-Luen

    2016-01-01

    [Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods] Wrist injuries caused by fatigue at work, improper exercise, and other conditions are very common. Therefore, the reconstruction of wrist joint function is an important issue. The efficacy of a newly developed integrated wrist joint rehabilitation game using a Blobo bluetooth ball with C# software installed was tested in wrist rehabilitation (Flexion, Extension, Ulnar Deviation, Radial Deviation). [Results] Eight subjects with normal wrist function participated in a test of the system's stability and repeatability. After performing the Blobo bluetooth ball wrist physical therapy training, eight patients with wrist dysfunction experienced approximately 10° improvements in range of motion (ROM) of flexion extension, and ulnar deviation and about 6° ROM improvement in radial deviation. The subjects showed progress in important indicators of wrist function. [Conclusion] This study used the Blobo bluetooth ball in wrist physical therapy training and the preliminary results were encouraging. In the future, more diverse wrist or limb rehabilitation games should be developed to meet the needs of physical therapy training.

  7. Wrist joint assembly

    Science.gov (United States)

    Kersten, L.; Johnson, J. D. (Inventor)

    1978-01-01

    A wrist joint assembly is provided for use with a mechanical manipulator arm for finely positioning an end-effector carried by the wrist joint on the terminal end of the manipulator arm. The wrist joint assembly is pivotable about a first axis to produce a yaw motion, a second axis is to produce a pitch motion, and a third axis to produce a roll motion. The wrist joint assembly includes a disk segment affixed to the terminal end of the manipulator arm and a first housing member, a second housing member, and a third housing member. The third housing member and the mechanical end-effector are moved in the yaw, pitch, and roll motion. Drive means are provided for rotating each of the housings about their respective axis which includes a cluster of miniature motors having spur gears carried on the output drive shaft which mesh with a center drive gear affixed on the housing to be rotated.

  8. Dexterous Humanoid Robotic Wrist

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Bridgwater, Lyndon (Inventor); Reich, David M. (Inventor); Wampler, II, Charles W. (Inventor); Askew, Scott R. (Inventor); Diftler, Myron A. (Inventor); Nguyen, Vienny (Inventor)

    2013-01-01

    A humanoid robot includes a torso, a pair of arms, a neck, a head, a wrist joint assembly, and a control system. The arms and the neck movably extend from the torso. Each of the arms includes a lower arm and a hand that is rotatable relative to the lower arm. The wrist joint assembly is operatively defined between the lower arm and the hand. The wrist joint assembly includes a yaw axis and a pitch axis. The pitch axis is disposed in a spaced relationship to the yaw axis such that the axes are generally perpendicular. The pitch axis extends between the yaw axis and the lower arm. The hand is rotatable relative to the lower arm about each of the yaw axis and the pitch axis. The control system is configured for determining a yaw angle and a pitch angle of the wrist joint assembly.

  9. Robo-Wrist Controller

    OpenAIRE

    Faraquddin Ahamed, Mohamed Athiq

    2015-01-01

    Robo-wrist controller is a Graphical User Interface (GUI) based application designed and developed to control, and monitor a wrist exoskeleton driven by micro-controllers. The software application is developed to better assist a physiotherapist in administering physical therapy to stroke patients with the help of the exoskeleton. Since the micro-controller device that directly controls the exoskeleton is not very intuitive to use and lacks visual feedback, a software application fills these g...

  10. MRI of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dick, Elizabeth A. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)], E-mail: dickelizabeth@hotmail.com; Burnett, Carole; Gedroyc, Wladyslaw M.W. [Department of MRI, St Mary' s Hospital, Praed St, London W2 1NY (United Kingdom)

    2008-08-15

    Magnetic resonance imaging of the wrist is increasingly recognised as the imaging modality of choice in wrist disorders as image resolution improves and clinicians realise its potential. Consequently the ability to confidently interpret such imaging will become more important to both general and musculoskeletal radiologists. This article reviews current optimal imaging protocols and describes common abnormalities with a particular emphasis on less well understood topics such as intercalated segment instability, the triangular fibrocartilage complex and carpal tunnel syndrome.

  11. Dynamic assessment of the wrist after total wrist arthroplasty.

    Science.gov (United States)

    Singh, H P; Bhattacharjee, D; Dias, J J; Trail, I

    2017-07-01

    Our aim was to assess the outcome in patients with total wrist arthroplasty performed for end stage wrist osteoarthritis. We analysed the ranges of motion of operated and un-operated wrists using a flexible electrogoniometer during the Sollerman hand function test. We assessed grip strength with a digital dynamometer and completed patient reported outcome scores more than one year post-operatively. We reviewed 12 patients with a mean age of 64 (range 48-82) years. The flexion-extension arc was 72% and radioulnar deviation arc was 53% of the un-operated side but the total range of motion (area of circumduction) was 43% of the un-operated side and only 20% of the circumduction in age and gender-matched normal volunteers. Peak grip strength was 68% of the un-operated side. The patients reported good outcome with mean Michigan Hand Questionnaire (MHQ) scores of 56 (range 25-84) and mean Patient Evaluation Measure (PEM) scores of 39 (range 20-68). Patients completed the activities of Sollerman hand function test in twice the time (6 min) as required for a normal volunteer (2.8 min). The circumduction ellipses were narrow and central with limited radio-ulnar deviation and small mean areas of motion during activities of daily living.

  12. Diagnostic performance of ultrasound in acute appendicitis

    Directory of Open Access Journals (Sweden)

    Omar Alejandro Ortega

    2012-12-01

    Full Text Available Background: acute appendicitis (AA is the acute surgical abdominal disease more common in the Hospital Susana López de Valencia Popayán, Colombia; its diagnosis is one of the most common problems in emergency. Objective: to determined the operating performance of emergency ultrasound in suspected acute appendicitis. Methods: retrospective study conducted with data obtained from the first of January to 31 December 2011, including patients with presumed diagnosis of AA and abdominal ultrasound before surgery. Results: a total of 134 individuals who underwent surgery, with pre-procedure ultrasound report and pathology report. The performance of ultrasound resulted in a sensitivity of 73.2%, specificity 86.3%, positive predictive value of 96.4%, negative predictive value of 38.7%. Conclusion: the overall performance of abdominal ultrasound in the diagnosis of acute appendicitis in our hospital is acceptable. But its usefulness is poor in excluding the diagnosis of acute appendicitis. Because of its accessibility and low cost is the best test available for diagnosis in doubtful cases in emergency or difficult diagnosis.

  13. Locked intramedullary total wrist arthrodesis.

    Science.gov (United States)

    Orbay, Jorge L; Feliciano, Eric; Orbay, Carolina

    2012-11-01

    Total wrist arthrodesis is commonly performed using fixation plates, which can produce soft tissue irritation, often require removal, and limit the ability to position the hand in space. The Skeletal Dynamics IMPLATE is an intramedullary total wrist fusion device designed to provide stable fixation while avoiding the problems associated with plates. Radial and metacarpal locked intramedullary nails are inserted and joined by a connector. Desired hand placement is achieved by selecting the proper connector length and angle, then orienting it appropriately. Fusion mass compression is obtained by virtue of longitudinal threads on the radial nail that allow for length adjustment. Seven wrists in three men and four women were treated with this device and followed for a minimum of 24 weeks. In all cases, local cancellous bone graft was used and the third carpometacarpal (CMC) joint incorporated into the fusion. The median age was 49 (range, 28-71) years. Indications for fusion were two posttraumatic arthritides, three rheumatoid arthritides, one spastic deformity, and one infection. Patients were evaluated before surgery and at final follow-up using the Fernandez pain score and grip strength measurements using a hand-held dynamometer. All patients improved their grip strength and decreased their pain scores. All fusions united, and none of the patients presented dorsal soft tissue problems or required implant removal. One rheumatoid patient required secondary surgery for removal of a retained palmar osteophyte. This device delivers stable fixation, facilitates hand placement, and does not require removal.

  14. Ultrasound evaluation of effect of different degree of wrist extension on radial artery dimension at the wrist joint.

    Science.gov (United States)

    Selvaraj, Venkatesh; Buhari, Faiza Sulaiman

    2016-01-01

    Successful arterial cannulation requires wide and patent arterial lumen. A recent study has shown that success rate of radial arterial cannulation at first attempt is more at 45° angle of wrist extension in both young and elderly patients. No study has reasoned whether these high success rates at 45° is because of less compression of the radial artery at this particular angle of wrist extension. Hence, we attempted to study whether the radial artery dimensions changes with increasing angles of wrist extension in young, healthy female volunteers using ultrasound examination. To investigate the effect of increasing angle of wrist extension of 0, 15, 30, 45, 60, and 75° on radial artery dimensions at the level of the wrist joint using ultrasound examination. A prospective single blinded study in volunteers. Sonographic measurements of radial artery dimension at the wrist level were performed in 48 young, healthy female subjects. Height (anteroposterior in mm), width (mediolateral in mm) and depth (skin to artery) were measured at wrist extension of 0, 15, 30, 45, 60, and 75°. The dimensions at each angle are compared with 0° as the control and statistical analysis done. One-way analysis of variance test. No statistically significant change in dimension of the radial artery is observed with increasing angle of wrist extension. Ultrasound evaluation showed that increasing angle of wrist extension does not significantly change the dimensions of radial artery at the wrist joint level in young healthy female volunteers.

  15. [Wrist joint arthroplasty: results after 41 prostheses].

    Science.gov (United States)

    Strunk, S; Bracker, W

    2009-06-01

    The advantage of wrist arthroplasty remains controversial, primarily due to the high complication rate. For this reason it seems sensible to monitor the results of different types of prostheses even with small numbers of cases. We were particularly interested to see if wrist joint arthroplasty is a useful alternative for patients with rheumatoid arthritis, and which of the types we used shows the best results. In our hospital, 41 wrist joint prostheses (15 Meuli, 16 BIAX and 10 Universal 2) were implanted in 36 patients from 1992 until 2005 (follow-up 1 to 14 years, mean 5.3 years). 33 patients had rheumatic destruction of the wrist, two had osteoarthritis following fracture of the scaphoid, and one pseudarthrosis after failed arthroplasty and arthrodesis for Kienböck's disease. Mean age was 54 years, ranging from 34 to 73 years. 14 patients had had surgery on this wrist before. The patients were sent a questionnaire including the DASH score, and a clinical evaluation and X-rays were performed. 33 patients with 38 wrist arthroplasties answered the questionnaire, 34 wrist joint prosthesis of 29 patients could be evaluated. 6 prostheses had to be removed because of complications (3 arthrodeses were performed after removal, 3 prostheses were exchanged). There were 4 dislocations (3 times with the Meuli type, once with the BIAX type). There was one case of CRPS type I. But subjectively, in answering our questionnaire, 31 of 38 patients claimed to be very satisfied or satisfied with the result of the operation, only 6 were less satisfied or not satisfied at all. An improvement of pain was found by all but one patient. An increase in strength or range of movement was found more rarely. The mean postoperative DASH score was 61 points. Mean wrist joint mobility was 50 degrees for extension/flexion, and 20 degrees for radial- and ulnar abduction. The result of total wrist joint arthroplasty depends very much on a careful patient selection. A preoperative bony malposition

  16. Colles wrist fracture - aftercare

    Science.gov (United States)

    The initial recovery from a wrist fracture can take 3 to 4 months or more. You may need physical therapy. You should start working with a physical therapist as soon as your provider recommends. The work may seem hard and at times ...

  17. Tuberculous Tenosynovitis Presenting as Ganglion of Wrist

    Directory of Open Access Journals (Sweden)

    Shahaji Chavan

    2012-01-01

    Full Text Available Tuberculosis (TB is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. A 57 years old male presented with swelling over the left wrist since 3 years Three swellings over dorsal aspect of the left wrist Soft in consistency Non tender Non compressible Mobile at right angles to the plane of the wrist joint. ESR: 45 mm in 1 hr and rest blood investigations were normal. Ultrsonography showed giant cell tumor of Extensor Digitorum sheath. X-ray: soft tissue swelling and MRI was suggestive of extensor tendon sheath extraskeletal synovial Koch’s, or giant cell tumor of tendon sheath. Excision of swelling was planned and intraoperatively, rice bodies were seen inside it. Histopathological examination showed caseous necrosis with granuloma formation. Patient was put on DOT1 therapy. Tuberculous tenosynovitis was first described by Acrel in 1777. Rice bodies occurring in joints affected by tuberculosis were first described in 1895 by Reise. Rice bodies will be diagnosed on plain radiographs when mineralization occurs. More than 50% of cases recur within 1 year of treatment. The currently recommended 6-month course is often adequate with extensive curettage lavage and synovectomy should be performed. Surgery is essential, but the extent of surgical debridement is still debatable. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia.

  18. Revision of a failed Swanson arthroplasty to a total wrist replacement restores wrist function and movements.

    Science.gov (United States)

    Khan, Yasmin; Konan, Sujith; Sorene, Elliot

    2014-04-01

    This study reports a case of revision of a failed Swanson silastic interpositional wrist replacement to a Universal 2 (KMI Medical Inc., San Diego, CA, Jan 2009) total wrist arthroplasty, in a 68-year-old woman with rheumatoid arthritis and pyrophosphate arthropathy. At the 2-year follow-up, the patient was pain-free and was able to perform all activities of daily living, documented by subjective assessment and objective scores. The disabilities of the arm, shoulder, and hand (DASH) scores improved from 98.3 preoperatively to 55.1 postoperatively. A failed Swanson silastic interpositional wrist replacement may be successfully revised to an uncemented primary wrist replacement with good functional results at early follow-up.

  19. [How Valid is the Performance Diagnostic in Soccer?].

    Science.gov (United States)

    Schwesig, R; Miserius, M; Hermassi, S; Delank, K S; Noack, F; Fieseler, G

    2016-03-01

    Assessments of physical and physiological performance tests in soccer sports are still unspecific yet. There is also a lack of scientific validation using those as a "golden standard". Concerning match performance a large deficit also exist in sports and medical science. The aim and purpose of this multicentric and prospective diagnostic study was to evaluate the validity of current established and recommended diagnostic tests for endurance and match performance (golden standard: real time of playing) in soccer. In a prospective study protocol two German soccer teams from the fourth (n = 22) and third (n = 24) national league first underwent different tests of performance and diagnostics ahead of the competition season (tapping, drop jump, counter movement jump, speed dribbling, treadmill running test). Afterwards, match performance of each athlete was assessed by real time of playing (as a surrogate parameter) during the half season (14 and 25 matches). We finally compared test parameters with the match performance in a linear regression analysis. Our analysis showed no statistical relevant relationship between test parameters and match performance (r(2) soccer sport and sport-specific performance. The time of real engagement during a match might be associated with a quality of performance for the single athlete. Therefore, the assessment of this match activity is the most important parameter for improving diagnostic tests in soccer. The existence of a "golden standard" is essential for validation of any tests and parameters and the development of new specific assessments. At the moment, physical performance tests have no scientific evidence in soccer sports. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Mastitis diagnostics and performance monitoring: a practical approach

    NARCIS (Netherlands)

    Lam, T.J.G.M.; Olde Riekerink, R.; Sampimon, O.C.; Smith, H.E.

    2009-01-01

    In this paper a review is given of frequently used mastitis diagnostic methods in modern dairy practice. Methods used at the quarter, cow, herd and regional or national level are discussed, including their usability for performance monitoring in udder health. Future developments, such as systems in

  1. String Teachers' Diagnostic Skills and Their Students' Performance Competencies.

    Science.gov (United States)

    Gillespie, Robert

    1991-01-01

    Presents results of a study of the relationship between the diagnostic skills of string music teachers and the performance competencies of their students. Reports no significant relationship between teacher skills and student competencies. Presents teacher ratings of the influence of 22 factors on students' musical achievement. (SG)

  2. Acoustic detection in superconducting magnets for performance characterization and diagnostics

    CERN Document Server

    Marchevsky, M.; Sabbi, G.; Prestemon, S.

    2013-01-01

    Quench diagnostics in superconducting accelerator magnets is essential for understanding performance limitations and improving magnet design. Applicability of the conventional quench diagnostics methods such as voltage taps or quench antennas is limited for long magnets or complex winding geometries, and alternative approaches are desirable. Here, we discuss acoustic sensing technique for detecting mechanical vibrations in superconducting magnets. Using LARP high-field Nb3Sn quadrupole HQ01 [1], we show how acoustic data is connected with voltage instabilities measured simultaneously in the magnet windings during provoked extractions and current ramps to quench. Instrumentation and data analysis techniques for acoustic sensing are reviewed.

  3. Diagnostic Performance of Visual Screening Tests in the Elderly

    Science.gov (United States)

    Lança, Carla Costa; Carolino, Elisabete

    2011-09-01

    This study aimed to determine and evaluate the diagnostic accuracy of visual screening tests for detecting vision loss in elderly. This study is defined as study of diagnostic performance. The diagnostic accuracy of 5 visual tests -near convergence point, near accommodation point, stereopsis, contrast sensibility and amsler grid—was evaluated by means of the ROC method (receiver operating characteristics curves), sensitivity, specificity, positive and negative likelihood ratios (LR+/LR-). Visual acuity was used as the reference standard. A sample of 44 elderly aged 76.7 years (±9.32), who were institutionalized, was collected. The curves of contrast sensitivity and stereopsis are the most accurate (area under the curves were 0.814-p = 0.001, C.I.95%[0.653;0.975]— and 0.713-p = 0.027, C.I.95%[0,540;0,887], respectively). The scores with the best diagnostic validity for the stereopsis test were 0.605 (sensitivity 0.87, specificity 0.54; LR+ 1.89, LR-0.24) and 0.610 (sensitivity 0.81, specificity 0.54; LR+ 1.75, LR-0.36). The scores with higher diagnostic validity for the contrast sensibility test were 0.530 (sensitivity 0.94, specificity 0.69; LR+ 3.04, LR-0.09). The contrast sensitivity and stereopsis test's proved to be clinically useful in detecting vision loss in the elderly.

  4. Statistical evaluation of diagnostic performance topics in ROC analysis

    CERN Document Server

    Zou, Kelly H; Bandos, Andriy I; Ohno-Machado, Lucila; Rockette, Howard E

    2016-01-01

    Statistical evaluation of diagnostic performance in general and Receiver Operating Characteristic (ROC) analysis in particular are important for assessing the performance of medical tests and statistical classifiers, as well as for evaluating predictive models or algorithms. This book presents innovative approaches in ROC analysis, which are relevant to a wide variety of applications, including medical imaging, cancer research, epidemiology, and bioinformatics. Statistical Evaluation of Diagnostic Performance: Topics in ROC Analysis covers areas including monotone-transformation techniques in parametric ROC analysis, ROC methods for combined and pooled biomarkers, Bayesian hierarchical transformation models, sequential designs and inferences in the ROC setting, predictive modeling, multireader ROC analysis, and free-response ROC (FROC) methodology. The book is suitable for graduate-level students and researchers in statistics, biostatistics, epidemiology, public health, biomedical engineering, radiology, medi...

  5. Compliant Robot Wrist

    Science.gov (United States)

    Voellmer, George

    1992-01-01

    Compliant element for robot wrist accepts small displacements in one direction only (to first approximation). Three such elements combined to obtain translational compliance along three orthogonal directions, without rotational compliance along any of them. Element is double-blade flexure joint in which two sheets of spring steel attached between opposing blocks, forming rectangle. Blocks moved parallel to each other in one direction only. Sheets act as double cantilever beams deforming in S-shape, keeping blocks parallel.

  6. Phoenix Deploying its Wrist

    Science.gov (United States)

    2008-01-01

    This animated gif shows a series of images taken by Phoenix's Stereo Surface Imager (SSI) on Sol 3. It illustrates the actions that Phoenix's Robotic Arm took to deploy its wrist. The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  7. Simulation-Driven Development and Optimization of a High-Performance Six-Dimensional Wrist Force/Torque Sensor

    Directory of Open Access Journals (Sweden)

    Qiaokang LIANG

    2010-05-01

    Full Text Available This paper describes the Simulation-Driven Development and Optimization (SDDO of a six-dimensional force/torque sensor with high performance. By the implementation of the SDDO, the developed sensor possesses high performance such as high sensitivity, linearity, stiffness and repeatability simultaneously, which is hard for tranditional force/torque sensor. Integrated approach provided by software ANSYS was used to streamline and speed up the process chain and thereby to deliver results significantly faster than traditional approaches. The result of calibration experiment possesses some impressive characters, therefore the developed fore/torque sensor can be usefully used in industry and the methods of design can also be used to develop industrial product.

  8. Dynamic CT technique for assessment of wrist joint instabilities.

    Science.gov (United States)

    Leng, Shuai; Zhao, Kristin; Qu, Mingliang; An, Kai-Nan; Berger, Richard; McCollough, Cynthia H

    2011-07-01

    To develop a 4D [three-dimensional (3D) + time] CT technique to capture high spatial and temporal resolution images of wrist joint motion so that dynamic joint instabilities can be detected before the development of static joint instability and onset of osteoarthritis (OA). A cadaveric wrist was mounted onto a custom motion simulator and scanned with a dual source CT scanner during radial-ulnar deviation. A dynamic 4D CT technique was utilized to reconstruct images at 20 equidistant time points from one motion cycle. 3D images of carpal bones were generated using volume rendering techniques (VRT) at each of the 20 time points and then 4D movies were generated to depict the dynamic joint motion. The same cadaveric wrist was also scanned after cutting all portions of the scapholunate interosseus ligament to simulate scapholunate joint instability. Image quality were assessed on an ordinal scale (1-4, 4 being excellent) by three experienced orthopedic surgeons (specialized in hand surgery) by scoring 2D axial images. Dynamic instability was evaluated by the same surgeons by comparing the two 4D movies of joint motion. Finally, dose reduction was investigated using the cadaveric wrist by scanning at different dose levels to determine the lowest radiation dose that did not substantially alter diagnostic image quality. The mean image quality scores for dynamic and static CT images were 3.7 and 4.0, respectively. The carpal bones, distal radius and ulna, and joint spaces were clearly delineated in the 3D VRT images, without motion blurring or banding artifacts, at all time points during the motion cycle. Appropriate viewing angles could be interactively selected to view any articulating structure using different 3D processing techniques. The motion of each carpal bone and the relative motion among the carpal bones were easily observed in the 4D movies. Joint instability was correctly and easily detected in the scan performed after the ligament was cut by observing the

  9. Performance of Advanced Light Source particle beam diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Hinkson, J.

    1993-05-01

    The Advanced Light Source (ALS), a third-generation synchrotron radiation facility, is complete. The particle beam diagnostics have been installed and tested. The beam injection systems have been running for two years. We have performance data on beam position monitors, beam intensity monitors, scintillators, beam collimators, a 50 {Omega} Faraday cup, and broad-band striplines and kickers used in the linac, transport lines, and the booster synchrotron. The single-turn monitoring capability of the booster beam position monitoring system has been particularly useful for studying beam dynamics. Beam diagnostics for the storage ring are being commissioned. In this paper we describe each instrument, show its performance, and outline how the instruments are controlled and their output data displayed.

  10. Wrist ultrasound examination – scanning technique and ultrasound anatomy. Part 1: Dorsal wrist

    Directory of Open Access Journals (Sweden)

    Cyprian Olchowy

    2015-06-01

    Full Text Available Ultrasound imaging of the musculoskeletal system is superior to other imaging methods in many aspects, such as multidimensional character of imaging, possibility of dynamic evaluation and precise assessment of soft tissues. Moreover, it is a safe and relatively inexpensive method, broadly available and well-tolerated by patients. A correctly conducted ultrasound examination of the wrist delivers detailed information concerning the condition of tendons, muscles, ligaments, nerves and vessels. However, the knowledge of anatomy is crucial to establish a correct ultrasound diagnosis, also in wrist assessment. An ultrasound examination of the wrist is one of the most common US examinations conducted in patients with rheumatological diseases. Ultrasonographic signs depend on the advancement of the disease. The examination is equally frequently conducted in patients with pain or swelling of the wrist due to non-rheumatological causes. The aim of this publication was to present ultrasound images and anatomic schemes corresponding to them. The correct scanning technique of the dorsal part of the wrist was discussed and some practical tips, thanks to which highly diagnostic images can be obtained, were presented. The f ollowing anatomical structures should be visualized in an ultrasound examination of the dorsal wrist: distal radio-ulnar joint, radiocarpal joint, midcarpal joint, carpometacarpal joints, dorsal radiocarpal ligament, compartments of extensor tendons, radial artery, cephalic vein, two small branches of the radial nerve: superfi cial and deep, as well as certain midcarpal ligaments, particularly the scapholunate ligament and lunotriquetral ligament. The paper was distinguished in 2014 as the “poster of the month” (poster number C-1896 during the poster session of the European Congress of Radiology in Vienna.

  11. Measuring Sleep by Wrist Actigraph.

    Science.gov (United States)

    1979-10-01

    noweeas ebb a -a" neeem ideotify by block nbo~hr) Using a piezo-electric transducer, wrist activity was recorded simultaneousll with EEG, EOG, and EKG to...wrist activity alone was used to estimate Sleep Time. Blind inde- pendent scoring of the EEG-EOG- EKG records was also done for Sleep and Wakeful- ness...recordings for estimating sleep, parietal-occipital EEG, submental electromyogram (EMG), *and electro - occulogram (EOG) were recorded with wrist activity. A

  12. Animation of Phoenix's Wrist Unlatching

    Science.gov (United States)

    2008-01-01

    This animation shows what happened underneath Phoenix's Robotic Arm wrist on Sol 3. The pin that goes through the loop is what holds the wrist in place. The rotation of the wrist pops the pin free. The Phoenix Mission is led by the University of Arizona, Tucson, on behalf of NASA. Project management of the mission is by NASA's Jet Propulsion Laboratory, Pasadena, Calif. Spacecraft development is by Lockheed Martin Space Systems, Denver.

  13. Forecast of the Economic- Financial Performance Based on Diagnostic Analysis

    Directory of Open Access Journals (Sweden)

    Daniela Solomon

    2010-12-01

    Full Text Available To ensure efficient financial management is necessary to achieve the forecast of economic and financial performance on the basis of diagnostic analysis, approach most often developed starting from the prediction of turnover and also necessary for shaping an organization's prospects. In financial management, the turnover’s increasing is considered an objective in itself, being interpreted as generating increased market share, profit. Sales condition therefore the entire activity of a company, their variation being considered the main risk factor of enterprise’s economic and financial performance and the staring point in their forecast.

  14. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint ulnar (hemi-wrist) polymer prosthesis... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis...

  15. System characterization of RiceWrist-S: a forearm-wrist exoskeleton for upper extremity rehabilitation.

    Science.gov (United States)

    Pehlivan, Ali Utku; Rose, Chad; O'Malley, Marcia K

    2013-06-01

    Rehabilitation of the distal joints of the upper extremities is crucial to restore the ability to perform activities of daily living to patients with neurological lesions resulting from stroke or spinal cord injury. Robotic rehabilitation has been identified as a promising new solution, however, much of the existing technology in this field is focused on the more proximal joints of the upper arm. A recently presented device, the RiceWrist-S, focuses on the rehabilitation of the forearm and wrist, and has undergone a few important design changes. This paper first addresses the design improvements achieved in the recent design iteration, and then presents the system characterization of the new device. We show that the RiceWrist-S has capabilities beyond other existing devices, and exhibits favorable system characteristics as a rehabilitation device, in particular torque output, range of motion, closed loop position performance, and high spatial resolution.

  16. Tubercular monoarthritis of wrist

    Directory of Open Access Journals (Sweden)

    Prakash Joshi

    2017-01-01

    Full Text Available Tuberculosis (TB has been a major health concern since decades, and millions continue to be afflicted with this disease. Extrapulmonary sites of TB must not be neglected as there is paucity of systemic manifestations and absence of distinct clinical features which delay its diagnosis and can lead to functional disability and severe infirmities. Osteoarticular TB is an infrequent form of the disease and monoarthritis of the wrist accounts for 1% of all cases of skeletal involvement. Hereby, we report a 45-year-old female patient with history of progressive pain and swelling of right wrist joint which is refractory to analgesics and anti-inflammatory drugs. She was diagnosed to have tubercular monoarthritis after synovial fluid analysis and radiographic findings. Standard antitubercular treatment for 6 months was given. The joint was salvaged after 9 months from the start of the treatment. Pain and swelling of joint were subsided and joint was rehabilitated with full range of motion and weight bearing.

  17. Diagnostic performance of rapid diagnostic tests versus blood smears for malaria in US clinical practice.

    Science.gov (United States)

    Stauffer, William M; Cartwright, Charles P; Olson, Douglas A; Juni, Billie Anne; Taylor, Charlotte M; Bowers, Susan H; Hanson, Kevan L; Rosenblatt, Jon E; Boulware, David R

    2009-09-15

    Approximately 4 million US travelers to developing countries are ill enough to seek health care, with 1500 malaria cases reported in the United States annually. The diagnosis of malaria is frequently delayed because of the time required to prepare malaria blood films and lack of technical expertise. An easy, reliable rapid diagnostic test (RDT) with high sensitivity and negative predictive value (NPV), particularly for Plasmodium falciparum, would be clinically useful. The objective of this study was to determine the diagnostic performance of a RDT approved by the US Food and Drug Administration compared with traditional thick and thin blood smears for malaria diagnosis. This prospective study tested 852 consecutive blood samples that underwent thick and thin smears and blinded malaria RDTs at 3 hospital laboratories during 2003-2006. Polymerase chain reaction verified positive test results and discordant results. Malaria was noted in 95 (11%) of the 852 samples. The RDT had superior performance than the standard Giemsa thick blood smear (p = .003). The RDT's sensitivity for all malaria was 97% (92 of 95 samples), compared with 85% (81 of 95) for the blood smear, and the RDT had a superior NPV of 99.6%, compared with 98.2% for the blood smear (p = .001). The P. falciparum performance was excellent, with 100% rapid test sensitivity, compared with only 88% (65 of 74) by blood smear (p = .003). This operational study demonstrates that the US Food and Drug Administration-approved RDT for malaria is superior to a single set of blood smears performed under routine US clinical laboratory conditions. The most valuable clinical role of the RDT is in the rapid diagnosis or the exclusion of P. falciparum malaria, which is particularly useful in outpatient settings when evaluating febrile travelers.

  18. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated...... in the emergency room were examined according to an algorithm until a diagnosis was established. The overall incidence of wrist trauma was 69 per 10,000 inhabitants per year. Incidence of wrist trauma requiring x-ray examination was 58 per 10,000 per year. The incidence of distal radius fractures was 27 per 10...... using data from a population-based study. A completeness rate of 0.56 (95% confidence interval: 0.31-0.78) was found. An x-ray had been taken for all patients reporting a fracture thus justifying the use of fractures as an incidence measure when comparing groups of patients with wrist trauma....

  19. Diagnostic performance of different pleural fluid biomarkers in tuberculous pleurisy.

    Science.gov (United States)

    Klimiuk, J; Krenke, R; Safianowska, A; Korczynski, P; Chazan, R

    2015-01-01

    Due to the paucibacillary nature of tuberculous pleural effusion the diagnosis of pleural tuberculosis is challenging. This prospective study was undertaken to evaluate the diagnostic performance of ten different pleural fluid biomarkers in the differentiation between tuberculous and non-tuberculous pleural effusions. Two hundred and three patients with pleural effusion (117 men and 86 women, median age 65 years) were enrolled. Routine diagnostic work-up, including thoracentesis and pleural fluid analysis, was performed to determine the cause of pleural effusion. The following biomarkers were measured in pleural fluid: adenosine deaminase (ADA), interferon gamma (IFN-γ), interleukin 2 soluble receptor (IL-2sRα), sub-unit p40 of interleukin 12b (IL-12p40), interleukin 18 (IL-18), interleukin 23 (IL-23), IFN-γ induced protein 10 kDa (IP-10), Fas-ligand, human macrophage-derived chemokine (MDC) and tumor necrosis factor alfa (TNF-α). There were 44 (21.7%) patients with tuberculous pleural effusion, 88 (43.3%) patients with malignant pleural effusion, 35 (17.2%) with parapneumonic effusion/pleural empyema, 30 (14.8%) with pleural transudates, and 6 (3%) with miscellaneous underlying diseases. Pleural fluid IFN-γ was found the most accurate marker differentiating tuberculous from non-tuberculous pleural effusion, with sensitivity, specificity, PPV, NPV, and AUC 97%, 98%, 95.5%, 99.4%, and 0.99, respectively. Two other biomarkers (IP-10 and Fas ligand) also showed very high diagnostic accuracy with AUC≥0.95. AUC for ADA was 0.92. We conclude that IFN-γ, IP-10, and Fas-ligand in pleural fluid are highly accurate biomarkers differentiating tuberculous from non-tuberculous pleural effusion.

  20. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis.

    Science.gov (United States)

    Czaja, Albert J

    2008-11-01

    The diagnostic criteria for autoimmune hepatitis (AIH) have been codified by an international panel, and a revision of the original scoring system based on 12 clinical components has been promulgated. A simplified scoring system has been proposed recently that is based on four clinical components. The goals of this study were to compare the performance parameters of the revised original and the simplified scoring systems and to determine the prowess of each as a diagnostic instrument. Diagnostic scores were determined using each scoring system in 435 patients with diverse chronic liver diseases, including 153 individuals with AIH by codified clinical criteria. The sensitivity, specificity, and predictability of each scoring system for the pretreatment diagnosis of AIH were determined. The revised original scoring system had greater sensitivity for the diagnosis than the simplified scoring system (100% versus 95%), and seven patients diagnosed as AIH using the revised original system were nondiagnostic by the simplified system (5%). The revised original scoring system also ascribed a diagnosis of AIH to 20 of 21 patients with cryptogenic chronic hepatitis, whereas only five patients were similarly classified by the simplified system (95% versus 24%). The simplified system had greater specificity (90% versus 73%) and predictability (92% versus 82%) for AIH than the revised original system, and it more commonly excluded the diagnosis in other diseases with concurrent immune features (83% versus 64%). The revised original scoring system performs better in patients with few or atypical features of AIH, and the simplified system is better at excluding the diagnosis in diseases with concurrent immune manifestations. Each system has attributes that can be exploited.

  1. Reliability control for wrist watches and their casements

    Science.gov (United States)

    Schneider, Jean-Claude

    The reliability tests developed for controlling wrist watch movements and their casements are summarized. For controlling the watch movements, ageing accelerated tests and impact tests were performed. Testing the performance of a wrist watch casement is of great importance: since it is this which is initially attacked by the environment. The casement is submitted to impact, fatigue, vibration, and corrosion tests. The waterproof capabilities and ageing behavior of the casements are examined.

  2. Diagnostic performance of the atopy patch test with inhalant allergens.

    Science.gov (United States)

    Fuiano, N; Diddi, G; Delvecchio, M; Incorvaia, C

    2015-01-01

    This study evaluated the diagnostic performance of the atopy patch test (APT) compared with skin prick testing (SPT) and in vitro IgE measurement in a large group of patients with atopic dermatitis (AD) with or without respiratory symptoms (RS). The study included 521 patients (292 males, 229 females; age, 0.5-18 years; median age, 6 years) with AD and RS with different clinical presentations: current AD, 47 patients (Group A); current AD and RS, 72 patients (Group B), past AD and RS, 69 patients (Group C); and RS only, 280 patients (Group D). Fifty-three healthy individuals served as controls. All participants underwent the APT, SPT, and CAP/RAST with the most common inhalant allergens. The presence of a control group allowed calculation of specificity and positive and negative predictive values. A significant difference was found for a positive APT versus both SPT and CAP/RAST (P RAST. The differences for APT were significant in all group comparisons except group B vs C and group C vs D. In the control group, the APT was positive in 2% of cases (specificity of 96.2%), SPT was positive in 6% of cases (specificity of 88.4%), and CAP/RAST was positive in 4% of cases (specificity of 92.5%). In young patients sensitized to inhalant allergens with AD in addition to RS, the APT has a superior diagnostic performance to SPT and in vitro IgE measurement.

  3. A modular low-clearance wrist orthosis for improving wrist motion in children with cerebral palsy.

    Science.gov (United States)

    Holley, Devon; Johnson, Michelle; Harris, Gerald; Beardsley, Scott

    2014-01-01

    Children with Cerebral Palsy (CP) often exhibit impairments in the coordination of the grip and lift phases of arm movements that directly impact their ability to perform activities of daily living (ADLs). The application of assistive robotic therapy to children with spastic hemiplegic CP has shown that augmented movement training can lead to improved functional outcomes and improved arm kinematics. Assistive robotic therapy of the wrist has been shown to help improve motor skills in stroke patients, but the devices employed are often large and obtrusive, focusing on a repeated motion rather than a task-based itinerary. Here, we propose a lightweight low clearance wrist orthosis for use in children with Cerebral Palsy that actuates pronation/supination and flexion/extension of the wrist.

  4. The instability of wrist joint and total wrist replacement.

    Science.gov (United States)

    Ma, Jin-Xing; Xu, Yong-Qing

    2016-01-01

    Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.

  5. Ganglion cysts in the paediatric wrist: magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer; Bartlett, Murray [Royal Children' s Hospital, Medical Imaging Department, Melbourne, VIC (Australia)

    2013-12-15

    The majority of published literature on ganglion cysts in children has been from a surgical perspective, with no dedicated radiologic study yet performed. Our aim was to assess the magnetic resonance (MR) imaging appearance of ganglion cysts in a series of paediatric MR wrist examinations. Ninety-seven consecutive paediatric MR wrist examinations were retrospectively reviewed for the presence of ganglion cysts. Only those studies with wrist ganglia were included. Cysts were assessed for location, size, internal characteristics and secondary effect(s). Forty-one ganglion cysts (2-32 mm in size) were seen in 35/97 (36%) patients (24 female, 11 male), mean age: 13 years 11 months (range: 6 years 3 months-18 years). The majority were palmar (63.4%) with the remainder dorsal. Of the cysts, 43.9% were related to a wrist ligament(s), 36.6% to a joint and 17.1% to the triangular fibrocartilage complex. Of the patients, 91.4% had wrist symptoms: pain (n=29, 82.9%), swelling (n=7, 20%) and/or palpable mass (n=4, 11.4%); 71.4% patients had significant additional wrist abnormalities. Ganglion cysts were frequently found in children referred for wrist MRI. (orig.)

  6. Epidemiology of suspected wrist joint infection versus inflammation.

    Science.gov (United States)

    Skeete, Kshamata; Hess, Erik P; Clark, Tod; Moran, Steven; Kakar, Sanjeev; Rizzo, Marco

    2011-03-01

    To determine the cumulative prevalence of septic arthritis presenting to the emergency department of an academic medical center and evaluate the use of clinical data to diagnose infection versus inflammation. We conducted a records review of a single institution with 80,000 annual emergency room visits. We included a consecutive series of patients with suspected wrist infection from January 1, 2007, to December 31, 2008. Adults complaining of atraumatic wrist pain with either erythema or swelling on physical examination or a final diagnosis of septic arthritis, gout, pseudogout, cellulitis, wrist hematoma/edema, or wrist arthritic flare were suspected to have infection. We collected data using a standardized data abstraction form. We reviewed 804 patient records. A total of 104 patients meeting inclusion criteria for suspected wrist joint infection during the 2-year study period were included. Mean age was 62.5 years (SD, 20.2 y); 63 were men. There were 12 patients with a history of gout, 4 with a history of pseudogout, and 19 with a history of diabetes. Wrist arthrocentesis was performed in 31 patients, and 11 underwent surgical treatment. There were 16 patients with a final diagnosis of gout, 11 with pseudogout, 43 with cellulitis, 13 with upper extremity hematoma/edema, and 15 with wrist arthritic flare. The cumulative prevalence of septic arthritis was 5%. In this series of emergency department patients with suspected wrist joint infection, gout, pseudogout, and cellulitis were the most common etiologies. The cumulative incidence of septic wrist arthritis was low. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Diagnostic performance on briefly presented digital pathology images

    Directory of Open Access Journals (Sweden)

    Joseph P Houghton

    2015-01-01

    Full Text Available Background: Identifying new and more robust assessments of proficiency/expertise (finding new "biomarkers of expertise" in histopathology is desirable for many reasons. Advances in digital pathology permit new and innovative tests such as flash viewing tests and eye tracking and slide navigation analyses that would not be possible with a traditional microscope. The main purpose of this study was to examine the usefulness of time-restricted testing of expertise in histopathology using digital images. Methods: 19 novices (undergraduate medical students, 18 intermediates (trainees, and 19 experts (consultants were invited to give their opinion on 20 general histopathology cases after 1 s and 10 s viewing times. Differences in performance between groups were measured and the internal reliability of the test was calculated. Results: There were highly significant differences in performance between the groups using the Fisher′s least significant difference method for multiple comparisons. Differences between groups were consistently greater in the 10-s than the 1-s test. The Kuder-Richardson 20 internal reliability coefficients were very high for both tests: 0.905 for the 1-s test and 0.926 for the 10-s test. Consultants had levels of diagnostic accuracy of 72% at 1 s and 83% at 10 s. Conclusions: Time-restricted tests using digital images have the potential to be extremely reliable tests of diagnostic proficiency in histopathology. A 10-s viewing test may be more reliable than a 1-s test. Over-reliance on "at a glance" diagnoses in histopathology is a potential source of medical error due to over-confidence bias and premature closure.

  8. Performance of Dengue Diagnostic Tests in a Single-Specimen Diagnostic Algorithm.

    Science.gov (United States)

    Hunsperger, Elizabeth A; Muñoz-Jordán, Jorge; Beltran, Manuela; Colón, Candimar; Carrión, Jessica; Vazquez, Jesus; Acosta, Luz Nereida; Medina-Izquierdo, Juan F; Horiuchi, Kalanthe; Biggerstaff, Brad J; Margolis, Harold S

    2016-09-15

    Anti-dengue virus (DENV) immunoglobulin M (IgM) seroconversion has been the reference standard for dengue diagnosis. However, paired specimens are rarely obtained, and the interval for this testing negates its usefulness in guiding clinical case management. The presence of DENV viremia and appearance of IgM during the febrile phase of dengue provides the framework for dengue laboratory diagnosis by using a single serum specimen. Archived paired serum specimens (n = 1234) from patients with laboratory-confirmed dengue from 2005 through 2011 were used to determine the diagnostic performance of real-time reverse transcription polymerase chain reaction (RT-PCR), for detection of DENV serotypes 1-4, and enzyme-linked immunosorbent assays (ELISAs), for detection of DENV nonstructural protein 1 (NS1) antigen and anti-DENV IgM. During 1-3 days after illness onset, real-time RT-PCR and NS1 antigen testing detected 82%-69% and 90%-84% of cases, respectively, as viremia levels declined, while anti-DENV IgM ELISA detected 5%-41% of cases as antibody appeared. Over the 10-day period of the febrile phase of dengue, the cumulative effect of using these 3 types of tests in a diagnostic algorithm confirmed ≥90% of dengue cases. The use of molecular or NS1 antigen tests to detect DENV and one to detect anti-DENV IgM in a single serum specimen collected during the first 10 days of illness accurately identified ≥90% of dengue primary and secondary cases. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  9. X-Ray Exam: Wrist

    Science.gov (United States)

    ... done, you'll be asked to wear a lead apron to protect certain parts of your body. Your child's reproductive organs will also be protected with a lead shield. The technician will position your child's wrist, ...

  10. Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults.

    Science.gov (United States)

    Kirschenbaum, D; Sieler, S; Solonick, D; Loeb, D M; Cody, R P

    1995-08-01

    Fifty-two asymptomatic adults who were between twenty and thirty-five years old had arthrography of the wrist with use of a single injection into the radiocarpal joint. The purpose of the study was to evaluate the integrity of the triangular fibrocartilage, the scapholunate ligament, and the lunotriquetral ligament. Contrast medium was injected under fluoroscopic guidance, and posteroanterior and lateral radiographs of the wrist were made after the subjects had performed exercises of the wrist. No patient who had a history of trauma to the wrist, pain in the wrist, or inflammatory arthritis was included in the study. All of the subjects had an examination of both upper extremities that included measurement of the active motion of the wrist with a goniometer, strength-testing with a Jamar dynamometer, ballottement and testing for impingement, and palpation for tenderness. Plain radiographs were evaluated, and the ulnar variance was recorded. The arthrograms revealed an abnormal communication of the contrast medium in fourteen wrists (27 per cent), and four of the fourteen had multiple areas of communication. The abnormal communication was through the triangular fibrocartilage alone in six wrists, the scapholunate ligament alone in two wrists, the lunotriquetral ligament alone in two wrists, and in more than one of these areas in four wrists. A positive arthrogram was associated with a greater positive ulnar variance. All of the subjects had symmetrical motion of the wrists and grip strength, and none of them had tenderness in the wrist. There were no complications related to the arthrography. Perforation of a ligament in the wrist is common in young asymptomatic adults.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Small Business Innovations (Robotic Wrist)

    Science.gov (United States)

    1991-01-01

    Under a Langley Research Center Small Business Innovation Research (SBIR) contract, Ross-Hime Designs, Inc. Minneapolis, MN, developed the Omni-Wrist actuator, which has a 25-pound capacity, 180 degrees of pitch/yaw, and 360 degrees of roll. Company literature calls it "the first successful singularity-free high-precision (robotic) wrist." Applications include spray painting, sealing, ultrasonic testing, welding and a variety of nuclear industry, aerospace and military uses.

  12. Masses and pseudomasses of the hand and wrist: MR findings in 134 cases

    Energy Technology Data Exchange (ETDEWEB)

    Capelastegui, A. [Magnetic Resonance OSATEK, Hospital de Galdacano, Vizcaya (Spain); Astigarraga, E.; Merino, A. [Magnetic Resonance OSATEK, Unit of Galdacano, Basque Country (Spain); Fernandez-Canton, G.; Saralegui, I.; Larena, J.A. [Magnetic Resonance OSATEK, Unit of Vitoria, Basque Country (Spain)

    1999-09-01

    Objective. To assess the utility of magnetic resonance imaging (MRI) in the investigation of palpable masses in the hand or wrist.< rate at head-abs-p1.lf>Design and patients. We retrospectively reviewed the MRI examinations and case records of 134 patients referred because of a palpable mass in the hand or wrist. MRI was performed on a 1.0 T magnet using an extremity coil. Intravenous gadolinium-DTPA was injected when considered appropriate.< rate at head-abs-p1.lf>Results and conclusions. MRI demonstrated the cause of the palpable mass in 126 cases (94.02%). Soft tissue neoplasms were found in 34 cases (25.37%). The majority were benign and included giant cell tumours of tendon sheath, lipomas and hemangiomas and had a characteristic appearance. There were three malignant tumours (myxoid liposarcoma, malignant fibroushistiocytoma and rhabdomyosarcoma). Ganglia were found in 36 cases (26.86%) and non-tumour tendon pathology in 31 cases (23.13%). Less common causes included articular diseases (5.97%) and anatomical variants (4.47%). No focal lesion was present in 8 cases (5.97%). In conclusion, MRI is an accurate diagnostic technique in patients who present with a palpable mass of the hand and wrist. (orig.)

  13. Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases.

    Science.gov (United States)

    Löw, Steffen; Spies, Christian K; Unglaub, Frank; van Schoonhoven, Jörg; Prommersberger, Karl-Josef; Mühldorfer-Fodor, Marion

    2017-02-01

    Background Frequently, patients undergo repeated wrist arthroscopies for single wrist problems. Purpose The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures. Methods For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies. Results Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists. Conclusion In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures. Level of Evidence Level IV.

  14. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review

    NARCIS (Netherlands)

    Kox, Laura S.; Kuijer, P. Paul F. M.; Kerkhoffs, Gino M. M. J.; Maas, Mario; Frings-Dresen, Monique H. W.

    2015-01-01

    Overuse wrist injuries can cause long-term symptoms in young athletes performing wrist-loading sports. Information on the prevalence, incidence and associated risk factors is required. We aimed to review the prevalence and incidence of overuse wrist injuries in young athletes and to identify

  15. Proximal row carpectomy in total arthrodesis of the rheumatoid wrist.

    Science.gov (United States)

    Pham, T T; Lenoir, H; Coulet, B; Wargny, M; Lazerges, C; Chammas, M

    2015-12-01

    Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. In 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. After a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0-7), the mean PRWE score was 21 (range: 0-80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. IV, retrospective study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Design and fuzzy logic control of an active wrist orthosis.

    Science.gov (United States)

    Kilic, Ergin; Dogan, Erdi

    2017-08-01

    People who perform excessive wrist movements throughout the day because of their professions have a higher risk of developing lateral and medial epicondylitis. If proper precautions are not taken against these diseases, serious consequences such as job loss and early retirement can occur. In this study, the design and control of an active wrist orthosis that is mobile, powerful and lightweight is presented as a means to avoid the occurrence and/or for the treatment of repetitive strain injuries in an effective manner. The device has an electromyography-based control strategy so that the user's intention always comes first. In fact, the device-user interaction is mainly activated by the electromyography signals measured from the forearm muscles that are responsible for the extension and flexion wrist movements. Contractions of the muscles are detected using surface electromyography sensors, and the desired quantity of the velocity value of the wrist is extracted from a fuzzy logic controller. Then, the actuator system of the device comes into play by conveying the necessary motion support to the wrist. Experimental studies show that the presented device actually reduces the demand on the muscles involved in repetitive strain injuries while performing challenging daily life activities including extension and flexion wrist motions.

  17. The effects of electromechanical wrist robot assistive system with neuromuscular electrical stimulation for stroke rehabilitation.

    Science.gov (United States)

    Hu, X L; Tong, K Y; Li, R; Xue, J J; Ho, S K; Chen, P

    2012-06-01

    An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (Probot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. The influence of passive wrist joints on the functionality of prosthetic hands.

    Science.gov (United States)

    Kyberd, Peter J

    2012-03-01

    The addition of a passive wrist to a single degree of freedom prosthesis has an effect on its functionality. The amount of impact is undetermined. To measure the grasping function of a commercial single degree of freedom hands with and without two forms of passive wrist flexor. Form-board and timed tasks. Repeated measures with a single subject using a validated assessment tool. The test measured the function of one conventional, single axis, powered hand controlled by the same myocontroller format. It was used in conjunction with a passive three position wrist flexor, a wrist with compliance in the flex/extend and radial/ulnar deviation and compared with a hand without these axes. The overall functional score of the hand alone was 80 out of 100. The use of a wrist flexion unit resulted in a higher score (83) and the compliant wrist achieved a score of 79. The addition of a wrist allowed improved performance in Power, Lateral and Tips grips for both wrist designs, in addition the Extension grip was improved with the compliant wrist. Wrist flexion had a positive impact on the functional score. It enabled some tasks to be performed quicker and with less difficulty.

  19. A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults

    Directory of Open Access Journals (Sweden)

    Quinn Stephen

    2009-10-01

    Full Text Available Abstract Background To compare the effectiveness of a custom-made leather wrist splint (LS with a commercially available fabric splint (FS in adults with chronic wrist pain. Methods Participants (N = 25, mean age = 54 were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN, the Canadian Occupational Performance Measure (COPM and Jamar dynamometer by an observer blinded to treatment allocation. Results Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43, improved hand function and increased grip strength compared to baseline (all p Conclusion Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction.

  20. Diagnostic performance of the "MESACUP anti-Skin profile TEST".

    Science.gov (United States)

    Horváth, Orsolya N; Varga, Rita; Kaneda, Makoto; Schmidt, Enno; Ruzicka, Thomas; Sárdy, Miklós

    2016-01-01

    The "MESACUP anti-Skin profile TEST" is a new, commercially available ELISA kit to detect circulating IgG autoantibodies against desmoglein 1, desmoglein 3, BP180, BP230, and type VII collagen, both simultaneously and more rapidly than previous assays. The aim of this study was to evaluate the diagnostic accuracy of this kit for the diagnosis of pemphigus foliaceus, pemphigus vulgaris, bullous pemphigoid and epidermolysis bullosa acquisita. Dual-centre retrospective study in which 138 patients with autoimmune blistering diseases were compared to 40 controls Using the MESACUP anti-Skin profile TEST, both sensitivities and specificities for desmoglein 1, desmoglein 3, BP180, BP230, and type VII collagen autoantibodies were similar to those obtained using previous, specific ELISA systems and 88% of the results were concordant without any significant difference. The MESACUP anti-Skin profile TEST had a similar performance to previously produced ELISA systems. The novel kit can be used for rapid diagnosis of most common autoimmune blistering diseases and is especially suitable for identifying overlapping disorders.

  1. Myoelectrically controlled wrist robot for stroke rehabilitation.

    Science.gov (United States)

    Song, Rong; Tong, Kai-yu; Hu, Xiaoling; Zhou, Wei

    2013-06-10

    Robot-assisted rehabilitation is an advanced new technology in stroke rehabilitation to provide intensive training. Post-stroke motor recovery depends on active rehabilitation by voluntary participation of patient's paretic motor system as early as possible in order to promote reorganization of brain. However, voluntary residual motor efforts to the affected limb have not been involved enough in most robot-assisted rehabilitation for patients after stroke. The objective of this study is to evaluate the feasibility of robot-assisted rehabilitation using myoelectric control on upper limb motor recovery. In the present study, an exoskeleton-type rehabilitation robotic system was designed to provide voluntarily controlled assisted torque to the affected wrist. Voluntary intention was involved by using the residual surface electromyography (EMG) from flexor carpi radialis(FCR) and extensor carpi radialis (ECR)on the affected limb to control the mechanical assistance provided by the robotic system during wrist flexion and extension in a 20-session training. The system also applied constant resistant torque to the affected wrist during the training. Sixteen subjects after stroke had been recruited for evaluating the tracking performance and therapeutical effects of myoelectrically controlled robotic system. With the myoelectrically-controlled assistive torque, stroke survivors could reach a larger range of motion with a significant decrease in the EMG signal from the agonist muscles. The stroke survivors could be trained in the unreached range with their voluntary residual EMG on the paretic side. After 20-session rehabilitation training, there was a non-significant increase in the range of motion and a significant decrease in the root mean square error (RMSE) between the actual wrist angle and target angle. Significant improvements also could be found in muscle strength and clinical scales. These results indicate that robot-aided therapy with voluntary participation of

  2. Social humanoid robot SARA: development of the wrist mechanism

    Science.gov (United States)

    Penčić, M.; Rackov, M.; Čavić, M.; Kiss, I.; Cioată, V. G.

    2018-01-01

    This paper presents the development of a wrist mechanism for humanoid robots. The research was conducted within the project which develops social humanoid robot Sara – a mobile anthropomorphic platform for researching the social behaviour of robots. There are two basic ways for the realization of humanoid wrist. The first one is based on biologically inspired structures that have variable stiffness, and the second one on low backlash mechanisms that have high stiffness. Our solution is low backlash differential mechanism that requires small actuators. Based on the kinematic-dynamic requirements, a dynamic model of the robot wrist is formed. A dynamic simulation for several hand positions was performed and the driving torques of the wrist mechanism were determined. The realized wrist has 2 DOFs and enables movements in the direction of flexion/extension 115°, ulnar/radial deviation ±45° and the combination of these two movements. It consists of a differential mechanism with three spur bevel gears, two of which are driving and identical, while the last one is the driven gear to which the robot hand is attached. Power transmission and motion from the actuator to the input links of the differential mechanism is realized with two parallel placed identical gear mechanisms. The wrist mechanism has high carrying capacity and reliability, high efficiency, a compact design and low backlash that provides high positioning accuracy and repeatability of movements, which is essential for motion control.

  3. In-vivo three-dimensional carpal bone kinematics during flexion-extension and radio-ulnar deviation of the wrist: Dynamic motion versus step-wise static wrist positions

    NARCIS (Netherlands)

    Foumani, M.; Strackee, S. D.; Jonges, R.; Blankevoort, L.; Zwinderman, A. H.; Carelsen, B.; Streekstra, G. J.

    2009-01-01

    An in-vivo approach to the measurement of three-dimensional motion patterns of carpal bones in the wrist may have future diagnostic applications, particularly for ligament injuries of the wrist. Static methods to measure carpal kinematics in-vivo only provide an approximation of the true kinematics

  4. Restoring wrist extension in obstetric palsy of the brachial plexus by transferring wrist flexors to wrist extensors

    NARCIS (Netherlands)

    Alphen, N.A.; van Doorn-Loogman, M.H.; Maas, H.; van der Sluijs, J.A.; Ritt, M.J.P.F.

    2013-01-01

    Wrist extension is essential in the development of motor skills in young children. Adequate wrist extension is important for good grip function of the hand, as a slightly extended wrist Results in a better and stronger grip. This retrospective study reviews the transfer of the flexor carpi ulnaris

  5. Schizophrenia in males of cognitive performance: discriminative and diagnostic values

    Directory of Open Access Journals (Sweden)

    Analuiza Camozzato

    2002-12-01

    Full Text Available OBJECTIVE: To evaluate the discriminative and diagnostic values of neuropsychological tests for identifying schizophrenia patients. METHODS: A cross-sectional study with 36 male schizophrenia outpatients and 72 healthy matched volunteers was carried out. Participants underwent the following neuropsychological tests: Wisconsin Card Sorting test, Verbal Fluency, Stroop test, Mini Mental State Examination, and Spatial Recognition Span. Sensitivity and specificity estimated the diagnostic value of tests with cutoffs obtained using Receiver Operating Characteristic curves. The latent class model (diagnosis of schizophrenia was used as gold standard. RESULTS: Although patients presented lower scores in most tests, the highest canonical function for the discriminant analysis was 0.57 (Verbal Fluency M. The best sensitivity and specificity were obtained in the Verbal Fluency M test (75 and 65, respectively. CONCLUSIONS: The neuropsychological tests showed moderate diagnostic value for the identification of schizophrenia patients. These findings suggested that the cognitive impairment measured by these tests might not be homogeneous among schizophrenia patients.

  6. Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques.

    Science.gov (United States)

    Colio, Sean W; Smith, Jay; Pourcho, Adam M

    2016-08-01

    Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Kinematic synthesis of bevel-gear-type robotic wrist mechanisms

    Science.gov (United States)

    Lin, Chen-Chou

    Bevel-gear-type robotic wrist mechanisms are commonly used in industry. The reasons for their popularity are that they are compact, light-weight, and relatively inexpensive. However, there are singularities in their workspace, which substantially degrade their manipulative performance. The objective of this research is to develop an atlas of three-degree-of-freedom bevel-gear-type wrist mechanisms, and through dimensional synthesis to improve their kinematic performance. The dissertation contains two major parts: the first is structural analysis and synthesis, the other is kinematic analysis and dimensional synthesis. To synthesize the kinematic structures of bevel-gear-type wrist mechanisms, the kinematic structures are separated from their functional considerations. All kinematic structures which satisfy the mobility condition are enumerated in an unbiased, systematic manner. Then the bevel-gear-type wrist mechanisms are identified by applying the functional requirements. Structural analysis shows that a three-degree-of-freedom wrist mechanism usually consists of non-fractionated, two degree-of-freedom epicyclic gear train jointed with the base link. Therefore, the structural synthesis can be simplified into a problem of examining the atlas of non-fractionated, two-degree-of-freedom epicyclic gear trains. The resulting bevel-gear-type wrist mechanism has been categorized and evaluated. It is shown that three-degree-of-freedom, four-jointed wrist mechanisms are promising for further improving the kinematic performance. It is found that a spherical planetary gear train is necessarily imbedded in a three-degree-of-freedom, four-jointed wrist mechanism. Therefore, to study the workspace and singularity problems of three-degree-of-freedom four-jointed spherical wrist mechanisms, we have to study the trajectories of spherical planetary gear trains. The parametric equations of the trajectories and some useful geometric properties for the analysis and synthesis of

  8. Computational Biomechanics of the Wrist Joint

    CERN Document Server

    Nazri Bajuri, Mohd

    2013-01-01

    This book presents an analysis of the stress distribution and contact stresses in severe rheumatoid wrist after total wrist arthroplasty. It assesses and compares the load transfer throughout the joint and contact pressure at the articulations. The data obtained from this study is of importance as this provide greater evidence to the benefits of total wrist arthroplasty in rheumatoid arthritis patients.

  9. Constrained Registration of the Wrist Joint

    NARCIS (Netherlands)

    Van de Giessen, M.; Streekstra, G.J.; Strackee, S.D.; Maas, M.; Grimbergen, K.A.; Van Vliet, L.J.; Vos, F.M.

    2009-01-01

    Comparing wrist shapes of different individuals requires alignment of these wrists into the same pose. Unconstrained registration of the carpal bones results in anatomically nonfeasible wrists. In this paper, we propose to constrain the registration using the shapes of adjacent bones, by keeping the

  10. Constrained registration of the wrist joint

    NARCIS (Netherlands)

    van de Giessen, M.; Streekstra, G.J.; Strackee, S.D.; Maas, M.; Grimbergen, K.A.; van Vliet, L.J.; Vos, F.M.

    2009-01-01

    Comparing wrist shapes of different individuals requires alignment of these wrists into the same pose. Unconstrained registration of the carpal bones results in anatomically nonfeasible wrists. In this paper, we propose to constrain the registration using the shapes of adjacent bones, by keeping the

  11. Wrist motion in handrim wheelchair propulsion

    NARCIS (Netherlands)

    Veeger, H E J; Meershoek, L S; van der Woude, L H; Langenhoff, J M

    Prevalence rates of carpal tunnel syndrome (CTS) in the wheelchair user population are high. One of the possible causes of CTS in this population is the movement pattern of the wrist during handrim wheelchair propulsion, which could include large wrist joint angles and wrist/finger flexor activity.

  12. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Gideon, P; Sørensen, K

    1995-01-01

    MRI-scores of synovial membrane hypertrophy and bone erosions of the RA-wrist are introduced. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) and conventional radiography (CR) of the wrist were performed in 16 patients with rheumatoid arthritis (RA) and 3 healthy controls. A MRI......-score of synovial membrane hypertrophy was obtained by summation of gradings of synovial hypertrophy in 6 regions of the wrist. The score was significantly higher in wrists with than in wrists without clinical signs of active arthritis. The score was 0 in all healthy controls. Each bone of the wrist was assessed...

  13. Wrist ultrasound analysis of patients with early rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    J.A. Mendonça

    2011-01-01

    Full Text Available In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS and gray scale ultrasound (GSUS with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP. The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546, GSUS of right wrist and swelling of left wrist (r = 0.511, PDUS of right wrist and pain in left wrist (r = 0.436, PDUS of right wrist and C-reactive protein (r = 0.466. Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

  14. Performance of diagnostic mammography differs in the United States and Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Geller, Berta M; Gard, Charlotte C

    2010-01-01

    workup's final assessment to determine sensitivity, specificity and an estimate of accuracy: area under the receiver-operating characteristics (ROCs) curve (AUC). Diagnostic mammography had slightly higher sensitivity in the United States (85%) than in Denmark (82%). In contrast, it had higher......Diagnostic mammography is the primary imaging modality to diagnose breast cancer. However, few studies have evaluated variability in diagnostic mammography performance in communities, and none has done so between countries. We compared diagnostic mammography performance in community-based settings......, Danish mammography facilities specialize in either diagnosis or screening, possibly leading to greater diagnostic mammography expertise in facilities dedicated to symptomatic patients. Performance of community-based diagnostic mammography settings varied markedly between the 2 countries, indicating...

  15. A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults.

    Science.gov (United States)

    Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme

    2009-10-21

    To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain. Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Canadian Occupational Performance Measure (COPM) and Jamar dynamometer by an observer blinded to treatment allocation. Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43), improved hand function and increased grip strength compared to baseline (all p wrist stiffness. There was a consistent trend for the LS to be superior to the FS but this was statistically significant only for patient perceived occupational performance (p = 0.008) and satisfaction (p = 0.015). Lastly, 72% of patients preferred the custom-made leather splint compared to the commercially available splint. Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction.

  16. Determinants of the use of wrist working splints in rheumatoid arthritis

    NARCIS (Netherlands)

    Veehof, M.M.; Taal, Erik; Willems, Marjanne J.; van de Laar, Mart A F J

    2008-01-01

    Objective: To gain insight into the determinants of the use of wrist working splints among patients with rheumatoid arthritis (RA). - Methods: A qualitative descriptive study was performed among 18 patients with RA who recently received a fabric wrist working splint because of pain due to arthritis

  17. Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace: a case report

    Directory of Open Access Journals (Sweden)

    Schafflhuber Caroline

    2011-04-01

    Full Text Available Abstract Introduction Psychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed. Case presentation A 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl's parents' conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%. Two weeks after she was discharged from hospital, the tremor had completely disappeared. Conclusion After careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.

  18. Development of new malaria diagnostics: matching performance and need.

    Science.gov (United States)

    Bell, David; Fleurent, Alessandra E; Hegg, Michael C; Boomgard, John D; McConnico, Caitlin C

    2016-08-11

    Despite advances in diagnostic technology, significant gaps remain in access to malaria diagnosis. Accurate diagnosis and misdiagnosis leads to unnecessary waste of resources, poor disease management, and contributes to a cycle of poverty in low-resourced communities. Despite much effort and investment, few new technologies have reached the field in the last 30 years aside from lateral flow assays. This suggests that much diagnostic development effort has been misdirected, and/or that there are fundamental blocks to introduction of new technologies. Malaria diagnosis is a difficult market; resources are broadly donor-dependent, health systems in endemic countries are frequently weak, and the epidemiology of malaria and priorities of malaria programmes and donors are evolving. Success in diagnostic development will require a good understanding of programme gaps, and the sustainability of markets to address them. Targeting assay development to such clearly defined market requirements will improve the outcomes of product development funding. Six market segments are identified: (1) case management in low-resourced countries, (2) parasite screening for low density infections in elimination programmes, (3) surveillance for evidence of continued transmission, (4) clinical research and therapeutic efficacy monitoring, (5) cross-checking for microscopy quality control, and (6) returned traveller markets distinguished primarily by resource availability. While each of these markets is potentially compelling from a public health standpoint, size and scale are highly variable and continue to evolve. Consequently, return on investment in research and development may be limited, highlighting the need for potentially significant donor involvement or the introduction of novel business models to overcome prohibitive economics. Given the rather specific applications, a well-defined set of stakeholders will need to be on board for the successful introduction and scaling of any new

  19. Dose Reduction in Tomosynthesis of the Wrist.

    Science.gov (United States)

    Becker, Anton S; Martini, Katharina; Higashigaito, Kai; Guggenberger, Roman; Andreisek, Gustav; Frauenfelder, Thomas

    2017-01-01

    The purpose of this study was to quantitatively and qualitatively determine the impact of radiation dose reduction on the image noise and quality of tomosynthesis studies of the wrist. Imaging of six cadaver wrists was performed with tomosynthesis in anteroposterior position at a tube voltage of 60 kV and tube current of 80 mA and subsequently at 60 or 50 kV with different tube currents of 80, 40, or 32 mA. Dose-area products (DAP) were obtained from the electronically logged protocol. Image noise was measured with an ROI. Two independent and blinded readers evaluated all images. Interreader agreement was measured with a Cohen kappa. Readers assessed overall quality and delineation of soft tissue, cortical bone, and trabecular bone on a 4-point Likert scale. The highest DAP (3.892 ± 0.432 Gy · cm(2)) was recorded for images obtained with 60 kV and 80 mA; the lowest (0.857 ± 0.178 Gy · cm(2)) was recorded for images obtained with 50 kV and 32 mA. Noise was highest when a combination of 50 kV and 32 mA (389 ± 26.6) was used and lowest when a combination of 60 kV and 80 mA (218 ± 12.3) was used. The amount of noise on images acquired using 60 kV and 80 mA was statistically significantly different from the amount measured on all other images (p wrist is possible while image quality and delineation of anatomic structures remain preserved.

  20. PERFORMANCE OF DIAGNOSTIC MAMMOGRAPHY DIFFERS IN THE UNITED STATES AND DENMARK

    Science.gov (United States)

    Jensen, Allan; Geller, Berta M.; Gard, Charlotte C.; Miglioretti, Diana L.; Yankaskas, Bonnie; Carney, Patricia A.; Rosenberg, Robert D.; Vejborg, Ilse; Lynge, Elsebeth

    2013-01-01

    Diagnostic mammography is the primary imaging modality to diagnose breast cancer. However, few studies have evaluated variability in diagnostic mammography performance in communities, and none has done so between countries. We compared diagnostic mammography performance in community-based settings in the United States and Denmark. The performance of 93,585 diagnostic mammograms from 180 facilities contributing data to the U.S. Breast Cancer Surveillance Consortium (BCSC) from 1999 through 2001 was compared to that of all 51,313 diagnostic mammograms performed at Danish clinics in 2000. We used the imaging workup’s final assessment to determine sensitivity, specificity, and an estimate of accuracy: area under the receiver-operating characteristics (ROC) curve (AUC). Diagnostic mammography had slightly higher sensitivity in the United States (85%) than in Denmark (82%). In contrast, it had higher specificity in Denmark (99%) than in the United States (93%). The AUC was high in both countries: U.S. 0.91; and Denmark 0.95. Denmark’s higher accuracy may result from supplementary ultrasound examinations, which are provided to 74% of Danish women but only 37% to 52% of U.S. women. In addition, Danish mammography facilities specialize in either diagnosis or screening, possibly leading to greater diagnostic mammography expertise in facilities dedicated to symptomatic patients. Performance of community-based diagnostic mammography settings varied markedly between the two countries, indicating that it can be further optimized. PMID:20104518

  1. Real-time magnetic resonance imaging (MRI) during active wrist motion--initial observations.

    Science.gov (United States)

    Boutin, Robert D; Buonocore, Michael H; Immerman, Igor; Ashwell, Zachary; Sonico, Gerald J; Szabo, Robert M; Chaudhari, Abhijit J

    2013-01-01

    Non-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist--occurring during joint motion--is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability. A 3-Tesla "active-MRI" protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, "clenched-fist", and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images. The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished. This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.

  2. Real-Time Magnetic Resonance Imaging (MRI) during Active Wrist Motion—Initial Observations

    Science.gov (United States)

    Boutin, Robert D.; Buonocore, Michael H.; Immerman, Igor; Ashwell, Zachary; Sonico, Gerald J.; Szabo, Robert M.; Chaudhari, Abhijit J.

    2013-01-01

    Background Non-invasive imaging techniques such as magnetic resonance imaging (MRI) provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist – occurring during joint motion – is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability. Methods A 3-Tesla “active-MRI” protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, “clenched-fist”, and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ) congruity, extensor carpi ulnaris (ECU) tendon translation, the scapholunate (SL) interval, and the SL, radiolunate (RL) and capitolunate (CL) angles from the resulting images. Results The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished. Conclusion This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo. PMID:24391865

  3. Real-time magnetic resonance imaging (MRI during active wrist motion--initial observations.

    Directory of Open Access Journals (Sweden)

    Robert D Boutin

    Full Text Available Non-invasive imaging techniques such as magnetic resonance imaging (MRI provide the ability to evaluate the complex anatomy of bone and soft tissues of the wrist without the use of ionizing radiation. Dynamic instability of wrist--occurring during joint motion--is a complex condition that has assumed increased importance in musculoskeletal medicine. The objective of this study was to develop an MRI protocol for evaluating the wrist during continuous active motion, to show that dynamic imaging of the wrist is realizable, and to demonstrate that the resulting anatomical images enable the measurement of metrics commonly evaluated for dynamic wrist instability.A 3-Tesla "active-MRI" protocol was developed using a bSSFP sequence with 475 ms temporal resolution for continuous imaging of the moving wrist. Fifteen wrists of 10 asymptomatic volunteers were scanned during active supination/pronation, radial/ulnar deviation, "clenched-fist", and volarflexion/dorsiflexion maneuvers. Two physicians evaluated distal radioulnar joint (DRUJ congruity, extensor carpi ulnaris (ECU tendon translation, the scapholunate (SL interval, and the SL, radiolunate (RL and capitolunate (CL angles from the resulting images.The mean DRUJ subluxation ratio was 0.04 in supination, 0.10 in neutral, and 0.14 in pronation. The ECU tendon was subluxated or translated out of its groove in 3 wrists in pronation, 9 wrists in neutral, and 11 wrists in supination. The mean SL interval was 1.43 mm for neutral, ulnar deviation, radial deviation positions, and increased to 1.64 mm during the clenched-fist maneuver. Measurement of SL, RL and CL angles in neutral and dorsiflexion was also accomplished.This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo.

  4. [Biomechanic considerations in wrist prostheses].

    Science.gov (United States)

    Kapandji, A I

    1992-01-01

    At the present time, in disorders of the wrist, avulsion of the first carpal row is the most commonly used technique as a last resort. However, there are many wrist prostheses, which are reviewed here. Roughly, they belong to two families: the three axis prostheses (spherical) that cannot transmit to the hand the pronation supination torque, because of their geometrical characteristics, and the two axis prostheses (universal joint) that are able to transmit this movement. The characteristics of future prostheses must include: based on the "universal joint" principle, occupy minimum space, isometric, maintain tendon tension, an axis identical to the true axis of the wrist, to maintain the hand in line with the forearm, fixed without cement but, not shortened with time, possibilities of mechanical flexibility immediately and lastingly stable, to be easily replaced modularly. This ideal prosthesis will certainly exist one day and will take the place of the first carpal row avulsion. In the meantime, this technique will still have a long use.

  5. Sensor Selection for Aircraft Engine Performance Estimation and Gas Path Fault Diagnostics

    Science.gov (United States)

    Simon, Donald L.; Rinehart, Aidan W.

    2016-01-01

    This paper presents analytical techniques for aiding system designers in making aircraft engine health management sensor selection decisions. The presented techniques, which are based on linear estimation and probability theory, are tailored for gas turbine engine performance estimation and gas path fault diagnostics applications. They enable quantification of the performance estimation and diagnostic accuracy offered by different candidate sensor suites. For performance estimation, sensor selection metrics are presented for two types of estimators including a Kalman filter and a maximum a posteriori estimator. For each type of performance estimator, sensor selection is based on minimizing the theoretical sum of squared estimation errors in health parameters representing performance deterioration in the major rotating modules of the engine. For gas path fault diagnostics, the sensor selection metric is set up to maximize correct classification rate for a diagnostic strategy that performs fault classification by identifying the fault type that most closely matches the observed measurement signature in a weighted least squares sense. Results from the application of the sensor selection metrics to a linear engine model are presented and discussed. Given a baseline sensor suite and a candidate list of optional sensors, an exhaustive search is performed to determine the optimal sensor suites for performance estimation and fault diagnostics. For any given sensor suite, Monte Carlo simulation results are found to exhibit good agreement with theoretical predictions of estimation and diagnostic accuracies.

  6. Profiling wrist pulse from skin surface by Advanced Vibrometer Interferometer Device

    Science.gov (United States)

    Lee, Hao-Xiang; Lee, Shu-Sheng; Hsu, Yu-Hsiang; Lee, Chih-Kung

    2017-02-01

    With global trends in population aging, the need to decrease and prevent the onset of cardiovascular disease has drawn a great attention. The traditional cuff-based upper arm sphygmomanometer is still the standard method to retrieve blood pressure information for diagnostics. However, this method is not easy to be adapted by patients and is not comfortable enough to perform a long term monitoring process. In order to correlate the beating profile of the arterial pulse on the wrist skin, an Advanced Vibrometer Interferometer Device (AVID) is adopted in this study to measure the vibration amplitude of skin and compare it with blood pressure measured from the upper arm. The AVID system can measure vibration and remove the directional ambiguity by using circular polarization interferometer technique with two orthogonal polarized light beams. The displacement resolution of the system is nearly 1.0 nm and the accuracy is experimentally verified. Using an optical method to quantify wrist pule, it provides a means to perform cuff-less, noninvasive and continuous measurement. In this paper, the correlations between the amplitude of skin vibration and the actual blood pressure is studied. The success of this method could potentially set the foundation of blood pressure monitor system based on optical approaches.

  7. Diagnostic Techniques to Elucidate the Aerodynamic Performance of Acoustic Liners

    Science.gov (United States)

    June, Jason; Bertolucci, Brandon; Ukeiley, Lawrence; Cattafesta, Louis N., III; Sheplak, Mark

    2017-01-01

    In support of Topic A.2.8 of NASA NRA NNH10ZEA001N, the University of Florida (UF) has investigated the use of flow field optical diagnostic and micromachined sensor-based techniques for assessing the wall shear stress on an acoustic liner. Stereoscopic particle image velocimetry (sPIV) was used to study the velocity field over a liner in the Grazing Flow Impedance Duct (GFID). The results indicate that the use of a control volume based method to determine the wall shear stress is prone to significant error. The skin friction over the liner as measured using velocity curve fitting techniques was shown to be locally reduced behind an orifice, relative to the hard wall case in a streamwise plane centered on the orifice. The capacitive wall shear stress sensor exhibited a linear response for a range of shear stresses over a hard wall. PIV over the liner is consistent with lifting of the near wall turbulent structure as it passes over an orifice, followed by a region of low wall shear stress.

  8. Improving Inspection and Maintenance Performance and On-board Diagnostics Monitor Readiness Memo

    Science.gov (United States)

    This EPA memorandum transmits an updated list of vehicles that exhibit issues related to OBD (on board diagnostics) monitor readiness and makes suggestions for how Inspection/Maintenance (I/M) programs can improve operational performance by addressing

  9. Neuromechanical control of the forearm muscles during gripping with sudden flexion and extension wrist perturbations.

    Science.gov (United States)

    Holmes, Michael W R; Tat, Jimmy; Keir, Peter J

    2015-01-01

    The purpose of this study was to investigate how gripping modulates forearm muscle co-contraction prior to and during sudden wrist perturbations. Ten males performed a sub-maximal gripping task (no grip, 5% and 10% of maximum) while a perturbation forced wrist flexion or extension. Wrist joint angles and activity from 11 muscles were used to determine forearm co-contraction and muscle contributions to wrist joint stiffness. Co-contraction increased in all pairs as grip force increased (from no grip to 10% grip), corresponding to a 36% increase in overall wrist joint stiffness. Inclusion of individual muscle contributions to wrist joint stiffness enhanced the understanding of forearm co-contraction. The extensor carpi radialis longus (ECRL) and brevis had the largest stiffness contributions (34.5 ± 1.3% and 20.5 ± 2.3%, respectively), yet muscle pairs including ECRL produced the lowest co-contraction. The muscles contributing most to wrist stiffness were consistent across conditions (ECRL for extensors; Flexor Digitorum Superficialis for flexors), suggesting enhanced contributions rather than muscular redistribution. This work provides investigation of the neuromuscular response to wrist perturbations and gripping demands by considering both co-contraction and muscle contributions to joint stiffness. Individual muscle stiffness contributions can be used to enhance the understanding of forearm muscle control during complex tasks.

  10. Radiographic study on the pattern of wrist joint destruction in rheumatoid arthritis.

    Science.gov (United States)

    Kitamura, Takashi; Murase, Tsuyoshi; Hashimoto, Jun; Tomita, Tetsuya; Arimitsu, Sayuri; Yoshikawa, Hideki; Sugamoto, Kazuomi

    2011-03-01

    When planning therapy for rheumatoid arthritis (RA) in the wrist joint, knowing the pattern of joint destruction is important. There were a few studies using the Larsen and modified Larsen method to evaluate RA wrist joint destruction. However, these methods are inadequate for thoroughly assessing the severity of joint destruction because joint bone erosion and joint space narrowing could not be evaluated individually in these methods. To clarify the pattern of RA wrist joint destruction in the different zones of the wrist, we conducted a large-scale radiographic study. We modified the van der Heijde/Sharp method to assess radiographic images. Subjects were 191 RA patients (22 men and 169 women; mean age 57.0 years) who were examined at our center between 2001 and 2003 and underwent plain X-ray of both wrist joints (n = 382). Using X-ray images of the wrist joint, classification was performed based on the severity of wrist joint surface bone erosion and joint space narrowing at different zones, and the results were statistically analyzed. The results showed that joint space narrowing in the midcarpal joint (MCJ) advanced faster than in the radiocarpal joint (RCJ). Conversely, bone erosion in the RCJ advanced faster than in the MCJ. In X-ray diagnosis of RA wrist joint disorders, knowing the pattern of destruction is useful for assessing the presence or absence of early joint destruction and in planning therapy.

  11. Evaluation of a wrist orthosis on lofstrand crutch-assisted gait.

    Science.gov (United States)

    Farooq, Deen; Jahanian, Omid; Slavens, Brooke A; Hsiao-Wecksler, Elizabeth T

    2016-08-01

    Lofstrand, or forearm, crutches are a common assistive mobility device for those with functional impairments. However, repeated loading of the wrist and palmar region and continual hyperextension of the wrist during Lofstrand crutch usage may cause wrist strain, pain, and secondary injuries such as carpal tunnel syndrome. In order to reduce risk of injury, a novel wrist orthosis was developed with the intent of improving wrist posture and reducing/redirecting palmar loads from the carpal tunnel region to the adductor pollicis area. Dominant-hand palmar loads and wrist extension angles of 10 healthy, able-bodied subjects were measured during swing-through Lofstrand crutch-assisted gait to demonstrate the orthosis effectiveness. Each subject performed 10 trials each with and without the orthosis. An enhanced understanding of the effects of the wrist orthosis on kinematics and palmar loading was gained through this study. Results indicated a significant decrease in maximum palmar force, contact area, and wrist extension when using the orthosis. Palmar loads were observed to be redirected toward the adductor pollicis when using an orthosis during Lofstrand crutch-assisted gait. Ultimately, this device was effective in redistributing palmar loads with the potential to reduce pain and risk of carpal tunnel syndrome in long-term Lofstrand crutch users.

  12. Overuse wrist injuries in young athletes: What do sports physicians consider important signals and functional limitations?

    Science.gov (United States)

    Kox, Laura S; Kuijer, P Paul F M; Opperman, Jip; Kerkhoffs, Gino M M J; Maas, Mario; Frings-Dresen, Monique H W

    2018-01-01

    This study's objective was to collect items from experienced sports physicians, relating to the presence and severity of overuse wrist injuries in young athletes, for developing a measurement instrument for signals of overuse wrist injury. Seven Dutch elite sports physicians involved in guidance and treatment of young athletes in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) participated in a focus group. They discussed signals and limitations related to overuse wrist injuries in young athletes. Data were coded and categorised into signals and limitations with subcategories, using an inductive approach. Of the resulting 61 signals and limitations in nineteen (sub)categories, 20 were considered important, forming a comprehensive item set for identifying overuse wrist injury in young athletes. Signals such as pain, "click", crepitations, swelling and limited range of motion were marked useful for early identification of overuse wrist injury. Limitations in movement and performance were considered indicative of severe overuse injury but less relevant for initial injury identification. The focus group provided 17 important signals and 3 important limitations indicative of overuse wrist injury. These provide the basis for a valid measurement instrument for identifying overuse wrist injury in young athletes, with equal emphasis on pain and on other symptoms.

  13. Arthroscopic Synovectomy of Wrist in Rheumatoid Arthritis.

    Science.gov (United States)

    Shim, Jae Woo; Park, Min Jong

    2017-11-01

    Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting multiple joints. Wrist involvement is common. Patients with persistent symptoms despite medical management are candidates for surgery. Synovectomy can provide pain relief and functional improvement for rheumatoid wrist. Arthroscopic synovectomy is a safe and reliable method, with minimal postoperative morbidity. This article reviews the role, technique, and results of arthroscopic synovectomy in the rheumatoid wrist. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-01-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  15. Current European Practice in Wrist Arthroplasty.

    Science.gov (United States)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2017-08-01

    The results of wrist arthroplasty for severely destroyed and painful wrists are generally good in pain reduction, increased grip strength, and upper limb function. The wrist range of motion is usually preserved but not improved. Implant survival seems better than it was with earlier implant designs; however, there are problems of carpal component loosening. Patient selection plays an important role, requiring experience, careful patient information, and discussing the pros and cons of arthroplasty and partial or total wrist arthrodesis. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Sex-specific performance of routine TB diagnostic tests

    NARCIS (Netherlands)

    Kivihya-Ndugga, L. E. A.; van Cleeff, M. R. A.; Ng'ang'a, L. W.; Meme, H.; Odhiambo, J. A.; Klatser, P. R.

    2005-01-01

    City Council Chest Clinic, Nairobi, Kenya. To determine to what extent the performance of smear microscopy is responsible for sex differences in notification rates. Three sputum samples from TB suspects were subjected to smear microscopy with Ziehl-Neelsen (ZN) and auramine (FM) staining.

  17. The effect of common wrist orthoses on the stiffness of wrist rotations.

    Science.gov (United States)

    Seegmiller, Daniel B; Eggett, Dennis L; Charles, Steven K

    2016-01-01

    Wrist orthoses (also known as splints, braces, or supports) are commonly used to support or restrict the motion of a weak or injured wrist. These orthoses generally function by stiffening the wrist joint. Therefore, choosing the proper orthosis (or improving orthoses) requires that we understand their stiffness properties. In this study, we present a method for measuring the stiffness of wrist orthoses, and we apply this method to 12 of the most common wrist orthoses. We found similarities and differences between these orthoses, indicating that different orthoses have different effects on the wrist joint and, presumably, on wrist behavior. In particular, all six orthoses with a stay on the volar side or the volar and dorsal sides added a significant amount of stiffness to the wrist joint. In contrast, only one of three orthoses with a stay on the dorsal side and none of the three orthoses without stays exhibited a significant amount of stiffness, calling into question their ability to support the wrist joint. This work lays a foundation for future studies investigating the effect of wrist orthosis stiffness on wrist behavior and how wrist orthosis stiffness can be designed to produce behavior that facilitates healing.

  18. Erosion or normal variant? 4-year MRI follow-up of the wrists in healthy children

    Energy Technology Data Exchange (ETDEWEB)

    Avenarius, Derk F.M. [University of Tromsoe, Faculty of Health Sciences, Tromsoe (Norway); University Hospital of North Norway, Department of Radiology, Tromsoe (Norway); Ording Mueller, Lil-Sofie [Oslo University Hospital, Department for Radiology and Intervention, Oslo (Norway); Rosendahl, Karen [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Clinical Medicine K1, Bergen (Norway)

    2016-03-15

    A large proportion of healthy children have wrist changes on MRI, namely carpal depressions, findings that have been described as pathological in children with juvenile idiopathic arthritis. We performed follow-up imaging in a cohort of healthy children to evaluate carpal surface depressions over time, focusing on the presence of overlying cartilage as a potential discriminator between normal variants and true erosions. 74 of the initial cohort of 89 healthy children (83%) had a re-scan of their wrists using the same protocol, including coronal T1 and fat-saturated T2 sequences. A cartilage-selective sequence was added for this study. We registered number and location of bony depressions and presence of overlying cartilage. The total number of carpal depressions increased by age group and over time; their location was unchanged in 370 of 487 (76%) carpal sites and 91 of 117 (78%) metacarpal sites. In total, 426 of the 1,087 (39.2%) bony depressions were covered by cartilage, with a decreasing percentage by age (P = 0.001). Normal appearances during growth, such as bony depressions, should not be mistaken for pathology. There must be additional findings to support a diagnosis of disease. A cartilage sequence may add to the diagnostic image analysis. (orig.)

  19. Universal haptic drive: a robot for arm and wrist rehabilitation.

    Science.gov (United States)

    Oblak, Jakob; Cikajlo, Imre; Matjacić, Zlatko

    2010-06-01

    In this paper we present a universal haptic drive (UHD), a device that enables rehabilitation of either arm ("ARM" mode) or wrist ("WRIST" mode) movement in two degrees-of-freedom. The mode of training depends on the selected mechanical configuration, which depends on locking/unlocking of a passive universal joint. Actuation of the device is accomplished by utilizing a series elastic actuation principle, which enables use of off-the-shelf mechanical and actuation components. A proportional force control scheme, needed for implementation of impedance control based movement training, was implemented. The device performance in terms of achievable lower and upper bound of viable impedance range was evaluated through adequately chosen sinusoidal movement in eight directions of a planar movement for the "ARM" mode and in eight directions of a combined wrist flexion/extension and forearm pronation/supination movement for the "WRIST" mode. Additionally, suitability of the universal haptic drive for movement training was tested in a series of training sessions conducted with a chronic stroke subject. The results have shown that reliable and repeatable performance can be achieved in both modes of operation for all tested directions.

  20. Performing Detailed Diagnostics Using a Hypothesis Driven Approach

    Directory of Open Access Journals (Sweden)

    Ioana OLARIU

    2012-11-01

    Full Text Available This paper is about understanding through deep market analysis what are the issues and opportunities in distribution. It highlights the detailed hypotheses driven ‘diagnostic’ framework to perform this analysis and shows the selling force role in successfully managing distribution excellence as a change intervention. For each issue we built the most common hypotheses which can conduct to a certain situation and we have highlighted different type of key questions which can describe each hypothesis.

  1. Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity.

    Science.gov (United States)

    Mitropoulou, Vivian; Harvey, Phillip D; Maldari, Liza A; Moriarty, Patrick J; New, Antonia S; Silverman, Jeremy M; Siever, Larry J

    2002-12-15

    Individuals with schizotypal personality disorder (SPD) share cognitive deficits with schizophrenic patients, suggesting that these deficits represent a core feature of the schizophrenia spectrum. We investigated the neuropsychological profile in SPD patients compared with two comparison groups: healthy volunteers (HV) and patients who met criteria for another non-schizophrenia spectrum personality disorder (NSS). We tested 48 DSM-III-R SPD patients, 22 NSS and 32 HV on a neuropsychologic battery that included the California Verbal Learning Test (CVLT), Trail Making A and B, the DOT test of working memory, the Stroop Color-Word Interference, the Paced Auditory Serial Addition Test (PASAT), the Wechsler Memory Scale Visual Reproduction Test (WMSV-R), and the Wechsler Adult Intelligence Scale vocabulary and block design. Normative standards for performance were created using the HV group. SPD patients performed significantly worse compared with HVs; specifically, SPD patients demonstrated impaired performance on the PASAT and the WMSV-R immediate and delayed recall compared to HV. Moreover, SPD patients were impaired in the PASAT and the WMSV-R immediate condition compared with the NSS group. The NSS patients did not differ from HV on any of the cognitive tasks. The interpersonal factor of the schizotypal symptoms inversely correlated with the PASAT score (r = -.32, p impairment. These differences reached statistical significance for the PASAT (an auditory working memory task), and the WMSV-R immediate and delayed recall (a learning-recall test). In contrast, performance of NSS patients did not differ from that of HVs. The types of deficits observed in SPD patients are qualitatively similar to but milder than those seen in patients with schizophrenia.

  2. The Role of Online Diagnostic Exams on the Higher Education Students Performance

    OpenAIRE

    Elshaiekh Mohamed , Nour Eldin; Fadlalla Ali, Musa

    2017-01-01

    International audience; Most of the current international exams and certificates have been changed to be conducted electronically online ; and in addition to keep up with current evaluation of ICT, this mechanism is used to improve the Higher Education institutions (HEI) students performance, the online diagnostic exams maybe is the one of ICT tools that could help effectively current century students. This paper focuses on studying the role of the online diagnostic exams and its impact on HE...

  3. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements.

    Science.gov (United States)

    Farmer, J E; Davis, T R C

    2008-08-01

    This case-control study investigated the associations between the body mass index (BMI), hand and wrist measurements and carpal tunnel syndrome (CTS). The hands and wrists of 50 patients with CTS and 50 age- and sex-matched controls were measured. The right and left wrist indices (wrist depth/wrist width) were significantly greater in CTS patients (mean = 0.71. SD = 0.04) than in the controls (mean = 0.69 SD = 0.04). The hand index (hand length/palm width) and BMI were not significantly different in the two groups. The hand, but not the wrist, index was found to correlate with the BMI. These results provide some support for a causative association between wrist morphometry, as measured by the wrist index, and CTS, but this difference is too small to be of diagnostic value in clinical or epidemiological practice. The results could also suggest that the previously reported association between CTS and the hand index may be secondary to differences in the BMI.

  4. Effective exposure level and diagnostic performance in endodontic radiography

    Energy Technology Data Exchange (ETDEWEB)

    Okano, T.; Wiebe, J.D.; Webber, R.L.; Wagner, R.F.

    1983-05-01

    Image quality is limited by the information capacity of the image-forming system and can be computed from three parameters: contrast, resolution, and noise. These parameters can be combined to yield a single measure which determines the maximum amount of information obtainable from any x-ray system and is called the noise-equivalent number of quanta (NEQ) per unit area. The effects of image quality, expressed as noise-equivalent number of quanta (NEQ) per unit area, on the radiographic performance by dentists reading the position of an endodontic file in a root canal were studied. Three different speed films were used in conjunction with a fixed screen. Components of variance associated with the position of the tooth apex and the tip of an endodontic file in a root canal were compared for the effect of different NEQs and observers. Results show that the standard deviation in locating a file tip and tooth apex may be a linear function of log NEQ. These findings indicate that a significant reduction in exposure would have a relatively small effect on the precision of endodontic distance measurements.

  5. Exploring the Knowledge Management Index as a Performance Diagnostic Tool

    Directory of Open Access Journals (Sweden)

    Jakov Crnkovic

    2005-04-01

    Full Text Available The knowledge management index (KMI has been proposed as a parsimonious and useful tool to help organizations gauge their knowledge management (KM capabilities. This may be the first step in understanding the difference between what an organization is currently doing and what it needs to do in order to maintain and improve its performance level. At the macro level, the index enables organizations to compare themselves with each other. At the micro level, it calls attention to areas needing improvement in current and future KM initiatives. In either case, the KMI provides a robust indicator and basis for business decision-making and organizational support and development. This paper presents a holistic approach to KM that relates key knowledge management processes (KMP and critical success factors (CSF needed to successfully implement it. By juxtaposing these processes and success factors, we create Belardo's matrix that will enable us to characterize an organization and estimate the KMI. At the macro level, we used realized KMI values and OP estimates to confirm the positive correlation between the KMI and OP. Additional findings include comparing the current and expected role of KM in organizations and discussion for marginal values of rows (CSF and columns (KM Processes of the proposed matrix.

  6. Robot-aided developmental assessment of wrist proprioception in children.

    Science.gov (United States)

    Marini, Francesca; Squeri, Valentina; Morasso, Pietro; Campus, Claudio; Konczak, Jürgen; Masia, Lorenzo

    2017-01-09

    Several neurodevelopmental disorders and brain injuries in children have been associated with proprioceptive dysfunction that will negatively affect their movement. Unfortunately, there is lack of reliable and objective clinical examination protocols and our current knowledge of how proprioception evolves in typically developing children is still sparse. Using a robotic exoskeleton, we investigated proprioceptive acuity of the wrist in a group of 49 typically developing healthy children (8-15 years), and a group of 40 young adults. Without vision participants performed an ipsilateral wrist joint position matching task that required them to reproduce (match) a previously experienced target position. All three joint degrees-of-freedom of the wrist/hand complex were assessed. Accuracy and precision were evaluated as a measure of proprioceptive acuity. The cross-sectional data indicating the time course of development of acuity were then fitted by four models in order to determine which function best describes developmental changes in proprioception across age. First, the robot-aided assessment proved to be an easy to administer method for objectively measuring proprioceptive acuity in both children and adult populations. Second, proprioceptive acuity continued to develop throughout middle childhood and early adolescence, improving by more than 50% with respect to the youngest group. Adult levels of performance were reached approximately by the age of 12 years. An inverse-root function best described the development of proprioceptive acuity across the age groups. Third, wrist/forearm proprioception is anisotropic across the three DoFs with the Abduction/Adduction exhibiting a higher level of acuity than those of Flexion/extension and Pronation/Supination. This anisotropy did not change across development. Proprioceptive development for the wrist continues well into early adolescence. Our normative data obtained trough this novel robot-aided assessment method provide a

  7. Effects of radiofrequency probe application on irrigation fluid temperature in the wrist joint.

    Science.gov (United States)

    Sotereanos, Dean G; Darlis, Nickolaos A; Kokkalis, Zinon T; Zanaros, George; Altman, Gregory T; Miller, Mark Carl

    2009-12-01

    Radiofrequency (RF) probes used in wrist arthroscopy may raise joint fluid temperature, increasing the risk of capsular and ligamentous damage. The purposes of the current study were to measure joint fluid temperature during wrist arthroscopy with the use of RF probes, and to determine whether using an outlet portal will reduce the maximum temperature. We performed wrist arthroscopy on 8 cadaveric arms. Ablation and coagulation cycles using RF probe were performed at documented locations within the joint. This was done for 60-second intervals on both the radial and ulnar side of the wrist, to mimic clinical practice. We used 4 fiberoptic phosphorescent probes to measure temperature (radial, ulnar, inflow-tube, and outflow-tube probes) and measured joint fluid temperature with and without outflow. There was a significant difference between wrists with and without outflow when examining maximum ablation temperatures (p wrist arthroscopy, the use of an outlet portal reduces the joint fluid temperature. Without an outlet portal, maximum temperatures can exceed desirable levels when using ablation; such temperatures have the potential to damage adjacent tissues. It is useful to maintain adequate outflow when using the radiofrequency probes during wrist arthroscopy.

  8. Intersection Syndrome: The Subtle Squeak of an Overused Wrist.

    Science.gov (United States)

    Skinner, Thomas M

    2017-01-01

    Patient histories that include wrist pain can be pivotal in the distinction between intersection syndrome (IS) and the more common de Quervain's tenosynovitis (DQT). Presented here is a 26-year-old pregnant woman with a history of rowing who developed left radial/dorsal wrist pain and a rubbing/squeaking sensation. Nine months of conservative DQT therapy and a landmark-guided corticosteroid injection failed to relieve her symptoms. An in-clinic ultrasound showed tenosynovitis at the intersection of the first and second compartments, confirming a diagnosis of IS. She found immediate relief with ultrasound-guided saline hydrodissection, the injection of saline into the intercompartmental space to reduce adhesions. Both DQT and IS are overuse injuries caused by repetitive wrist extension, as occurs in rowing, and either condition can worsen after pregnancy. Distinguishing the subtleties between DQT and IS can be challenging. Close attention to the patient's description of the pain can guide treatment, potentially expediting recovery. In addition, saline hydrodissection can be both a diagnostic tool and a potentially therapeutic alternative to steroid injections for such tendinopathies. © Copyright 2017 by the American Board of Family Medicine.

  9. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Science.gov (United States)

    Lee, Su-Ya; Chieh, Hsiao-Feng; Lin, Chien-Ju; Jou, I-Ming; Kuo, Li-Chieh; Su, Fong-Chin

    2016-01-01

    The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP), radial deviation (RD), and ulnar deviation (UD). The root mean square (RMS) of the electromyographic signal in the extensor digitorum communis (EDC), normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS) had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.

  10. The Potential Risk Factors Relevant to Lateral Epicondylitis by Wrist Coupling Posture.

    Directory of Open Access Journals (Sweden)

    Su-Ya Lee

    Full Text Available The use of awkward wrist postures and unskilled techniques might induce lateral epicondylitis. This study thus investigated the effects of wrist deviation combined with extension and movement velocity on the dynamic performances of the wrist muscles during the coupling posture via a custom-made bi-planar isokinetic dynamometer. Thirty subjects were recruited to perform the isokinetic testing. We measured the muscle strengths and activities for the wrist extensors and flexors during concentric and eccentric contractions at three movement velocities, 30°s-1, 90°s-1, and 180°s-1, combined with three wrist postures, neutral position (NP, radial deviation (RD, and ulnar deviation (UD. The root mean square (RMS of the electromyographic signal in the extensor digitorum communis (EDC, normalized peak torque of extensors, and ratio of normalized peak torque between wrist extensors and flexors, were all greater in the NP than RD and UD in both contractions. The ratio of RMS between EDC and flexor digitorum superficialis (FDS had a significantly greater value in RD than UD during the concentric contraction. The EDC showed significantly higher activity at the fast velocity in both contractions. Nevertheless, a significantly higher RMS of the electromyographic signal between EDC and FDS and the ratio of strength between wrist extensors and flexors were found at slow velocity in both contractions. The wrist deviation combined with extension and movement velocity of the wrist joint should thus be considered as influential factors which might alter the dynamic performances, and may result in further injury of the elbow joint.

  11. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007....... The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination...

  12. A systematic review of the diagnostic performance of orthopedic physical examination tests of the hip.

    Science.gov (United States)

    Rahman, Labib Ataur; Adie, Sam; Naylor, Justine Maree; Mittal, Rajat; So, Sarah; Harris, Ian Andrew

    2013-08-30

    Previous reviews of the diagnostic performances of physical tests of the hip in orthopedics have drawn limited conclusions because of the low to moderate quality of primary studies published in the literature. This systematic review aims to build on these reviews by assessing a broad range of hip pathologies, and employing a more selective approach to the inclusion of studies in order to accurately gauge diagnostic performance for the purposes of making recommendations for clinical practice and future research. It specifically identifies tests which demonstrate strong and moderate diagnostic performance. A systematic search of Medline, Embase, Embase Classic and CINAHL was conducted to identify studies of hip tests. Our selection criteria included an analysis of internal and external validity. We reported diagnostic performance in terms of sensitivity, specificity, predictive values and likelihood ratios. Likelihood ratios were used to identify tests with strong and moderate diagnostic utility. Only a small proportion of tests reported in the literature have been assessed in methodologically valid primary studies. 16 studies were included in our review, producing 56 independent test-pathology combinations. Two tests demonstrated strong clinical utility, the patellar-pubic percussion test for excluding radiologically occult hip fractures (negative LR 0.05, 95% Confidence Interval [CI] 0.03-0.08) and the hip abduction sign for diagnosing sarcoglycanopathies in patients with known muscular dystrophies (positive LR 34.29, 95% CI 10.97-122.30). Fifteen tests demonstrated moderate diagnostic utility for diagnosing and/or excluding hip fractures, symptomatic osteoarthritis and loosening of components post-total hip arthroplasty. We have identified a number of tests demonstrating strong and moderate diagnostic performance. These findings must be viewed with caution as there are concerns over the methodological quality of the primary studies from which we have extracted our

  13. Quantifying forearm and wrist joint power during unconstrained movements in healthy individuals.

    Science.gov (United States)

    Flores, Diana Castillo; Laurendeau, Simon; Teasdale, Normand; Simoneau, Martin

    2014-11-17

    Wrist movement-related injuries account for a large number of repetitive motion injuries. Remarkably little, if any, empirical data exist to quantify the impact of neuromuscular disorders affecting the wrist or to validate the effectiveness of rehabilitation training programs on wrist functions. The aim of this project was to develop a biomechanical model for quantifying wrist and forearm kinetics during unconstrained movements, to assess its reliability and to determine its sensitivity. Twenty healthy subjects with no history of upper arm and wrist pain volunteered for the experiment. To evaluate the reliability of the data, we quantified their forearm and wrist kinetics on two different days (minimum and maximum number of days between experimental sessions were 1 and 4 days respectively). To measure forearm and wrist kinetics, an apparatus was built to offer rotational inertia during forearm and wrist movements. An inertial measurement unit was located near the top of the device measuring its angular position along the frontal and sagittal planes. We used a mathematical model to infer forearm and wrist torque. Thereafter, we calculated the product of torque and angular velocity to determine forearm and wrist power. Results revealed that for 75% of the power and torque measurements the ICC was greater than 0.75 (range: 0.77 - 0.83). Torque and power measurements for adduction movements, however, were less reliable (i.e., ICC of 0.60 and 0.47, respectively) across testing sessions. The biomechanical model was robust to small measurement errors, and the power peaks between the first and second testing session were not different indicating that there was no systematic bias (i.e., motor performance improvement) between testing sessions. The biomechanical model can be used to assess the effectiveness of rehabilitation programs, document the progression of athletes or conduct research-oriented testing of maximum forearm and wrist kinetic capacities. Nonetheless

  14. Diagnostic Performance of the Intraoral Radiographs on the Interproximal Dental Caries

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Ji; Kang, Byung Cheol [Faculty of Dental Science, Graduate School, Department of Oral and Maxillofacial Radiology, College of Dentistry, Chonnam National University, Kwangju (Korea, Republic of)

    1998-02-15

    The purpose of this study was to evaluated the diagnostic performance of the senior dental students for the proximal dental caries in intraoral radiographs and to compare it with the dental hospital residents, the reference group. It was also investigated the diagnostic performance according to the carious lesion depth. Thirty-five intraoral periapical and bitewing radiographs with 213 proximal surface included in this study were selected from the dental patients at Chonnam National University Hospital. The observers were 181 senior dental students from 5 dental schools and 40 dentists who were second year resident from 5 dental hospitals. They were asked to evaluate the presence ro the absence of the proximal dental caries. The results were as follows : 1. The mean of the hitting rate for the overall observers was 184.51 surfaces and the diagnostic accuracy was 86.62%. 2. The diagnostic performance of the sound proximal tooth surfaces was very high, i.e., 91.5% true negative rate and 8.5% false positive rate. 3. The diagnostic performance of the dentist group was higher than the student group (P<0.05). 4. The proximal dental caries perceptibility increased as the lesion depth increased significantly (P<0.001) except no difference between the carious lesion depth III and IV (P>0.001).

  15. A real-time diagnostic and performance monitor for UNIX. M.S. Thesis

    Science.gov (United States)

    Dong, Hongchao

    1992-01-01

    There are now over one million UNIX sites and the pace at which new installations are added is steadily increasing. Along with this increase, comes a need to develop simple efficient, effective and adaptable ways of simultaneously collecting real-time diagnostic and performance data. This need exists because distributed systems can give rise to complex failure situations that are often un-identifiable with single-machine diagnostic software. The simultaneous collection of error and performance data is also important for research in failure prediction and error/performance studies. This paper introduces a portable method to concurrently collect real-time diagnostic and performance data on a distributed UNIX system. The combined diagnostic/performance data collection is implemented on a distributed multi-computer system using SUN4's as servers. The approach uses existing UNIX system facilities to gather system dependability information such as error and crash reports. In addition, performance data such as CPU utilization, disk usage, I/O transfer rate and network contention is also collected. In the future, the collected data will be used to identify dependability bottlenecks and to analyze the impact of failures on system performance.

  16. A Hybrid Neural Network-Genetic Algorithm Technique for Aircraft Engine Performance Diagnostics

    Science.gov (United States)

    Kobayashi, Takahisa; Simon, Donald L.

    2001-01-01

    In this paper, a model-based diagnostic method, which utilizes Neural Networks and Genetic Algorithms, is investigated. Neural networks are applied to estimate the engine internal health, and Genetic Algorithms are applied for sensor bias detection and estimation. This hybrid approach takes advantage of the nonlinear estimation capability provided by neural networks while improving the robustness to measurement uncertainty through the application of Genetic Algorithms. The hybrid diagnostic technique also has the ability to rank multiple potential solutions for a given set of anomalous sensor measurements in order to reduce false alarms and missed detections. The performance of the hybrid diagnostic technique is evaluated through some case studies derived from a turbofan engine simulation. The results show this approach is promising for reliable diagnostics of aircraft engines.

  17. Entrance surface dose according to dose calculation: Head and wrist

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Ho Jin [Dept. Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Han, Jae Bok; Song, Jong Nam; Choi, Nam Gil [Dept. of Radiological Science, Dongshin University, Naju (Korea, Republic of)

    2016-09-15

    This study were compared with the direct measurement and indirect dose methods through various dose calculation in head and wrist. And, the modified equation was proposed considering equipment type, setting conditions, tube voltage, inherent filter, added filter and its accompanied back scatter factor. As a result, it decreased the error of the direct measurement than the existing dose calculation. Accordingly, diagnostic radiography patient dose comparison would become easier and radiographic exposure control and evaluation will become more efficient. The study findings are expected to be useful in patients' effective dose rate evaluation and dose reduction.

  18. Hybrid Neural-Network: Genetic Algorithm Technique for Aircraft Engine Performance Diagnostics Developed and Demonstrated

    Science.gov (United States)

    Kobayashi, Takahisa; Simon, Donald L.

    2002-01-01

    As part of the NASA Aviation Safety Program, a unique model-based diagnostics method that employs neural networks and genetic algorithms for aircraft engine performance diagnostics has been developed and demonstrated at the NASA Glenn Research Center against a nonlinear gas turbine engine model. Neural networks are applied to estimate the internal health condition of the engine, and genetic algorithms are used for sensor fault detection, isolation, and quantification. This hybrid architecture combines the excellent nonlinear estimation capabilities of neural networks with the capability to rank the likelihood of various faults given a specific sensor suite signature. The method requires a significantly smaller data training set than a neural network approach alone does, and it performs the combined engine health monitoring objectives of performance diagnostics and sensor fault detection and isolation in the presence of nominal and degraded engine health conditions.

  19. MRI features in de Quervain`s tenosynovitis of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Glajchen, N. [Mount Sinai Hospital, New York, NY (United States). Dept. of Radiology; Schweitzer, M. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology

    1996-01-01

    De Quervain`s stenosing tenosynovitis of the first dorsal extensor component is traditionally diagnosed clinically but may be encountered when performing MRI of the wrist. A retrospective review of wrist MR images was performed in cases where the diagnosis of de Quervain`s synovitis was suggested (n=5). Imaging findings were correlated with clinical findings in four cases and with wrist arthroscopy in one case. Increased thickness of the extensor pollicus brevis and abductor pollicis longus tendons was the most reliable finding on MRI, being present in all cases. Peritendinous edema was also a reliable finding. Surrounding subcutaneous edema and increased intratendinous signal were less reliable findings in confirmed cases of de Quervain`s disease. De Quervain`s tenosynovitis may be encountered when performing MRI of the wrist. Increased tendon thickness and peritendinous edema are the most reliable imaging findings. (orig.)

  20. Effect of Age on Performance Parameters of Screening and Diagnostic Mammography Examinations

    Directory of Open Access Journals (Sweden)

    Tamnit Ansusinha

    2016-01-01

    Full Text Available Objective: To assess the effect of age specific on performance parameters among screening and diagnostic mam- mography examinations. Methods: During 1 January 2006 to 31 December 2007, 22,278 screening mammography examinations (MG and 13,435 diagnostic MG , were retrospectively reviewed. Patients with breast cancer were either confirmed by histopathology report, Siriraj cancer registry or follow-up post treatment up to 12 months, while the negative breast cancer were followed up for at least 12 months. Cancer detection rate (CDR, sensitivity, specificity, and positive predictive value (PPV were analysed according to age group distribution. Results: Of the total 22,278 screening examinations, 43.1% and 56.9% were below and above 50 years old, respec- tively. Among 13,435 diagnostic examinations, 66.9% and 33.1% were below and above 50 years, respectively. The mean age was 50.8 for screening and 53.3 for diagnostic (S.D.=8.1,9.0, respectively. The CDR of screening and diagnostic was 4.6 and 49.6 per 1,000 examinations, respectively. The CDR, PPV and specificity of screening and diagnostic mammography examination increased with higher age with statistical significance (p<0.005. The sensitivity of the diagnostic MG also increased with age (p<0.05, but not in the screening group. Conclusion: Age is one of the most important risk factors of breast cancer and also in outcome of key parameters on mammography performance. The study showed that the CDR, PPV and specificity increase with age both in the screening and diagnostic group as in the literatures except for the sensitivity in screening was not related to increased age. Our study also supported that MG screening among women 40-49 years is suitable as there were high cancer rate in both screening and diagnosis in 40-49 years with high sensitivity and specificity.

  1. The influence of elbow joint kinematics on wrist speed in cricket fast bowling.

    Science.gov (United States)

    Middleton, Kane Jytte; Alderson, Jacqueline Anne; Elliott, Bruce Clifford; Mills, Peter Michael

    2015-01-01

    This modelling study sought to describe the relationships between elbow joint kinematics and wrist joint linear velocity in cricket fast bowlers, and to assess the sensitivity of wrist velocity to systematic manipulations of empirical joint kinematic profiles. A 12-camera Vicon motion analysis system operating at 250 Hz recorded the bowling actions of 12 high performance fast bowlers. Empirical elbow joint kinematic data were entered into a cricket bowling specific "Forward Kinematic Model" and then subsequently underwent fixed angle, angular offset and angle amplification manipulations. A combination of 20° flexion and 20° abduction at the elbow was shown to maximise wrist velocity within the experimental limits. An increased elbow flexion offset manipulation elicited an increase in wrist velocity. Amplification of elbow joint flexion-extension angular displacement indicated that, contrary to previous research, elbow extension range of motion and angular velocity at the time of ball release were negatively related to wrist velocity. Some relationships between manipulated joint angular waveforms and wrist velocity were non-linear, supporting the use of a model that accounts for the non-linear relationships between execution and outcome variables in assessing the relationships between elbow joint kinematics and wrist joint velocity in cricket fast bowlers.

  2. An electromyography study of wrist extension orthoses and upper-extremity function.

    Science.gov (United States)

    Bulthaup, S; Cipriani, D J; Thomas, J J

    1999-01-01

    This study examined the effect of commonly used long and short styles of commercially produced wrist extension orthoses on the activity of the proximal muscles of the shoulder and elbow and on wrist flexor and extensor muscle activity. While 17 women between 22 and 40 years of age (M = 26.6) performed a specified movement wearing each of the two styles of orthosis and without an orthosis, their motor unit recruitment of five proximal joint muscle groups, wrist extensors, and wrist flexors was measured by surface electromyography. Motor unit recruitment was significantly greater in both orthosis conditions for four of five proximal muscles and for wrist flexors. There were no significant differences between the short and long orthosis conditions for proximal muscle groups. Wearing a wrist extension orthosis appears to place additional stress on the proximal joint musculature beyond that found without splint use. The study has implications for the prescription of wrist extension orthoses, especially for patients whose proximal joints are already compromised.

  3. A survey to medical residents on the performance of diagnostic and therapeutic thoracenteses: a training gap?

    Science.gov (United States)

    Porcel, J M; Cases-Viedma, E; Bielsa, S

    2016-12-01

    Pleural fluid aspiration is a routine procedure for pulmonologists and internists. Our aim was to evaluate technical and methodological aspects of diagnostic and therapeutic thoracenteses performed by last two-year residents of Pulmonology and Internal Medicine. An online 24-item questionnaire was sent to participants, and responses were evaluated according to the medical specialty. The survey was completed by 139 (17.1%) residents (71 internists and 68 pulmonologists). 29.5% and 41% performed one or no diagnostic or therapeutic thoracenteses monthly, respectively. Only 44% used ultrasonography to guide pleural procedures. Less than half of respondents used local anesthesia for diagnostic aspirations. Contrary to current recommendations, 25% of residents employed intramuscular needles for therapeutic aspirations. More than 80% of residents routinely ordered pleural fluid cultures and cytological studies, regardless of the clinical suspicion. About 40% requested imaging studies after a diagnostic thoracentesis. Half or more of the respondents were unaware of pH measurement methodologies, culture type for mycobacteria, and performance of cell blocks. Pulmonologists were more experienced than internists, and also made use of ultrasonography more frequently. This survey highlights gaps of knowledge and skills in conducting diagnostic and therapeutic thoracenteses. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance

    Energy Technology Data Exchange (ETDEWEB)

    Li, Minghua; Zhang, Jiayin [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Department of Radiology, Shanghai (China); Zhang, Qingyong; Pan, Jingwei; Lu, Zhigang; Wei, Meng [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Department of Cardiology, Shanghai (China)

    2014-09-26

    To evaluate the incidence and diagnostic performance of reverse attenuation gradient (RAG) sign in patients with coronary stent occlusion. We retrospectively included patients with suspected restenosis who underwent both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 2 weeks. Stent occlusion at CCTA was defined as (1) complete contrast filling defect of large calibre stents (at least 3 mm), or (2) presence of RAG sign in patients with small calibre stents (less than 3 mm) or (3) presence of RAG sign in patients with non-diagnostic image quality of stents. The diagnostic performance of RAG sign was further assessed by comparison to ICA results. A total of 162 patients with 231 implanted stents were included. ICA confirmed stent occlusion in 59 patients (99 stents). RAG sign was present in 59.3 % (35/59) of all stent occlusions. As shown by patient-based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our diagnostic criteria for detection of stent occlusion were 79.7 % (47/59), 100 % (103/103), 100 % (47/47) and 89.6 % (103/115) respectively. Superior diagnostic performance was confirmed by receiver operating characteristic (ROC) analysis with an area under the curve of 0.898. RAG sign observed at CCTA in patients with coronary stenting represents reverse collateral flow distal to stents and is highly specific to indicate stent occlusion. (orig.)

  5. Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

    Science.gov (United States)

    Anderson, Melissa L.; Smith, Robert A.; Carney, Patricia A.; Miglioretti, Diana L.; Monsees, Barbara S.; Sickles, Edward A.; Taplin, Stephen H.; Geller, Berta M.; Yankaskas, Bonnie C.; Onega, Tracy L.

    2014-01-01

    Purpose To examine radiologists’ screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials and Methods In an institutional review board–approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPRfalse-positive rate], and cancer detection rate [CDRcancer detection rate]). Logistic regression was used to assess the association between the volume of recalled screening mammograms (“own” mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and “any” mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0–50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0–50 mammograms, 32% performed the work-up for 51–125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPRfalse-positive rate (P = .004), and CDRcancer detection rate (P work-ups for any radiologist yielded significant increases in FPRfalse-positive rate (P = .011) and CDRcancer detection rate (P

  6. Performance Evaluation of Commercial Dengue Diagnostic Tests for Early Detection of Dengue in Clinical Samples

    Directory of Open Access Journals (Sweden)

    Tuan Nur Akmalina Mat Jusoh

    2017-01-01

    Full Text Available The shattering rise in dengue virus infections globally has created a need for an accurate and validated rapid diagnostic test for this virus. Rapid diagnostic test (RDT and reverse transcription-polymerase chain reaction (RT-PCR diagnostic detection are useful tools for diagnosis of early dengue infection. We prospectively evaluated the diagnostic performance of nonstructural 1 (NS1 RDT and real-time RT-PCR diagnostic kits in 86 patient serum samples. Thirty-six samples were positive for dengue NS1 antigen while the remaining 50 were negative when tested with enzyme-linked immunosorbent assay (ELISA. Commercially available RDTs for NS1 detection, RTK ProDetect™, and SD Bioline showed high sensitivity of 94% and 89%, respectively, compared with ELISA. GenoAmp® Trioplex Real-Time RT-PCR and RealStar® Dengue RT-PCR tests presented a comparable kappa agreement with 0.722. The result obtained from GenoAmp® Real-Time RT-PCR Dengue test showed that 14 samples harbored dengue virus type 1 (DENV-1, 8 samples harbored DENV-2, 2 samples harbored DENV-3, and 1 sample harbored DENV-4. 1 sample had a double infection with DENV-1 and DENV-2. The NS1 RDTs and real-time RT-PCR tests were found to be a useful diagnostic for early and rapid diagnosis of acute dengue and an excellent surveillance tool in our battle against dengue.

  7. The effect of arm and wrist supports on the load of he upper extrimity during VDU work

    NARCIS (Netherlands)

    Visser, B.; de Korte, E.; van der Kraan, I.; Kuijer, P.

    2000-01-01

    Objective. To evaluate the effectiveness of arm and wrist supports in reducing the workload during computer work. Design. Female subjects (n=10) performed computer work in conditions with arm or wrist supports and in a condition without supports. Background. Sustained muscle tension in the trapezius

  8. Development of prosthetic arm with pneumatic prosthetic hand and tendon-driven wrist.

    Science.gov (United States)

    Takeda, Hiroyuki; Tsujiuchi, Nobutaka; Koizumi, Takayuki; Kan, Hiroto; Hirano, Masanori; Nakamura, Yoichiro

    2009-01-01

    Recently, various prosthetic arms have been developed, but few are both attractive and functional. Considering human coexistence, prosthetic arms must be both safe and flexible. In this research, we developed a novel prosthetic arm with a five-fingered prosthetic hand using our original pneumatic actuators and a slender tendon-driven wrist using a wire drive and two small motors. Because the prosthetic hand's driving source is comprised of small pneumatic actuators, the prosthetic hand is safe when it makes contact with people; it can also operate flexibly. In addition, the arm has a tendon-driven wrist to expand its motion space and to perform many operations. First, we explain the pneumatic hand's drive mechanism and its tendon-driven wrist. Next, we identify the characteristics of the hand and the wrist and construct a control system for this arm and verify its control performance.

  9. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  10. Predictive Modeling of Student Performances for Retention and Academic Support in a Diagnostic Medical Sonography Program

    Science.gov (United States)

    Borghese, Peter; Lacey, Sandi

    2014-01-01

    As part of a retention and academic support program, data was collected to develop a predictive model of student performances in core classes in a Diagnostic Medical Sonography (DMS) program. The research goal was to identify students likely to have difficulty with coursework and provide supplemental tutorial support. The focus was on the…

  11. Diagnostic Utility of the Social Skills Improvement System Performance Screening Guide

    Science.gov (United States)

    Krach, S. Kathleen; McCreery, Michael P.; Wang, Ye; Mohammadiamin, Houra; Cirks, Christen K.

    2017-01-01

    Researchers investigated the diagnostic utility of the Social Skills Improvement System: Performance Screening Guide (SSIS-PSG). Correlational, regression, receiver operating characteristic (ROC), and conditional probability analyses were run to compare ratings on the SSIS-PSG subscales of Prosocial Behavior, Reading Skills, and Math Skills, to…

  12. Low cut-off values increase diagnostic performance of protein S assays

    NARCIS (Netherlands)

    Mulder, Rene; ten Kate, Min Ki; Kluin-Nelemans, Hanneke C.; Mulder, Andre B.

    Conflicting data have been reported on the accuracy of protein S (PS) assays for detection of hereditary PS deficiency. In this study we assessed the diagnostic performance of two total PS antigen assays, four free PS assays and three PS activity assays in a group of 28 heterozygous carriers of

  13. Diagnostic Performance Tests for Suspected Scaphoid Fractures Differ with Conventional and Latent Class Analysis

    NARCIS (Netherlands)

    Buijze, Geert A.; Mallee, Wouter H.; Beeres, Frank J. P.; Hanson, Timothy E.; Johnson, Wesley O.; Ring, David

    2011-01-01

    Evaluation of the diagnostic performance characteristics of radiographic tests for diagnosing a true fracture among suspected scaphoid fractures is hindered by the lack of a consensus reference standard. Latent class analysis is a statistical method that takes advantage of unobserved, or latent,

  14. A Wrist-Worn Thermohaptic Device for Graceful Interruption

    DEFF Research Database (Denmark)

    Bolton, Frank; Jalaliniya, Shahram; Pederson, Thomas

    2015-01-01

    the negative influence on the ongoing activity is minimal. In this article we present our self-mitigated interruption concept (essentially a symbiosis of artificial external stimuli tuned to existing human attention management mechanisms) and perform a pilot study laying the ground for using a wrist......-Aware-systems-inspired approach “Egocentric Interaction” aimed at supporting the design of envisioned Wearable Personal Assistants intended to, among other things, help human perception and cognition with the management of interruptions....

  15. Kinematics and Dynamics of an Asymmetrical Parallel Robotic Wrist

    DEFF Research Database (Denmark)

    Wu, Guanglei

    2014-01-01

    This paper introduces an asymmetrical parallel robotic wrist, which can generate a decoupled unlimited-torsion motion and achieve high positioning accuracy. The kinematics, dexterity, and singularities of the manipulator are investigated to visualize the performance contours of the manipulator....... Using the method of Lagrange multipliers and considering all the mobile components, the equations of motion of the manipulator are derived to investigate the dynamic characteristics efficiently. The developed dynamic model is numerically illustrated and compared with its simplified formulation to show...

  16. Forward and inverse kinematics of double universal joint robot wrists

    Science.gov (United States)

    Williams, Robert L., II

    1991-01-01

    A robot wrist consisting of two universal joints can eliminate the wrist singularity problem found on many individual robots. Forward and inverse position and velocity kinematics are presented for such a wrist having three degrees of freedom. Denavit-Hartenberg parameters are derived to find the transforms required for the kinematic equations. The Omni-Wrist, a commercial double universal joint robot wrist, is studied in detail. There are four levels of kinematic parameters identified for this wrist; three forward and three inverse maps are presented for both position and velocity. These equations relate the hand coordinate frame to the wrist base frame. They are sufficient for control of the wrist standing alone. When the wrist is attached to a manipulator arm; the offset between the two universal joints complicates the solution of the overall kinematics problem. All wrist coordinate frame origins are not coincident, which prevents decoupling of position and orientation for manipulator inverse kinematics.

  17. Changes in the pressure distribution by wrist angle and hand position in a wrist splint.

    Science.gov (United States)

    Cha, Y J

    2017-12-07

    The study was conducted to provide basic data to develop a system that distributes pressure over a broader area by measuring and analyzing pressures in various wrist angles and hand positions while wearing a wrist splint. With 0, 15, 30, and 45 degrees of wrist extension, full-finger extension and finger flexion, pressure distribution changes were measured three times. Average peak pressure was analyzed and mean value picture (MVP) in zones 3-5 was calculated. A one-way Anova was conducted to identify changes in pressure distribution by wrist angle and hand position. Mean peak pressure values (kPa) in zones 3-5 changed depending on the wrist angle. Peak pressures (kPa) changed significantly in 15, 30, and 45 degrees wrist extension, depending on the hand position. Since pressure distributions differ depending the wrist angle and hand position (finger flexion), it is necessary to consider how pressure varies in each wrist position and to provide information on postures that should be avoided during tasks and occupational activities based on various wrist angles or hand positions. Copyright © 2017. Published by Elsevier Masson SAS.

  18. Optimization of Classification Strategies of Acetowhite Temporal Patterns towards Improving Diagnostic Performance of Colposcopy

    OpenAIRE

    Guti?rrez-Fragoso, Karina; Acosta-Mesa, H?ctor Gabriel; Cruz-Ram?rez, Nicandro; Hern?ndez-Jim?nez, Rodolfo

    2017-01-01

    Efforts have been being made to improve the diagnostic performance of colposcopy, trying to help better diagnose cervical cancer, particularly in developing countries. However, improvements in a number of areas are still necessary, such as the time it takes to process the full digital image of the cervix, the performance of the computing systems used to identify different kinds of tissues, and biopsy sampling. In this paper, we explore three different, well-known automatic classification meth...

  19. Diagnostic Performance of Coronary Computed Tomography Angiography and Myocardial Perfusion Imaging in Kidney Transplantation Candidates

    DEFF Research Database (Denmark)

    Winther, Simon; Svensson, My; Jørgensen, Hanne Mari Skou

    2015-01-01

    Abstract Objectives The goal of this study was to compare the diagnostic accuracy of the coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and a combination of these tools in the diagnosis of obstructive...... that established noninvasive stress tests have low diagnostic accuracy, while the diagnostic performance of coronary CTA remains unknown. Methods We prospectively studied 138 patients referred for pre-transplant cardiac evaluation (mean age 54 years; age range 22 to 72 years; 68% male; 43% treated with dialysis......% for SPECT, 40% for Hybrid (CACS/SPECT), and 75% for Hybrid (coronary CTA/SPECT). Conclusions Coronary CTA is a reliable test with high sensitivity and a high negative predictive value for diagnosing obstructive CAD before kidney transplantation. A noninvasive approach with use of either coronary CTA...

  20. Dynamics of wrist and forearm rotations.

    Science.gov (United States)

    Peaden, Allan W; Charles, Steven K

    2014-08-22

    Human movement generally involves multiple degrees of freedom (DOF) coordinated in a graceful and seemingly effortless manner even though the underlying dynamics are generally complex. Understanding these dynamics is important because it exposes the challenges that the neuromuscular system faces in controlling movement. Despite the importance of wrist and forearm rotations in everyday life, the dynamics of movements involving wrist and forearm rotations are currently unknown. Here we present equations of motion describing the torques required to produce movements combining flexion-extension (FE) and radial-ulnar deviation (RUD) of the wrist and pronation-supination (PS) of the forearm. The total torque is comprised of components required to overcome the effects of inertia, damping, stiffness, and gravity. Using experimentally measured kinematic data and subject-specific impedance parameters (inertia, damping, and stiffness), we evaluated movement torques to test the following hypotheses: the dynamics of wrist and forearm rotations are (1) dominated by stiffness, not inertial or damping effects, (2) significantly coupled through interaction torques due to stiffness and damping (but not inertia), and (3) too complex to be well approximated by a simple, linear model. We found that (1) the dynamics of movements combining the wrist and forearm are similar to wrist rotations in that stiffness dominates over inertial and damping effects (pwrist and forearm are significantly coupled through stiffness, while interactions due to inertia and damping are small, and (3) despite the complexity of the exact equations of motion, the dynamics of wrist and forearm rotations are well approximated by a simple, linear (but still coupled) model (the mean error in predicting torque was less than 1% of the maximum torque). The exact and approximate models are presented for modeling wrist and forearm rotations in future studies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Wrist Injuries in Elderly Women is Overlooked when Using X-ray in Comparison to MRI

    DEFF Research Database (Denmark)

    Eckmann, Johan Høising; Brix, Lau; Nielsen, Randi

    by X-ray (Fractured radius = 12, fractures carpalbones = 3, bone bruise = 4, fractured scaphoid = 3, other pathology = 3, noappreciable disease = 15).   Discussion:The standard strategy for unraveling wrist injuries is by conventional X-ray.This approach is fast, economically feasible and is able...... strength, lower mobility andincreased risk of degenerative joint disease. The standard approach fordiagnosing fractures or injuries of the ligaments is by conventional X-ray. Ifno pathology can be established and there is a suspected scaphoid bone fracturea supplemental MRI of the wrist is performed....... The MRI often show pathology inthe wrist which is not visible on X-ray. The purposeof this project was to evaluate how often the supplemental MRI of the wrist wasable to demonstrate pathology which was invisible using standard X-ray.   Subjects& Methods: Forty women were included in the study (mean age...

  2. Extrinsic wrist ligaments: prevalence of injury by magnetic resonance imaging and association with intrinsic ligament tears.

    Science.gov (United States)

    Taneja, Atul K; Bredella, Miriam A; Chang, Connie Y; Joseph Simeone, F; Kattapuram, Susan V; Torriani, Martin

    2013-01-01

    The objective of this study was to determine the prevalence of extrinsic wrist ligament injury by magnetic resonance imaging and its association with intrinsic ligament tears. We reviewed conventional magnetic resonance images performed over a 5-year period from adult patients in the setting of wrist trauma. Two musculoskeletal radiologists examined the integrity of wrist ligaments and presence of bone abnormalities. In a cohort of 75 subjects, extrinsic ligament injury was present in 75%, with radiolunotriquetral being most frequently affected (45%). Intrinsic ligament injury was present in 60%. Almost half of subjects had combined intrinsic and extrinsic ligament injury. Bone abnormalities were seen in 69%. The rate of extrinsic injury was higher in subjects with bone injury (P = 0.008). There is high prevalence of extrinsic ligament injury in the setting of wrist trauma, especially in the presence of bone abnormalities, with combined injury of intrinsic and extrinsic ligaments in about half of cases.

  3. Transseptal dorsal approaches to the wrist.

    Science.gov (United States)

    Zemirline, Ahmed; Hoël, Gérard; Naïto, Kiyohito; Uguen, Arnaud; Liverneaux, Philippe; Le Nen, Dominique

    2013-04-01

    The dorsal approach to the wrist is the exposure of choice for most of the surgical procedures on the radiocarpal and intercarpal joints. Contrary to the volar approach, it encounters neither the main arteries nor the motor nerve branch. However, the dorsal approach goes necessarily through the extensor retinaculum. We describe two transseptal dorsal approaches that pass through the extensor retinaculum in the thickness of a septum between two compartments. A virtual space was developed beneath the infratendinous retinaculum (which is a deep layer covering the floor of the extensor compartments) to expose the periosteum, the ligaments and the joint capsule without opening the extensor compartments. Twenty cadaveric wrists have been dissected to study the feasibility of the two transseptal approaches. Ten wrists were exposed through a 3-4 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the third and fourth compartments. Ten wrists were exposed through a 4-5 transseptal approach, passing through the extensor retinaculum in the thickness of the septum between the fourth and fifth compartments. The extent of violations of extensor compartments and joint capsule, and the exposed anatomical structures were noted. At the end of each dissection, the whole extensor system was outrightly removed for histological study. The feasibility of the transseptal approaches was demonstrated for all the dissected wrists. The dissection plane beneath the infratendinous retinaculum was macroscopically and microscopically highlighted. The transseptal approaches provide a good exposure to the dorsal side of the wrist joint, without opening the extensor tendon compartments.

  4. [Biomechanical modelling of the wrist joint].

    Science.gov (United States)

    Eschweiler, J; Allmendinger, F; Stromps, J P; Nick, H E; Pallua, N; Radermacher, K

    2014-04-01

    The hand represents one of the most complex joint mechanisms of the human body. The hand is also an important communication medium. The spectrum of today's hand injuries reaches from minor damage up to complex traumata with loss of several functional aspects. Enormous subsequent economic costs result. The therapeutic re-establishment of the equilibrium between maximum stress and the actual applied stress is the condition for a lifelong joint function. A literature review about biomechanical wrist models was realised. The previous models found in the literature were systematically analysed as well as verifying their suitability for clinical use regarding pathological changes, therapy approaches and modelling/simulation approaches, respectively, of wrist injuries. The return of the wrist joint biomechanics to the normal condition is a key factor for a successful therapy. Furthermore, it is important for the re-establishment of an unimpaired joint function. Currently, there exist only simplified descriptions and models of the wrist joint, approximated by technical joints and furthermore, they are partially contradictory. Therefore, no uniform validated biomechanical wrist model exists as yet. Regarding the arising complex clinical problems, however, a valid biomechanical wrist joint model would be necessary as assistance, in order to improve the success of systematised therapies on the basis of computer-aided model-based planning and intervention. Georg Thieme Verlag KG Stuttgart · New York.

  5. Application of a motion capture data glove for hand and wrist ergonomic analysis during laparoscopy.

    Science.gov (United States)

    Sánchez-Margallo, Francisco M; Pérez-Duarte, Francisco J; Sánchez-Margallo, Juan A; Lucas-Hernández, Marcos; Matos-Azevedo, Ana Maria; Díaz-Güemes, Idoia

    2014-12-01

    This study aims to analyze the surgeons' hand spatial configuration during the use of two different instrument handles for laparoscopy, by obtaining information from the data glove CyberGlove®, and establishing existing risk levels for wrist disorders. Fifty surgeons participated in this study and were distributed into three groups (novices, intermediate and experts). Each subject carried out suturing and dissection tasks on a physical simulator, using axial-handled or ring-handled instruments, respectively. Hand and wrist positions were registered by the CyberGlove® and a modified RULA method was applied to establish appropriate risk levels for wrist disorders. We found statistically significant differences in seven of the eleven glove sensors when comparing both tasks. RULA method showed that all subjects, with the exception of the experts using an axial-handled instrument, assume a prejudicial wrist posture during the practice of suturing and dissection tasks on the simulator. Data glove CyberGlove® allows for the distinction between two laparoscopic exercises performed with different instruments. Also, laparoscopic intracorporeal suturing when performed with an axial-handled needle holder entails a more ergonomic posture for the wrist joint. Previous minimally invasive surgical experience is a positive influencing factor on the surgeons' wrist postures during laparoscopy.

  6. A passive wrist with switchable stiffness for a body-powered hydraulically actuated hand prosthesis.

    Science.gov (United States)

    Montagnani, Federico; Smit, Gerwin; Controzzi, Marco; Cipriani, Christian; Plettenburg, Dick H

    2017-07-01

    State of art upper limb prostheses lack several degrees of freedom (DoF) and force the individuals to compensate for them by changing the motions of their arms and body. Such movements often yield to articulation injuries, nonetheless these could be prevented by adding DoFs, for instance, an articulated passive wrist. Available stiff or compliant wrists with passive flexion/extension and/or radial/ulnar deviation are sub-optimal solutions. Indeed, stiff wrists induce the individuals wearing them to perform exaggerated compensatory movements during the reaching phase while compliant wrists proved to be unpractical while manipulating heavy objects. Here we present a wrist capable of combining the benefits of stiff and compliant wrists. It is provided with two switchable levels of passive compliance that are automatically selected. The prototype was integrated in a body-powered hydraulic hand prosthesis and actuated using the same hydraulic circuit of the hand. Detailed analysis of the parameters that affect the compliance, the critical load and the performance of the prosthesis are presented.

  7. Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis.

    Science.gov (United States)

    van Dijk, R; van Assen, M; Vliegenthart, R; de Bock, G H; van der Harst, P; Oudkerk, M

    2017-11-27

    Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory

  8. The effect of self-explanation of pathophysiological mechanisms of diseases on medical students' diagnostic performance.

    Science.gov (United States)

    Peixoto, José Maria; Mamede, Sílvia; de Faria, Rosa Malena Delbone; Moura, Alexandre Sampaio; Santos, Silvana Maria Elói; Schmidt, Henk G

    2017-12-01

    Self-explanation while diagnosing clinical cases fosters medical students' diagnostic performance. In previous studies on self-explanation, students were free to self-explain any aspect of the case, and mostly clinical knowledge was used. Elaboration on knowledge of pathophysiological mechanisms of diseases has been largely unexplored in studies of strategies for teaching clinical reasoning. The purpose of this two-phase experiment was to investigate the effect of self-explanation of pathophysiology during practice with clinical cases on students' diagnostic performance. In the training phase, 39 4th-year medical students were randomly assigned to solve 6 criterion cases (3 of jaundice; 3 of chest pain), either self-explaining the pathophysiological mechanisms of the findings (n = 20) or without self-explaining (n = 19). One-week later, in the assessment phase, all students solved 6 new cases of the same syndromes. A repeated-measures analysis of variance on the mean diagnostic accuracy scores showed no significant main effects of study phase (p = 0.34) and experimental condition (p = 0.10) and no interaction effect (p = 0.42). A post hoc analysis found a significant interaction (p = 0.022) between study phase and syndrome type. Despite equal familiarity with jaundice and chest pain, the performance of the self-explanation group (but not of the non-self-explanation group) on jaundice cases significantly improved between training and assessment phases (p = 0.035) whereas no differences between phases emerged on chest pain cases. Self-explanation of pathophysiology did not improve students' diagnostic performance for all diseases. Apparently, the positive effect of this form of self-explanation on performance depends on the studied diseases sharing similar pathophysiological mechanisms, such as in the jaundice cases.

  9. Analysis of Hand and Wrist Postural Synergies in Tolerance Grasping of Various Objects

    Science.gov (United States)

    Liu, Yuan; Jiang, Li; Yang, Dapeng; Liu, Hong

    2016-01-01

    Human can successfully grasp various objects in different acceptable relative positions between human hand and objects. This grasp functionality can be described as the grasp tolerance of human hand, which is a significant functionality of human grasp. To understand the motor control of human hand completely, an analysis of hand and wrist postural synergies in tolerance grasping of various objects is needed. Ten healthy right-handed subjects were asked to perform the tolerance grasping with right hand using 6 objects of different shapes, sizes and relative positions between human hand and objects. Subjects were wearing CyberGlove attaching motion tracker on right hand, allowing a measurement of the hand and wrist postures. Correlation analysis of joints and inter-joint/inter-finger modules were carried on to explore the coordination between joints or modules. As the correlation between hand and wrist module is not obvious in tolerance grasping, individual analysis of wrist synergies would be more practical. In this case, postural synergies of hand and wrist were then presented separately through principal component analysis (PCA), expressed through the principal component (PC) information transmitted ratio, PC elements distribution and reconstructed angle error of joints. Results on correlation comparison of different module movements can be well explained by the influence factors of the joint movement correlation. Moreover, correlation analysis of joints and modules showed the wrist module had the lowest correlation among all inter-finger and inter-joint modules. Hand and wrist postures were both sufficient to be described by a few principal components. In terms of the PC elements distribution of hand postures, compared with previous investigations, there was a greater proportion of movement in the thumb joints especially the interphalangeal (IP) and opposition rotation (ROT) joint. The research could serve to a complete understanding of hand grasp, and the design

  10. Radiologic examination and measurement of the wrist and distal radio-ulnar joint. New aspects

    Energy Technology Data Exchange (ETDEWEB)

    Toernvall, A.H.; Ekenstam, F. af; Hagert, C.G.; Irstam, L.

    Following fractures of the distal radius, a relatively high incidence of complications is caused by malalignment in the distal radio-ulnar (DRU) joint; recent anatomic and clinical investigations have shown a congruity of that joint to be of significant importance for restoring the function of the wrist. The radius forms a moderately arched bone, which moves around the ulna in pronation and supination. Biomechanically, the ulna may be regarded as the pillar around which the radius moves. In an anatomic investigation of 5 arm specimens, we have shown that the maximum cartilage contact in the DRU joint between the ulna head and the distal radius occurs in the neutral rotation position. A proposed routine examination method of the wrist and forearm includes a true antero-posterior and a lateral projection of the radius and the ulna, performed with the forearm and wrist in a neutral rotation, a neutral wrist deviation and with the elbow angled 90 degrees. Such an examination implies a standardized and reproducible method. In a radioanatomic investigation, a series of 50 healthy wrists and forearms were examined. A simple measuring technique is presented, applicable to the DRU joint and wrist favouring the ulna as the bone through which a reproducible long axis of the forearm/wrist may be drawn. It is suggested that the length of the radius should be judged relative to the ulna. Ulnar head inclination and radio-ulnar angle are new concepts, being major characteristics of the DRU joint. These angles of the right and left wrist were equal and no difference was found between the sexes. Minor alterations of the distal radius may be revealed when estimating these angles.

  11. Collective Thomson scattering energetic particle diagnostic in high performance tokamaks. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, P.Y.; Aamodt, R.E.; Russell, D.A.

    1997-07-08

    This report summarizes the work performed under DOE grant DE-FG03-95ER54334. Lodestar was an active participant in the low power Collective Thomson Scattering (CTS) diagnostic experiment at TFTR in collaboration with MIT. A simple and effective fitting technique was developed to extract key parameters from the scattered data. Utilizing this new technique, the concept of lower hybrid resonance scattering was adapted for a feasibility study of a low/medium power collective scattering diagnostic for ITER. The implementation and the testing of such a technique for actual parameter extraction using TFTR data, however, was severely limited due to experimental and instrumentation complications. Based on the studies the authors have performed up to date, it is believed that a combination of non-physics related effects such as multiple wall reflection of incident signal and spectral impurity problem o the gyrotron can account for the anomalous signal strength. A collaborative effort with GA was initiated and a feasibility study of developing and implementing a collective thomson scattering (CTS) diagnostic for the detection of energetic particles at DIII-D was completed. Specifically, the process of selecting an optimum receiver location for the diagnostic is discussed in detailed. Results presented here include detailed signal to noise calculations and ray-tracing studies. Critical physics issues and selection criteria are discussed and a procedure to detect anisotropic energetic ion temperatures is also outlined. Favorable results, obtained in the feasibility study, indicate that it should be possible to develop and implement a CTS diagnostic at DIII-D.

  12. Principal components of wrist circumduction from electromagnetic surgical tracking.

    Science.gov (United States)

    Rasquinha, Brian J; Rainbow, Michael J; Zec, Michelle L; Pichora, David R; Ellis, Randy E

    2017-02-01

    An electromagnetic (EM) surgical tracking system was used for a functionally calibrated kinematic analysis of wrist motion. Circumduction motions were tested for differences in subject gender and for differences in the sense of the circumduction as clockwise or counter-clockwise motion. Twenty subjects were instrumented for EM tracking. Flexion-extension motion was used to identify the functional axis. Subjects performed unconstrained wrist circumduction in a clockwise and counter-clockwise sense. Data were decomposed into orthogonal flexion-extension motions and radial-ulnar deviation motions. PCA was used to concisely represent motions. Nonparametric Wilcoxon tests were used to distinguish the groups. Flexion-extension motions were projected onto a direction axis with a root-mean-square error of [Formula: see text]. Using the first three principal components, there was no statistically significant difference in gender (all [Formula: see text]). For motion sense, radial-ulnar deviation distinguished the sense of circumduction in the first principal component ([Formula: see text]) and in the third principal component ([Formula: see text]); flexion-extension distinguished the sense in the second principal component ([Formula: see text]). The clockwise sense of circumduction could be distinguished by a multifactorial combination of components; there were no gender differences in this small population. These data constitute a baseline for normal wrist circumduction. The multifactorial PCA findings suggest that a higher-dimensional method, such as manifold analysis, may be a more concise way of representing circumduction in human joints.

  13. Wrist and finger joint MR imaging in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Gideon, P

    1999-01-01

    AND METHODS: MR imaging and conventional radiography of wrist and metacarpophalangeal (MCP) joints were performed in 41 RA patients and 3 healthy controls. The following pulse sequences were applied: T1-weighted spin-echo (T1-SE) with and without contrast enhancement, T2-SE, T2-turbo-SE, T1-2D-FLASH, T1-3D......-FLASH, fat-saturated-T1-SE, STIR and 3D-DESS. RESULTS: Bone erosions were found by MR compared to radiography in 261 versus 85 bones of the wrist (ratio 3.1) and 59 versus 21 MCP joint quadrants (ratio 2.81). MR and radiography interobserver agreements were both approximately 90%. Likewise, MR scored...... synovial membrane hypertrophy in wrist and MCP joints with a high interobserver agreement. The most informative MR sequence appeared to be contrast-enhanced T1-SE MR, preferably with fat saturation. A STIR sequence or T2-weighted fat saturation sequence was useful in screening for joint disease. CONCLUSION...

  14. 9 CFR 130.17 - User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for other veterinary... FEES USER FEES § 130.17 User fees for other veterinary diagnostic laboratory tests performed at NVSL (excluding FADDL) or at authorized sites. (a) User fees for veterinary diagnostics tests performed at the...

  15. 9 CFR 130.16 - User fees for veterinary diagnostic serology tests performed at NVSL (excluding FADDL) or at...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for veterinary diagnostic serology tests performed at NVSL (excluding FADDL) or at authorized sites. 130.16 Section 130.16 Animals... USER FEES § 130.16 User fees for veterinary diagnostic serology tests performed at NVSL (excluding...

  16. Sonography of Non-neoplastic Disorders of the Hand and Wrist Tendons.

    Science.gov (United States)

    Gitto, Salvatore; Draghi, Anna Guja; Draghi, Ferdinando

    2017-07-14

    Tendon disorders commonly cause hand and wrist disability and curtail the performance of work-related duties or routine tasks. Imaging is often needed for diagnosis, but it requires knowledge of the complex anatomic structures of the tendons of the hand and wrist as well as familiarity with related disorders. This review article aims to provide medical professionals with guidelines for the sonographic assessment of the tendons of hand and wrist and related disorders. Sonographic features of tendon disorders affecting the hand and wrist are described here, specifically: infectious tenosynovitis; tendon rupture or tearing; stenosing forms of tenosynovitis such as De Quervain disease and trigger finger; intersection syndrome; insertional tendinopathy; several forms of tendinous instability such as extensor carpi ulnaris instability, climber finger, and boxer knuckle; and tendinopathy in inflammatory rheumatic diseases. Postsurgical evaluation of the hand and wrist tendons is also discussed, including the healthy and pathologic appearances of operated tendons as well as impingement from orthopedic hardware. In conclusion, sonography is effective in assessing the tendons of the hand and wrist and related disorders and represents a valuable tool for diagnosis. © 2017 by the American Institute of Ultrasound in Medicine.

  17. Prophylactic Effects of Sauna on Delayed-Onset Muscle Soreness of the Wrist Extensors.

    Science.gov (United States)

    Khamwong, Peanchai; Paungmali, Aatit; Pirunsan, Ubon; Joseph, Leonard

    2015-06-01

    High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group. A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P wrist extensor muscle group.

  18. The Potential of Collective Intelligence in Emergency Medicine: Pooling Medical Students' Independent Decisions Improves Diagnostic Performance.

    Science.gov (United States)

    Kämmer, Juliane E; Hautz, Wolf E; Herzog, Stefan M; Kunina-Habenicht, Olga; Kurvers, Ralf H J M

    2017-08-01

    Evidence suggests that pooling multiple independent diagnoses can improve diagnostic accuracy in well-defined tasks. We investigated whether this is also the case for diagnostics in emergency medicine, an ill-defined task environment where diagnostic errors are rife. A computer simulation study was conducted based on empirical data from 2 published experimental studies. In the computer experiments, 285 medical students independently diagnosed 6 simulated patients arriving at the emergency room with dyspnea. Participants' diagnoses (n = 1,710), confidence ratings, and expertise levels were entered into a computer simulation. Virtual groups of different sizes were randomly created, and 3 collective intelligence rules (follow-the-plurality rule, follow-the-most-confident rule, and follow-the-most-senior rule) were applied to combine the independent decisions into a final diagnosis. For different group sizes, the performance levels (i.e., percentage of correct diagnoses) of the 3 collective intelligence rules were compared with each other and against the average individual accuracy. For all collective intelligence rules, combining independent decisions substantially increased performance relative to average individual performance. For groups of 4 or fewer, the follow-the-most-confident rule outperformed the other rules; for larger groups, the follow-the-plurality rule performed best. For example, combining 5 independent decisions using the follow-the-plurality rule increased diagnostic accuracy by 22 percentage points. These results were robust across case difficulty and expertise level. Limitations of the study include the use of simulated patients diagnosed by medical students. Whether results generalize to clinical practice is currently unknown. Combining independent decisions may substantially improve the quality of diagnoses in emergency medicine and may thus enhance patient safety.

  19. Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study

    OpenAIRE

    Wu Yuh-Ming; Tsai Yuh-Show; Chien Kuo-Liong; Chen Chin-Yu; Chang King-Jen; Wang Jane; Teng Yu-Chuan; Shih Tiffany

    2010-01-01

    Abstract Background The study was conducted to investigate the diagnostic performance of infrared (IR) imaging of the breast using an interpretive model derived from a scoring system. Methods The study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8) with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring...

  20. Association between Students Performance In Diagnostic And Readiness Tests in Secondary School Biology

    OpenAIRE

    Casmir N. Ebuoh,

    2015-01-01

    The purpose of the study was to find out the association between the students performance in readiness and diagnostic test scores in secondary school Biology. The design of the study was correlation and the population was all the 2256 students’ secondary school II students in biology in the 2014/2015 academic session. Simple random sampling (battling without replacement) was used to sample 420 students from 14 secondary schools in Udi Local Government area of Enugu State. The instruments for ...

  1. Simulated performance of the optical Thomson scattering diagnostic designed for the National Ignition Facility

    Energy Technology Data Exchange (ETDEWEB)

    Ross, J. S., E-mail: ross36@llnl.gov; Datte, P.; Divol, L.; Galbraith, J.; Hatch, B.; Landen, O.; Manuel, A. M.; Molander, W.; Moody, J. D.; Swadling, G. [Lawrence Livermore National Laboratory, Livermore, California 94551 (United States); Froula, D. H.; Katz, J. [Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623 (United States); Glenzer, S. H. [SLAC National Accelerator Laboratory, Menlo Park, California 94025 (United States); Kilkenny, J. [General Atomics, San Diego, California 92186 (United States); Montgomery, D. S. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States); Weaver, J. [Plasma Physics Division, Naval Research Laboratory, Washington, DC 20375 (United States)

    2016-11-15

    An optical Thomson scattering diagnostic has been designed for the National Ignition Facility to characterize under-dense plasmas. We report on the design of the system and the expected performance for different target configurations. The diagnostic is designed to spatially and temporally resolve the Thomson scattered light from laser driven targets. The diagnostic will collect scattered light from a 50 × 50 × 200 μm volume. The optical design allows operation with different probe laser wavelengths. A deep-UV probe beam (λ{sub 0} = 210 nm) will be used to Thomson scatter from electron plasma densities of ∼5 × 10{sup 20} cm{sup −3} while a 3ω probe will be used for plasma densities of ∼1 × 10{sup 19} cm{sup −3}. The diagnostic package contains two spectrometers: the first to resolve Thomson scattering from ion acoustic wave fluctuations and the second to resolve scattering from electron plasma wave fluctuations. Expected signal levels relative to background will be presented for typical target configurations (hohlraums and a planar foil).

  2. The Thomson scattering diagnostic at Wendelstein 7-X and its performance in the first operation phase

    Science.gov (United States)

    Bozhenkov, S. A.; Beurskens, M.; Dal Molin, A.; Fuchert, G.; Pasch, E.; Stoneking, M. R.; Hirsch, M.; Höfel, U.; Knauer, J.; Svensson, J.; Trimino Mora, H.; Wolf, R. C.

    2017-10-01

    The optimized stellarator Wendelstein 7-X started operation in December 2015 with a 10 week limiter campaign. Divertor experiments will begin in the second half of 2017. The W7-X Thomson scattering system is an essential diagnostic for electron density and temperature profiles. In this paper the Thomson scattering diagnostic is described in detail, including its design, calibration, data evaluation and first experimental results. Plans for further development are also presented. The W7-X Thomson system is a Nd:YAG setup with up to five lasers, two sets of light collection lenses viewing the entire plasma cross-section, fiber bundles and filter based polychromators. To reduce hardware costs, two or three scattering volumes are measured with a single polychromator. The relative spectral calibration is carried out with the aid of a broadband supercontinuum light source. The absolute calibration is performed by observing Raman scattering in nitrogen. The electron temperatures and densities are recovered by Bayesian modelling. In the first campaign, the diagnostic was equipped for 10 scattering volumes. It provided temperature profiles comparable to those measured using an electron cyclotron emission diagnostic and line integrated densities within 10% of those from a dispersion interferometer.

  3. Activity Recognition in Youth Using Single Accelerometer Placed at Wrist or Ankle.

    Science.gov (United States)

    Mannini, Andrea; Rosenberger, Mary; Haskell, William L; Sabatini, Angelo M; Intille, Stephen S

    2017-04-01

    State-of-the-art methods for recognizing human activity using raw data from body-worn accelerometers have primarily been validated with data collected from adults. This study applies a previously available method for activity classification using wrist or ankle accelerometer to data sets collected from both adults and youth. An algorithm for detecting activity from wrist-worn accelerometers, originally developed using data from 33 adults, is tested on a data set of 20 youth (age, 13 ± 1.3 yr). The algorithm is also extended by adding new features required to improve performance on the youth data set. Subsequent tests on both the adult and youth data were performed using crossed tests (training on one group and testing on the other) and leave-one-subject-out cross-validation. The new feature set improved overall recognition using wrist data by 2.3% for adults and 5.1% for youth. Leave-one-subject-out cross-validation accuracy performance was 87.0% (wrist) and 94.8% (ankle) for adults, and 91.0% (wrist) and 92.4% (ankle) for youth. Merging the two data sets, overall accuracy was 88.5% (wrist) and 91.6% (ankle). Previously available methodological approaches for activity classification in adults can be extended to youth data. Including youth data in the training phase and using features designed to capture information on the activity fragmentation of young participants allows a better fit of the methodological framework to the characteristics of activity in youth, improving its overall performance. The proposed algorithm differentiates ambulation from sedentary activities that involve gesturing in wrist data, such as that being collected in large surveillance studies.

  4. Assessment of the Kinetic Trajectory of the Median Nerve in the Wrist by High-Frequency Ultrasound

    Directory of Open Access Journals (Sweden)

    Yi-Hsun Lin

    2014-04-01

    Full Text Available Carpal tunnel syndrome (CTS is typically diagnosed by physical examination or nerve conduction measurements. With these diagnostics however it is difficult to obtain anatomical information in the carpal tunnel. To further improve the diagnosis of CTS, an attempt using 30 MHz high-frequency ultrasound to noninvasively detect the local anatomical structures and the kinetic trajectory of the median nerve (MN in the wrist was explored. Measurements were performed on the right wrist of 14 asymptomatic volunteers. The kinetic trajectory of the MN corresponding to flexion (from 0° to 90° and extension (from 90° to 0° movements of the fingers were detected by a cross correlation-based motion tracking technique. The average displacements of the MN according to finger movements were measured to be 3.74 and 2.04 mm for male and female subjects, respectively. Moreover, the kinetic trajectory of the MN in both the ulnar-palmar and total directions generally follows a sigmoidal curve tendency. This study has verified that the use of high-frequency ultrasound imaging and a motion tracking technique to sensitively detect the displacement and kinetic trajectory of the MN for the assessment of CTS patients is feasible.

  5. Diagnostic performance of on-site CT-derived fractional flow reserve versus CT perfusion.

    Science.gov (United States)

    Yang, Dong Hyun; Kim, Young-Hak; Roh, Jae Hyung; Kang, Joon-Won; Ahn, Jung-Min; Kweon, Jihoon; Lee, Jung Bok; Choi, Seong Hoon; Shin, Eun-Seok; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung-Jung; Lim, Tae-Hwan

    2017-04-01

    To compare the diagnostic accuracy of on-site computed tomography (CT)-derived fractional flow reserve (FFR) and stress CT myocardial perfusion (CTP) in patients with coronary artery disease. Using a prospective CTP registry, 72 patients with invasive FFR were enrolled. CT-derived FFR was computed on-site using rest-phase CTP data. The diagnostic accuracies of coronary CT angiography (CCTA), CT-derived FFR, and stress CTP were evaluated using an area under the receiver-operating characteristic curve (AUC) with invasive FFR as a reference standard. Logistic regression and the net reclassification index (NRI) were used to evaluate incremental differences in CT-derived FFR or CTP compared with CCTA alone. The per-vessel prevalence of haemodynamically significant stenosis (FFR ≤ 0.80) was 39% (54/138). Per-vessel sensitivity and specificity were 94 and 66% for CCTA, 87 and 77% for CT-derived FFR, and 79 and 91% for CTP, respectively. There was no significant difference in the AUC values of CT-derived FFR and CTP (P = 0.845). The diagnostic performance of CCTA (AUC = 0.856) was improved by combining it with CT-derived FFR (AUC = 0.919, P = 0.004, NRI = 1.01) or CTP (AUC = 0.913, P = 0.004, NRI = 0.66). CT-derived FFR values had a moderate correlation with invasive FFR (r = 0.671, P derived FFR combined with CCTA provides an incremental diagnostic improvement over CCTA alone in identifying haemodynamically significant stenosis defined by invasive FFR, with a diagnostic accuracy comparable with CTP.

  6. Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum.

    Science.gov (United States)

    Pérez Montilla, M E; Lombardo Galera, S; Espejo Herrero, J J; Sastoque, J M; Zurera Tendero, L

    2018-01-21

    To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum. We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign / malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement). All (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death). Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. The impact of companion diagnostic device measurement performance on clinical validation of personalized medicine.

    Science.gov (United States)

    Li, Meijuan; Yu, Tinghui; Hu, Yun-Fu

    2015-06-30

    A key component of personalized medicine is companion diagnostics that measure biomarkers, for example, protein expression, gene amplification or specific mutations. Most of the recent attention concerning molecular cancer diagnostics has been focused on the biomarkers of response to therapy, such as V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations in metastatic colorectal cancer, epidermal growth factor receptor mutations in metastatic malignant melanoma. The presence or absence of these markers is directly linked to the response rates of particular targeted therapies with small-molecule kinase inhibitors or antibodies. Therefore, testing for these markers has become a critical step in the target therapy of the aforementioned tumors. The core capability of personalized medicine is the companion diagnostic devices' (CDx) ability to accurately and precisely stratify patients by their likelihood of benefit (or harm) from a particular therapy. There is no reference in the literature discussing the impact of device's measurement performance, for example, analytical accuracy and precision on treatment effects, variances, and sample sizes of clinical trial for the personalized medicine. In this paper, using both analytical and estimation method, we assessed the impact of CDx measurement performance as a function of positive and negative predictive values and imprecision (standard deviation) on treatment effects, variances of clinical outcome, and sample sizes for the clinical trials. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome.

    Science.gov (United States)

    Golriz, Batol; Ahmadi Bani, Monireh; Arazpour, Mokhtar; Bahramizadeh, Mahmood; Curran, Sarah; Madani, Seyed Pezhman; Hutchins, Stephen W

    2016-10-01

    Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Quasi experimental design. A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks. The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel

  9. De quervain tenosynovitis of the wrist.

    Science.gov (United States)

    Ilyas, Asif M; Ilyas, Asif; Ast, Michael; Schaffer, Alyssa A; Thoder, Joseph

    2007-12-01

    De quervain disease, or stenosing tenosynovitis of the first dorsal compartment of the wrist, is a common wrist pathology. Pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendons in the fibro-osseus canal. de Quervain tenosynovitis of the wrist is more common in women than men. Diagnosis may be made on physical examination. Radiographs are helpful in ruling out offending bony pathology. Nonsurgical management, consisting of corticosteroid injections and supportive thumb spica splinting, is usually successful. In resistant cases, surgical release of the first dorsal compartment is done, taking care to protect the radial sensory nerve and identify all accessory compartments. Repair of the extensor retinaculum by step-cut lengthening or other techniques is rarely required.

  10. Wrist-arthrography for the determination of the prosthetic bed

    Energy Technology Data Exchange (ETDEWEB)

    Wuttge, R.; Kueffer, G.; Hahn, D.; Bauer, J.; Wilhelm, K.

    1988-03-01

    Arthrography was performed during the last 12 months in 14 patients who had 2 months to 10 years after implantation of a silicone-elastomere- or fascia-lata-prosthesis recurrent complaints in their operated wrists. Following an extensive radiological native examination either midcarpal or radiocarpal arthrography was performed in dependence of the site of carpal-bone-substitute. Inflammatory changes of the prosthetic bed, missing penetration of contrast medium into the periprosthetic space and other less common additional findings showed the advantages of the relatively handsome procedure.

  11. Evening physical activity alters wrist temperature circadian rhythmicity

    OpenAIRE

    Rubio-Sastre, Patricia; Gómez-Abellán, Purificación; Martinez-Nicolas, Antonio; Ordovás, José María; Madrid, Juan Antonio; Garaulet, Marta

    2013-01-01

    The adequate time to perform physical activity (PA) to maintain optimal circadian system health has not been defined. We studied the influence of morning and evening PA on circadian rhythmicity in 16 women with wrist temperature (WT). Participants performed controlled PA (45 min continuous-running) during 7 days in the morning (MPA) and evening (EPA) and results were compared with a no-exercise-week (C). EPA was characterized by a lower amplitude (evening: 0.028 ± 0.01 °C versus control: 0.03...

  12. 3D motion analysis of the wrist splint effect to wrist joint movement.

    Science.gov (United States)

    Shin, Joong-Il; Park, Soo-Hee

    2017-06-01

    [Purpose] This study aimed to investigate the degree of straightness of the wrist joint, depending on the use of a wrist splint while opening a bottle cap. Its results may provide data for later studies on preventing accidents at workplaces and improving efficiency. [Subjects and Methods] Thirty Male and Female in their twenties who did not have hand-related diseases, fractures, or history that included neurological impairments associated with the hand were selected as subjects of the study. Wrist splints were made to fit the hand and lower arm of each subject. Evaluation assignments were carried out without and with the splints after 10 minutes of rest. To analyze the wrist movement in opening the bottle cap, a three-dimensional movement analyzing system by Zebris was used. [Results] Wrist angle decreased while opening caps of four different diameters while wearing splints, but not when splints were not worn. This means that wearing a splint may aid weakened wrist muscles. [Conclusion] Future studies should be conducted among subjects with damaged wrist muscles and evaluate the subjects in actual workplaces to obtain more objective and more valid data.

  13. Favorable results after total wrist arthroplasty

    Science.gov (United States)

    Boeckstyns, Michel E H; Herzberg, Guillaume; Merser, Søren

    2013-01-01

    Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007. The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier generations of total wrist arthroplasty. PMID:23848216

  14. Safety and diagnostic performance of image-guided lung biopsy in the targeted therapy era.

    Science.gov (United States)

    Busso, Marco; Sardo, Diego; Garetto, Irene; Righi, Luisella; Libero, Giulia; Vavalà, Tiziana; Ardissone, Francesco; Novello, Silvia; Papotti, Mauro; Veltri, Andrea

    2015-11-01

    To identify risk factors for the adverse events and determine the diagnostic yield of a large series of image-guided thoracic biopsies performed in a single institution. We reviewed a consecutive series of 811 patients (546 males; average age: 68 years.) who underwent 824 image-guided biopsies of pulmonary lesions performed between 2009 and 2013. Indications for biopsy were always evaluated by a multidisciplinary board. All complications were registered. The diagnostic accuracy was calculated on the basis of histology after surgery, response to medical therapy, or outcome at imaging follow-up. Safety and accuracy was correlated with patient-related and lesion-related factors. 61 biopsies were performed under US-guidance, 750 under CT-guidance, and 13 under combined guidance. The average lesion size was 36.4 mm (6-150 mm). FNAB was exclusively performed in 247 patients, whereas 577 patients underwent also or only core biopsy (CB). 40 (4.8 %) major complications and 172 (20.8 %) minor complications occurred. US-guidance, absence of perilesional emphysema and minor depth of the target lesion from the skin resulted as favorable predictors against major complications. According to the gold standard criteria, we demonstrated 497 true positives, 72 true negatives, 18 false negatives, 0 false positives. Sensitivity, specificity and diagnostic accuracy were 96.5, 100 and 97 %. No predictors for accuracy were found, but the number of samples largely related to the pathologist on site. Image-guided lung biopsy is safe and highly accurate for diagnosing thoracic lesions. In the targeted therapy era, CB with larger needles can be safely applied when the need for larger amounts of tumor tissue is presumed.

  15. Diagnostic performance of a new red light LED device for approximal caries detection.

    Science.gov (United States)

    Neuhaus, Klaus W; Ciucchi, Philip; Rodrigues, Jonas Almeida; Hug, Isabelle; Emerich, Marta; Lussi, Adrian

    2015-07-01

    The aim of this study was to test a newly developed LED-based fluorescence device for approximal caries detection in vitro. We assembled 120 extracted molars without frank cavitations or fillings pairwise in order to create contact areas. The teeth were independently assessed by two examiners using visual caries detection (International Caries Detection and Assessment System, ICDAS), bitewing radiography (BW), laser fluorescence (LFpen), and LED fluorescence (Midwest Caries I.D., MW). The measurements were repeated at least 1 week later. The diagnostic performance was calculated with Bayesian analyses. Post-test probabilities were calculated in order to judge the diagnostic performance of combined methods. Reliability analyses were performed using kappa statistics for nominal data and intraclass correlation (ICC) for absolute data. Histology served as the gold standard. Sensitivities/specificities at the enamel threshold were 0.33/0.84 for ICDAS, 0.23/0.86 for BW, 0.47/0.78 for LFpen, and 0.32/0.87 for MW. Sensitivities/specificities at the dentine threshold were 0.04/0.89 for ICDAS, 0.27/0.94 for BW, 0.39/0.84 for LFpen, and 0.07/0.96 for MW. Reliability data were fair to moderate for MW and good for BW and LFpen. The combination of ICDAS and radiography yielded the best diagnostic performance (post-test probability of 0.73 at the dentine threshold). The newly developed LED device is not able to be recommended for approximal caries detection. There might be too much signal loss during signal transduction from the occlusal aspect to the proximal lesion site and the reverse.

  16. The influence of medical students' self-explanations on diagnostic performance.

    Science.gov (United States)

    Chamberland, Martine; St-Onge, Christina; Setrakian, Jean; Lanthier, Luc; Bergeron, Linda; Bourget, Annick; Mamede, Silvia; Schmidt, Henk; Rikers, Remy

    2011-07-01

    Skill in clinical reasoning is a highly valued attribute of doctors, but instructional approaches to foster medical students' clinical reasoning skills remain scarce. Self-explanation is an instructional procedure, the positive effects of which on learning have been demonstrated in a variety of domains, but which remain largely unexplored in medical education. The purpose of this study was to investigate the effects of self-explanation on students' learning of clinical reasoning during clerkships and to examine whether these effects are affected by topic familiarity. An experimental study with a training phase and an assessment phase was conducted with 36 Year 3 medical students, randomly assigned to one of two groups. In the training phase, students solved 12 clinical cases (four cases on a less familiar topic; four on a more familiar topic; four on filler topics), either generating self-explanations (n = 18) or not (n = 18). The self-explanations were generated after minimal instructions and no feedback was provided to students. One week later, in the assessment phase, students were requested to diagnose 12 different, more difficult cases, similarly distributed among the same more familiar topic, less familiar topic and filler topics, and their diagnostic performance was assessed. In the training phase the performance of the two groups did not differ. However, in the assessment phase 1 week later, a significant interaction was found between self-explanation and case topic familiarity (F(1,34) = 6.18, p explanation condition, compared with those in the control condition, demonstrated better diagnostic performance on subsequent clinical cases, but this effect emerged only for cases concerning the less familiar topic. The present study shows the beneficial influence of generating self-explanations when dealing with less familiar clinical contexts. Generating self-explanations without feedback resulted in better diagnostic performance than in the control

  17. Grip-force modulation in multi-finger prehension during wrist flexion and extension

    Science.gov (United States)

    Ambike, Satyajit S.; Paclet, Florent; Latash, Mark L.; Zatsiorsky, Vladimir M.

    2013-01-01

    Extrinsic digit muscles contribute to both fingertip forces and wrist movements (FDP and FPL – flexion, EDC - extension). Hence it is expected that finger forces depend on the wrist movement and position. We investigated the relation between grip force and wrist kinematics to examine whether and how the force: (1) scales with wrist flexion-extension (FE) angle; (2) can be predicted from accelerations induced during FE movement. In one experiment subjects naturally held an instrumented handle using a prismatic grasp and performed very slow FE movements. In another experiment, the same movement was performed cyclically at three prescribed frequencies. In quasistatic conditions, the grip force remained constant over the majority of the wrist range of motion. During the cyclic movements, the grip force changed. The changes were described with a linear regression model that represents the thumb and virtual finger (VF = four fingers combined) normal forces as the sum of the effects of the object’s tangential and radial accelerations and an object-weight-dependent constant term. The model explained 99% of the variability in the data. The independence of the grip force from wrist position agrees with the theory that that the thumb and VF forces are controlled with two neural variables that encode referent coordinates for each digit while accounting for changes in the position dependence of muscle forces, rather than a single neural variable like referent aperture. The results of the cyclical movement study extend the principle of superposition (some complex actions can be decomposed into independently controlled elemental actions) for a motor task involving simultaneous grip force exertion and wrist motion with significant length changes of the grip-force producing muscles. PMID:23625077

  18. Analytical performance of three diagnostic reagents for HBsAg on an automatic ELISA analyzer.

    Science.gov (United States)

    Hou, Jiayi; Ren, Jianping; Song, Ling; Zhao, Fen; Liang, Peijun

    2018-01-01

    We conducted performance tests of three HBsAg ELISA diagnostic reagents using an Addcare 600 (Yantai Addcare Bio-tech Limited Company) and studied the consistency between the qualitative results and chemiluminescent microparticle immunoassay (CMIA) results. Diagnostic kits (ELISA) for HBsAg manufactured by INTEC ("A"), KHB ("B") and Wantai ("C") were tested on an Addcare 600 to evaluate their intermediate precision, repeatability, and C50. Furthermore, three ELISA detection systems and a quantitative test kit for HBsAg (Abbott) were employed to screen 1000 serum samples, while CMIA reactive samples were used to perform the confirmatory tests. The evaluation indexes of the ELISA reagent performances were calculated. The intermediate precision and repeatability of each system were performance. Although the results consistency among the three systems and CMIA was good, our findings suggest that ELISA should be combined with a confirmatory test to exclude false-positive and false-negative results caused by low HBsAg levels. © 2017 Wiley Periodicals, Inc.

  19. Comparative diagnostic performance of multidetector computed tomography and MRI for characterization of pancreatic cystic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Min; Shin, Sang Soo; Park, Jin Gyoon [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Jeong, Yong Yeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2015-06-15

    To compare the diagnostic performance of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in characterization of pancreatic cystic lesions. We conducted a retrospective study on 34 patients with histopathologically proven cystic pancreatic lesions who underwent both preoperative MDCT and MRI. CT and MRI were independently evaluated for differentiating mucinous vs. non-mucinous lesions, differentiating aggressive vs. non-aggressive lesion, analyzing morphological features, and evaluating specific leading diagnoses. Sensitivity, specificity, and accuracy were determined. Competency assessment of lesional morphology analysis was performed using the kappa values of the 2 tests. The sensitivity, specificity, and accuracy of MRI for differentiating mucinous vs. non-mucinous lesions were higher than CT (p = 0.03). For differentiating aggressiveness, the sensitivity of MRI was better than CT, but the specificity of CT was better than MRI. In evaluation of morphologic features, MRI showed better performance in characterization of septa and wall. Otherwise, the 2 modalities showed similarly good performance. MRI was better than CT in determining a specific diagnosis (58.8% vs. 47.2%, respectively). CT and MRI are reasonable diagnostic methods for characterization of pancreatic cystic lesions. However, MRI enables more confident assessment than CT in differentiating mucinous vs. non-mucinous lesions and characterization of the septa and wall.

  20. Smartphone photography utilized to measure wrist range of motion.

    Science.gov (United States)

    Wagner, Eric R; Conti Mica, Megan; Shin, Alexander Y

    2018-02-01

    The purpose was to determine if smartphone photography is a reliable tool in measuring wrist movement. Smartphones were used to take digital photos of both wrists in 32 normal participants (64 wrists) at extremes of wrist motion. The smartphone measurements were compared with clinical goniometry measurements. There was a very high correlation between the clinical goniometry and smartphone measurements, as the concordance coefficients were high for radial deviation, ulnar deviation, wrist extension and wrist flexion. The Pearson coefficients also demonstrated the high precision of the smartphone measurements. The Bland-Altman plots demonstrated 29-31 of 32 smartphone measurements were within the 95% confidence interval of the clinical measurements for all positions of the wrists. There was high reliability between the photography taken by the volunteer and researcher, as well as high inter-observer reliability. Smartphone digital photography is a reliable and accurate tool for measuring wrist range of motion. II.

  1. Colorectal Cancer Liver Metastases: Diagnostic Performance and Prognostic Value of PET/MR Imaging.

    Science.gov (United States)

    Lee, Dong Ho; Lee, Jeong Min; Hur, Bo Yun; Joo, Ijin; Yi, Nam-Joon; Suh, Kyung-Suk; Kang, Keon Wook; Han, Joon Koo

    2016-09-01

    Purpose To evaluate the diagnostic performance of combined positron emission tomography (PET) and magnetic resonace (MR) imaging (hereafter, PET/MR imaging) in the detection of liver metastases and to assess its prognostic value in patients with colorectal cancer liver metastases (CRLMs). Materials and Methods Institutional review board approval was obtained for this retrospective study, with waiver of informed consent. A total of 55 patients with 98 CRLMs who underwent PET/MR imaging and multidetector computed tomography (CT) between January 2013 and June 2014 comprised the study population. Of these patients, 34 underwent hepatic resection, 18 of whom also underwent neoadjuvant chemotherapy (NAC). Two board-certificated radiologists independently assessed the four image sets (ie, multidetector CT, whole-body PET, MR imaging with a liver-specific contrast agent [hereafter, EOB MR imaging], and PET/MR imaging). To compare the diagnostic performance of each imaging modality, jackknife alternative free-response receiver operating characteristic and generalized estimating equations were used. To assess prognostic value, recurrence-free survival of the 18 patients who underwent NAC followed by hepatic resection was analyzed by using the Kaplan-Meier method and log-rank test. Results The reader-averaged figure of merit of PET/MR imaging was significantly higher than that of either multidetector CT (P = .003) or PET (P = .020) in the detection of CRLMs. However, no significant difference was observed between figure of merit for PET/MR imaging and that for EOB MR imaging (P = .231). After NAC, six of the 18 patients had isometabolic CRLMs on PET images, and 12 patients had hypermetabolic CRLMs. The 1-year recurrence-free survival rate was 80% in patients with isometabolic CRLMs and 14% in patients with hypermetabolic CRLMs, showing a significant difference (P = .026). Conclusion PET/MR imaging can yield significantly higher diagnostic performance in the detection of CRLMs

  2. Ruling out pulmonary embolism in primary care : Comparison of the diagnostic performance of “gestalt” and the wells rule

    NARCIS (Netherlands)

    Hendriksen, Janneke M T; Lucassen, Wim A M; Erkens, Petra M G; Stoffers, Henri E J H; van Weert, Henk C P M; Büller, Harry R.; Hoes, Arno W.; Moons, Karel G M; Geersing, Geert Jan

    2016-01-01

    PURPOSE Diagnostic prediction models such as the Wells rule can be used for safely ruling out pulmonary embolism (PE) when it is suspected. A physician’s own probability estimate (“gestalt”), however, is commonly used instead. We evaluated the diagnostic performance of both approaches in primary

  3. 9 CFR 130.15 - User fees for veterinary diagnostic isolation and identification tests performed at NVSL...

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for veterinary diagnostic isolation and identification tests performed at NVSL (excluding FADDL) or other authorized site. 130.15... AGRICULTURE USER FEES USER FEES § 130.15 User fees for veterinary diagnostic isolation and identification...

  4. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Zubler, Christoph; Mengiardi, Bernard; Schmid, Marius R.; Hodler, Juerg; Pfirrmann, Christian W.A. [University Hospital Balgrist, Radiology, Zurich (Switzerland); Jost, Bernhard [University Hospital Balgrist, Orthopedic Surgery, Zurich (Switzerland)

    2007-06-15

    The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs. (orig.)

  5. Overview of diagnostic performance and results for the first operation phase in Wendelstein 7-X (invited)

    Science.gov (United States)

    Krychowiak, M.; Adnan, A.; Alonso, A.; Andreeva, T.; Baldzuhn, J.; Barbui, T.; Beurskens, M.; Biel, W.; Biedermann, C.; Blackwell, B. D.; Bosch, H. S.; Bozhenkov, S.; Brakel, R.; Bräuer, T.; Brotas de Carvalho, B.; Burhenn, R.; Buttenschön, B.; Cappa, A.; Cseh, G.; Czarnecka, A.; Dinklage, A.; Drews, P.; Dzikowicka, A.; Effenberg, F.; Endler, M.; Erckmann, V.; Estrada, T.; Ford, O.; Fornal, T.; Frerichs, H.; Fuchert, G.; Geiger, J.; Grulke, O.; Harris, J. H.; Hartfuß, H. J.; Hartmann, D.; Hathiramani, D.; Hirsch, M.; Höfel, U.; Jabłoński, S.; Jakubowski, M. W.; Kaczmarczyk, J.; Klinger, T.; Klose, S.; Knauer, J.; Kocsis, G.; König, R.; Kornejew, P.; Krämer-Flecken, A.; Krawczyk, N.; Kremeyer, T.; Książek, I.; Kubkowska, M.; Langenberg, A.; Laqua, H. P.; Laux, M.; Lazerson, S.; Liang, Y.; Liu, S. C.; Lorenz, A.; Marchuk, A. O.; Marsen, S.; Moncada, V.; Naujoks, D.; Neilson, H.; Neubauer, O.; Neuner, U.; Niemann, H.; Oosterbeek, J. W.; Otte, M.; Pablant, N.; Pasch, E.; Sunn Pedersen, T.; Pisano, F.; Rahbarnia, K.; Ryć, L.; Schmitz, O.; Schmuck, S.; Schneider, W.; Schröder, T.; Schuhmacher, H.; Schweer, B.; Standley, B.; Stange, T.; Stephey, L.; Svensson, J.; Szabolics, T.; Szepesi, T.; Thomsen, H.; Travere, J.-M.; Trimino Mora, H.; Tsuchiya, H.; Weir, G. M.; Wenzel, U.; Werner, A.; Wiegel, B.; Windisch, T.; Wolf, R.; Wurden, G. A.; Zhang, D.; Zimbal, A.; Zoletnik, S.

    2016-11-01

    Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered a MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. An overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.

  6. The passive stiffness of the wrist and forearm

    Science.gov (United States)

    Charles, Steven K.; Zollo, Loredana; Guglielmelli, Eugenio; Hogan, Neville; Krebs, Hermano I.

    2012-01-01

    Because wrist rotation dynamics are dominated by stiffness (Charles SK, Hogan N. J Biomech 44: 614–621, 2011), understanding how humans plan and execute coordinated wrist rotations requires knowledge of the stiffness characteristics of the wrist joint. In the past, the passive stiffness of the wrist joint has been measured in 1 degree of freedom (DOF). Although these 1-DOF measurements inform us of the dynamics the neuromuscular system must overcome to rotate the wrist in pure flexion-extension (FE) or pure radial-ulnar deviation (RUD), the wrist rarely rotates in pure FE or RUD. Instead, understanding natural wrist rotations requires knowledge of wrist stiffness in combinations of FE and RUD. The purpose of this report is to present measurements of passive wrist stiffness throughout the space spanned by FE and RUD. Using a rehabilitation robot designed for the wrist and forearm, we measured the passive stiffness of the wrist joint in 10 subjects in FE, RUD, and combinations. For comparison, we measured the passive stiffness of the forearm (in pronation-supination), as well. Our measurements in pure FE and RUD agreed well with previous 1-DOF measurements. We have linearized the 2-DOF stiffness measurements and present them in the form of stiffness ellipses and as stiffness matrices useful for modeling wrist rotation dynamics. We found that passive wrist stiffness was anisotropic, with greater stiffness in RUD than in FE. We also found that passive wrist stiffness did not align with the anatomical axes of the wrist; the major and minor axes of the stiffness ellipse were rotated with respect to the FE and RUD axes by ∼20°. The direction of least stiffness was between ulnar flexion and radial extension, a direction used in many natural movements (known as the “dart-thrower's motion”), suggesting that the nervous system may take advantage of the direction of least stiffness for common wrist rotations. PMID:22649208

  7. Research and development of compact wrist rehabilitation robot system.

    Science.gov (United States)

    Yamamoto, Ikuo; Inagawa, Naohiro; Matsui, Miki; Hachisuka, Kenji; Wada, Futoshi; Hachisuka, Akiko

    2014-01-01

    Compact rehabilitation robot system which can support movement of the wrist of patients has been developed. The robot system can detect and analyze the patient's intention to move the wrist by such a biological signal as muscle potential, then, assist the wrist exercise of patients. Also, both-wrist rehabilitation robot system by mirror effect has been successfully developed for practical use in the hospital and at home.

  8. Identifying wrist fracture patients with high accuracy by automatic categorization of X-ray reports.

    Science.gov (United States)

    de Bruijn, Berry; Cranney, Ann; O'Donnell, Siobhan; Martin, Joel D; Forster, Alan J

    2006-01-01

    The authors performed this study to determine the accuracy of several text classification methods to categorize wrist x-ray reports. We randomly sampled 751 textual wrist x-ray reports. Two expert reviewers rated the presence (n = 301) or absence (n = 450) of an acute fracture of wrist. We developed two information retrieval (IR) text classification methods and a machine learning method using a support vector machine (TC-1). In cross-validation on the derivation set (n = 493), TC-1 outperformed the two IR based methods and six benchmark classifiers, including Naive Bayes and a Neural Network. In the validation set (n = 258), TC-1 demonstrated consistent performance with 93.8% accuracy; 95.5% sensitivity; 92.9% specificity; and 87.5% positive predictive value. TC-1 was easy to implement and superior in performance to the other classification methods.

  9. Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis.

    Science.gov (United States)

    Arslan, Serdar; Karahan, Ali Yavuz; Oncu, Fatih; Bakdik, Suleyman; Durmaz, Mehmet Sedat; Tolu, Ismet

    2017-08-29

    The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001). The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging. © 2017 by the American Institute of Ultrasound in Medicine.

  10. Diagnostic Performance of Ultrasonography for Pediatric Appendicitis: A Night and Day Difference?

    Science.gov (United States)

    Mangona, Kate Louise M; Guillerman, R Paul; Mangona, Victor S; Carpenter, Jennifer; Zhang, Wei; Lopez, Monica; Orth, Robert C

    2017-12-01

    For imaging pediatric appendicitis, ultrasonography (US) is preferred because of its lack of ionizing radiation, but is limited by operator dependence. This study investigates the US diagnostic performance during night shifts covered by radiology trainees compared to day shifts covered by attending radiologists. Appy-Scores (1 = completely visualized normal appendix; 2 = partially visualized normal appendix; 3 = nonvisualized appendix with no inflammatory changes in the expected region of the appendix; 4 = equivocal; 5a = nonperforated appendicitis; 5b = perforated appendicitis) from 2935 US examinations (2161:774, day-to-night) from July 2013 to 2014 were correlated with the intraoperative diagnoses and the clinical follow-up. The diagnostic performance of trainees and attendings was compared with Fisher exact test. Interobserver agreement was measured by Cohen kappa coefficient. Appendicitis prevalence was 25.3% (day) and 22.5% (night). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive vale were 94.0%, 93.7%, 93.8%, 97.9%, and 83.4% during the day and 92.0%, 91.2%, 91.3%, 97.5%, and 75.2% at night. Specificity (P = .048) and positive predictive value (P = .011) differed, with more false positives at night (7%) than during the day (4.7%). Trainee and attending agreement was high (k = 0.995), with Appy-Scores of 1, 4, and 5a most frequently discordant. US has a high diagnostic performance and interobserver agreement for pediatric appendicitis when interpreted by radiology trainees during night shifts or attending radiologists during day shifts. However, lower specificity and positive predictive value at night warrants a thorough trainee education to avoid false-positive examinations. Published by Elsevier Inc.

  11. Risk factors for hand-wrist disorders in repetitive work

    DEFF Research Database (Denmark)

    Thomsen, J. F.; Mikkelsen, S.; Andersen, JH

    2007-01-01

    OBJECTIVES: To identify the risk of hand-wrist disorders related to repetitive movements, use of hand force and wrist position in repetitive monotonous work. METHODS: Using questionnaires and physical examinations, the prevalence and incidence of hand-wrist pain and possible extensor tendonitis (...

  12. 21 CFR 888.3780 - Wrist joint polymer constrained prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint polymer constrained prosthesis. 888... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3780 Wrist joint polymer constrained prosthesis. (a) Identification. A wrist joint polymer constrained prosthesis is a device made of...

  13. Diagnostic Performance of Des-γ-carboxy Prothrombin for Hepatocellular Carcinoma: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Rong Zhu

    2014-01-01

    Full Text Available Background. There have been many reports on des-γ-carboxy prothrombin (DCP as a promising serum marker in the diagnosis of hepatocellular carcinoma (HCC; however, the results are inconsistent and even conflicting. Methods. This meta-analysis was performed to investigate the performance of DCP in the diagnosis of HCC. Following a systematic review of relevant studies, Meta-DiSc 1.4 software was used to extract data and to calculate the overall sensitivity, specificity, positive likelihood ratio (PLR, negative likelihood ratio (NLR, and diagnostic odds ratio (DOR. Data are presented as forest plots and summary receiver operating characteristic curve (SROC analysis was used to summarize the overall test performance. Results. Twelve studies were included in our meta-analysis. The overall sensitivity, specificity, PLR, and NLR of DCP for the detection of HCC in the studies included were 71% (95%CI: 68%–73%, 84% (95%CI: 83%–86%, 6.48 (95%CI: 4.22–9.93, and 0.33 (95%CI: 0.25–0.43, respectively. The area under the SROC curve was 0.8930 and the Q index was 0.8238. Significant heterogeneity was found. Conclusion. This meta-analysis indicated that DCP had moderate diagnostic accuracy in HCC. Further studies with rigorous design, large sample size, and mmultiregional cooperation are needed in the future.

  14. Diagnostic performance of dual-staining cytology for cervical cancer screening: A systematic literature review.

    Science.gov (United States)

    Tjalma, Wiebren A A

    2017-03-01

    Cervical cancer screening saves lives. Secondary prevention in cervical cancer screening relies on the results of primary cytology and/or HPV testing. However, primary screening with cytology has a low sensitivity, and HPV screening has a low specificity. This means that either cancers are missed, or women are over-treated. To improve performance outcomes, the concept of dual-stain cytology (CINtec ® PLUS Cytology test) has been introduced. In this approach, additional staining with p16/Ki-67 is performed in cases where cytology results are abnormal (LSIL or ASCUS) and/or HPV-positive. Another way to describe this approach might be "diagnostic" cytology. In order to assess the value of this "diagnostic cytology", a systematic literature review was conducted of dual-stain cytology performance across multiple studies until May 2016. In a Belgian screening population (women age 25-65 years), dual-stain cytology was significantly more sensitive (66%) and slightly less specific (-1.0%) than cytology. In the population referred to colposcopy or with abnormal cytology (ASCUS, LSIL), dual-staining showed a significantly higher increase in specificity, and a slightly lower sensitivity than HPV testing. Specificity gains resulted in fewer false positives and an increase in the number of correct referrals to colposcopy. Dual-staining with p16/Ki-67 cytology is an attractive biomarker approach for triage in cervical cancer screening. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Luminescence-Based Diagnostics of Thermal Barrier Coating Health and Performance

    Science.gov (United States)

    Eldridge, Jeffrey I.

    2013-01-01

    Thermal barrier coatings (TBCs) are typically composed of translucent ceramic oxides that provide thermal protection for metallic components exposed to high-temperature environments in both air- and land-based turbine engines. For advanced turbine engines designed for higher temperature operation, a diagnostic capability for the health and performance of TBCs will be essential to indicate when a mitigating action needs to be taken before premature TBC failure threatens engine performance or safety. In particular, it is shown that rare-earth-doped luminescent sublayers can be integrated into the TBC structure to produce luminescence emission that can be monitored to assess TBC erosion and delamination progression, and to map surface and subsurface temperatures as a measure of TBC performance. The design and implementation of these TBCs with integrated luminescent sublayers are presented.

  16. Design of Wrist Gimbal: a forearm and wrist exoskeleton for stroke rehabilitation.

    Science.gov (United States)

    Martinez, John A; Ng, Paul; Lu, Son; Campagna, McKenzie S; Celik, Ozkan

    2013-06-01

    In this paper, we present design, implementation and specifications of the Wrist Gimbal, a three degree-of-freedom (DOF) exoskeleton developed for forearm and wrist rehabilitation. Wrist Gimbal has three active DOF, corresponding to pronation/supination, flexion/extension and adduction/abduction joints. We mainly focused on a robust, safe and practical device design to facilitate clinical implementation, testing and acceptance. Robustness and mechanical rigidity was achieved by implementing two bearing supports for each of the pronation/supination and adduction/abduction axes. Rubber hard stops for each axis, an emergency stop button and software measures ensured safe operation. An arm rest with padding and straps, a handle with adjustable distal distance and height and a large inner volume contribute to ease of use, of patient attachment and to comfort. We present the specifications of Wrist Gimbal in comparison with similar devices in the literature and example data collected from a healthy subject.

  17. [Clocking diagnostic and therapeutic procedures in coronary care unit patients: analysis of clinical performance times].

    Science.gov (United States)

    Mazzarotto, P; Suardi, B; Brambilla, M; Musiani, A; Cernigliaro, C

    1998-05-01

    An optimal use and exploitation of professional personnel is of paramount importance for health management organizations, as human resources are both their greatest asset and heaviest financial burden. To better understand the amount of medic and paramedic work and time required for the typical diagnostic and therapeutic procedures in a coronary-care unit setting, we measured their average times and analyzed their inherent co-factors. This study was conducted on 206 consecutive coronary-care unit patients. These patients were divided into subgroups according to their admission diagnosis: acute myocardial infarction, unstable angina, acute cardiac failure, pulmonary embolism or other pathologies. Each subgroup was then subdivided even further according to the severity of their clinical status. Diagnostic and therapeutic procedures ("macroactivities") have been identified and each one was subdivided into sub-procedures ("microactivities"). All microactivities were carefully clocked in every patient in order to calculate the average execution time for every macroactivity. Our data show that myocardial infarction patients and, in general, a more severe clinical status required a longer stay in the coronary-care unit. Again, longer overall clinical performance times were necessary in myocardial infarction patients as compared to the unstable angina subgroup. There were no statistically significant differences among other subgroups. More severely ill patients required longer clinical performance times because of both a longer coronary-care unit stay and longer clinical performance time per day. More than half of the total clinical performance time for each patient was spent during the first two days. Paramedics supplied more than 80% of the total performance time. The authors undertook a study of typical coronary-care unit clinical activities by clocking the performance times of the usual diagnostic and therapeutic procedures. The data thus obtained come from direct

  18. PERIMENOPAUSAL WRIST FRACTURE - AN OPPORTUNITY FOR ...

    African Journals Online (AJOL)

    bone mass by means of calcium and vitamin D intake, exercise and maintenance of ... therefore develop reliable and appropriate methods for screening patients to determine their risk and need for a bone density test.'o In determining such risk, clinical guidelines .... history of wrist fracture, and bone mineral density in those.

  19. Periprosthetic osteolysis after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2014-01-01

    Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose...

  20. PERIMENOPAUSAL WRIST FRACTURE - AN OPPORTUNITY FOR ...

    African Journals Online (AJOL)

    MANAGEMENT OF OSTEOPOROSIS. Alan D Rothberg, Patrick K Matshidze. Objective. Review of Medscheme's administrative databases to study the relationship between hip fracture and previous wrist fracture in peri- and postmenopausal women. Design. Retrospective analysis of 1995 - 1998 data for women aged 50 ...

  1. Wrist arthrodesis: review of current techniques.

    Science.gov (United States)

    Jebson, P J; Adams, B D

    2001-01-01

    Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. Although a variety of techniques for achieving a solid fusion have been described, the combination of rigid stabilization with a dorsal plate and autogenous cancellous bone grafting results in a high fusion rate and obviates the need for prolonged postoperative cast immobilization. Successful results with dorsal plating with or without local bone graft have recently been reported for patients with posttraumatic conditions. Rod or pin fixation is an established procedure for patients with inflammatory arthritis or a connective tissue disorder; however, plate fixation for these conditions is becoming a more acceptable alternative. Complications are relatively common and range from minor transient problems to major problems, such as wound dehiscence, infection, extensor tendon adhesions, and plate tenderness, which may require implant removal. Preoperatively, patients should be assessed for the presence of carpal tunnel syndrome, distal radioulnar joint arthritis, or ulnocarpal impaction syndrome, which may become or remain symptomatic after arthrodesis. Wrist arthrodesis results in a high degree of patient satisfaction with respect to pain relief and correction of deformity. Patients are able to accomplish most daily tasks and activities by learning to adapt to, and compensate for, the loss of wrist motion.

  2. Reproducibility of wrist home blood pressure measurement with position sensor and automatic data storage

    Directory of Open Access Journals (Sweden)

    Nickenig Georg

    2009-05-01

    Full Text Available Abstract Background Wrist blood pressure (BP devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using etablished validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage. Methods To compare the reproducibility of three different(BP measurement methods: 1 office BP, 2 home BP (Omron wrist device HEM- 637 IT with position sensor, 3 24-hour ambulatory BP(24-h ABPM (ABPM-04, Meditech, Hunconventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coeffcient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH- guidelines. Results The reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differeces of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p Conclusion The short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targed organ damage as recently reported for upper arm devices. Although wrist devices have to be used cautious and with defined limitations, the use of validated devices with position sensor according to recently recommended measurement schedules might have the potential to be used for therapy monitoring.

  3. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  4. Comparative Evaluation of the Diagnostic Performance of the Prototype Cepheid GeneXpert Ebola Assay

    Science.gov (United States)

    Jansen van Vuren, Petrus; Grobbelaar, Antoinette; Storm, Nadia; Conteh, Ousman; Konneh, Kelfala; Kamara, Abdul; Sanne, Ian

    2015-01-01

    The Ebola virus disease (EVD) outbreak in West Africa has highlighted an urgent need for point-of-care (POC) assays for the diagnosis of this devastating disease in resource-limited African countries. The diagnostic performance characteristics of a prototype Cepheid GeneXpert Ebola POC used to detect Ebola virus (EBOV) in stored serum and plasma samples collected from suspected EVD cases in Sierra Leone in 2014 and 2015 was evaluated. The GeneXpert Ebola POC is a self-contained single-cartridge automated system that targets the glycoprotein (GP) and nucleoprotein (NP) genes of EBOV and yields results within 90 min. Results from 281 patient samples were compared to the results of a TaqMan real-time reverse transcription-PCR (RT-PCR) targeting the polymerase gene and performed on two real-time PCR machines. Agreement between the three platforms was 100% at cycle threshold (CT) values of ≤34.99, but discordant results were noted between CT values of 35 and 45.The diagnostic sensitivity of the three platforms was 100% in 91 patient samples that were confirmed to be infectious by virus isolation. All three molecular platforms detected viral EBOV RNA in additional samples that did not contain viable EBOV. The analytical sensitivity of the GeneXpert Ebola POC for the detection of NP was higher, and comparable to that of polymerase gene detection, than that for the detection of GP when using a titrated laboratory stock of EBOV. There was no detectable cross-reactivity with other hemorrhagic fever viruses or arboviruses. The GeneXpert Ebola POC offers an easy to operate and sensitive diagnostic tool that can be used for the rapid screening of suspected EVD cases in treatment or in holding centers during EVD outbreaks. PMID:26637383

  5. Diagnostic performance of combined cardiac MRI for detection of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Andrade Fernandes de Mello, Ricardo, E-mail: ricardoafmello@gmail.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Universidade Federal do Espirito Santo - UFES, Vitroria, ES (Brazil); Nacif, Marcelo Souto, E-mail: msnacif@gmail.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD (United States); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil); Sarmet dos Santos, Alair Augusto Sarmet, E-mail: alairsarmet@globo.com [Hospital de Clinicas de Niteroi - HCN, Niteroi, RJ (Brazil); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil); Cury, Ricardo Caldeira, E-mail: RCury@baptisthealth.net [Baptist Cardiac and Vascular Institute, Miami, FL (United States); Rochitte, Carlos Eduardo, E-mail: rochitte@incor.usp.br [Department of Cardiovascular MRI and CT InCor - HCFMUSP, SP (Brazil); Marchiori, Edson, E-mail: edmarchiori@gmail.com [Radiology Department, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Radiology Department, Universidade Federal Fluminense - UFF, Niteroi, RJ (Brazil)

    2012-08-15

    Highlights: Black-Right-Pointing-Pointer In this study, we evaluated the accuracy of a Combined CMR protocol in the detection of significant CAD. Black-Right-Pointing-Pointer The invasive coronary angiography was the reference standard. Black-Right-Pointing-Pointer Results obtained in our study indicate that combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis. Black-Right-Pointing-Pointer The Combined CMR protocol may therefore be helpful for risk stratification and defining treatment strategies. -- Abstract: Objective: To evaluate the diagnostic performance of stress perfusion cardiac MR (CMR) for detecting significant CAD ({>=}70% narrowing) in comparison with invasive coronary angiography (ICA) as a reference standard. Methods: Examinations of 54 patients who underwent both stress perfusion CMR and ICA for investigation of CAD between 2007 and 2009 were evaluated. The CMR protocol included dipyridamole stress and rest perfusion, stress and rest cine MRI for assessment of ventricular function and delayed gadolinium enhancement for assessment of myocardial viability and detection of infarction. CMR interpretation was performed by 2 observers blinded to the results of ICA and the clinical history. Results: From a total of 54 patients, 37 (68.5%) showed significant CAD in 71 coronary territories. A perfusion defect was detected in 35 patients and in 69 coronary territories. Individual stress perfusion CMR evaluation showed the highest accuracy (83%) of the CMR techniques. The combined analysis using all sequences increased the overall accuracy of CMR to 87%. Conclusion: Combination of perfusion and cine-MR during stress/rest, associated to delayed enhancement in the same protocol improves CMRI diagnostic accuracy and sensitivity for patients with significant coronary stenosis, and may therefore be helpful for

  6. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis.

    Directory of Open Access Journals (Sweden)

    Ritesh Agarwal

    Full Text Available AIM: The efficiency of various investigations and diagnostic criteria used in diagnosis of allergic bronchopulmonary aspergillosis (ABPA remain unknown, primarily because of the lack of a gold standard. Latent class analysis (LCA can provide estimates of sensitivity and specificity in absence of gold standard. Herein, we report the performance of various investigations and criteria employed in diagnosis of ABPA. METHODS: Consecutive subjects with asthma underwent all the following investigations Aspergillus skin test, IgE levels (total and A.fumigatus specific, Aspergillus precipitins, eosinophil count, chest radiograph, and high-resolution computed tomography (HRCT of the chest. We used LCA to estimate the performance of various diagnostic tests and criteria in identification of ABPA. RESULTS: There were 372 asthmatics with a mean age of 35.9 years. The prevalence of Aspergillus sensitization was 53.2%. The sensitivity and specificity of various tests were Aspergillus skin test positivity (94.7%, 79.7%; IgE levels>1000 IU/mL (97.1%, 37.7%; A.fumigatus specific IgE levels>0.35 kUA/L (100%, 69.3%; Aspergillus precipitins (42.7%, 97.1%; eosinophil count>1000 cells/µL (29.5%, 93.1%; chest radiographic opacities (36.1%, 92.5%; bronchiectasis (91.9%, 80.9%; and, high-attenuation mucus (39.7%, 100%. The most accurate criteria was the Patterson criteria using six components followed by the Agarwal criteria. However, there was substantial decline in accuracy of the Patterson criteria if components of the criteria were either increased or decreased from six. CONCLUSIONS: A.fumigatus specific IgE levels and high-attenuation mucus were found to be the most sensitive and specific test respectively in diagnosis of ABPA. The Patterson criteria remain the best diagnostic criteria however they have good veridicality only if six criteria are used.

  7. Semantic fluency: cognitive basis and diagnostic performance in focal dementias and Alzheimer's disease.

    Science.gov (United States)

    Reverberi, Carlo; Cherubini, Paolo; Baldinelli, Sara; Luzzi, Simona

    2014-05-01

    Semantic fluency is widely used both as a clinical test and as a basic tool for understanding how humans extract information from the semantic store. Recently, major efforts have been made to devise fine-grained scoring procedures to measure the multiple cognitive processes underlying fluency performance. Nevertheless, it is still unclear how many and which independent components are necessary to thoroughly describe performance on the fluency task. Furthermore, whether a combination of multiple indices can improve the diagnostic performance of the test should be assessed. In this study, we extracted multiple indices of performance on the semantic fluency test from a large sample of healthy controls (n = 307) and patients (n = 145) suffering from three types of focal dementia or Alzheimer's Disease (AD). We found that five independent components underlie semantic fluency performance. We argue that these components functionally map onto the generation and application of a search strategy (component 2), to the monitoring of the overall sequence to avoid repetitions (component 3) and out-of-category items (component 4), and to the full integrity of the semantic store (component 5). The integrated and effective work of all these components would relate to a "general effectiveness" component (component 1). Importantly, while all the focal dementia groups were equally impaired on general effectiveness measures, they showed differential patterns of failure in the other components. This finding suggests that the cognitive deficit that impairs fluency differs among the three focal dementia groups: a semantic store deficit in the semantic variant of primary progressive aphasia (sv-PPA), a strategy deficit in the non-fluent variant of primary progressive aphasia (nfv-PPA), and an initiation deficit in the behavioural variant of fronto-temporal dementia (bv-FTD). Finally, we showed that the concurrent use of multiple fluency indices improves the diagnostic accuracy of

  8. Evaluation of diagnostic performance of whole-body simultaneous PET/MRI in pediatric lymphoma.

    Science.gov (United States)

    Ponisio, Maria Rosana; McConathy, Jonathan; Laforest, Richard; Khanna, Geetika

    2016-08-01

    Whole-body (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the standard of care for lymphoma. Simultaneous PET/MRI (magnetic resonance imaging) is a promising new modality that combines the metabolic information of PET with superior soft-tissue resolution and functional imaging capabilities of MRI while decreasing radiation dose. There is limited information on the clinical performance of PET/MRI in the pediatric setting. This study evaluated the feasibility, dosimetry, and qualitative and quantitative diagnostic performance of simultaneous whole-body FDG-PET/MRI in children with lymphoma compared to PET/CT. Children with lymphoma undergoing standard of care FDG-PET/CT were prospectively recruited for PET/MRI performed immediately after the PET/CT. Images were evaluated for quality, lesion detection and anatomical localization of FDG uptake. Maximum and mean standardized uptake values (SUVmax/mean) of normal organs and SUVmax of the most FDG-avid lesions were measured for PET/MRI and PET/CT. Estimation of radiation exposure was calculated using specific age-related factors. Nine PET/MRI scans were performed in eight patients (mean age: 15.3 years). The mean time interval between PET/CT and PET/MRI was 51 ± 10 min. Both the PET/CT and PET/MRI exams had good image quality and alignment with complete (9/9) concordance in response assessment. The SUVs from PET/MRI and PET/CT were highly correlated for normal organs (SUVmean r(2): 0.88, Pcompared with PET/CT. Simultaneous whole-body PET/MRI is clinically feasible in pediatric lymphoma. PET/MRI performance is comparable to PET/CT for lesion detection and SUV measurements. Replacement of PET/CT with PET/MRI can significantly decrease radiation dose from diagnostic imaging in children.

  9. Diagnostic performance of 3D standing CT imaging for detection of knee osteoarthritis features.

    Science.gov (United States)

    Segal, Neil A; Nevitt, Michael C; Lynch, John A; Niu, Jingbo; Torner, James C; Guermazi, Ali

    2015-07-01

    To determine the diagnostic performance of standing computerized tomography (SCT) of the knee for osteophytes and subchondral cysts compared with fixed-flexion radiography, using MRI as the reference standard. Twenty participants were recruited from the Multicenter Osteoarthritis Study. Participants' knees were imaged with SCT while standing in a knee-positioning frame, and with postero-anterior fixed-flexion radiography and 1T MRI. Medial and lateral marginal osteophytes and subchondral cysts were scored on bilateral radiographs and coronal SCT images using the OARSI grading system and on coronal MRI using Whole Organ MRI Scoring. Imaging modalities were read separately with images in random order. Sensitivity, specificity and accuracy for the detection of lesions were calculated and differences between modalities were tested using McNemar's test. Participants' mean age was 66.8 years, body mass index was 29.6 kg/m(2) and 50% were women. Of the 160 surfaces (medial and lateral femur and tibia for 40 knees), MRI revealed 84 osteophytes and 10 subchondral cysts. In comparison with osteophytes and subchondral cysts detected by MRI, SCT was significantly more sensitive (93 and 100%; p MRI, SCT imaging was more sensitive and accurate for detection of osteophytes and subchondral cysts than conventional fixed-flexion radiography. Additional study is warranted to assess diagnostic performance of SCT measures of joint space width, progression of OA features and the patellofemoral joint.

  10. Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Soussan, Michael [Hopital Beaujon, Department of Radiology, Assistance Publique des Hopitaux de Paris, APHP, Clichy (France); Aube, Christophe [CHU Angers, Department of Radiology, Angers (France); Laboratoire HIFIH, Angers (France); Bahrami, Stephane [Universite Paris-Dauphine, Department of Medical Statistics, Assistance Publique des Hopitaux de Paris, APHP, Paris (France); Boursier, Jerome [CHU Angers, Department of Hepatogastroenterology and Laboratoire HIFIH, Angers (France); Valla, Dominique Charles [Universite Paris-7 Denis Diderot, Paris (France); INSERM Centre de recherche Biomedicale Bichat Beaujon, Paris (France); Hopital Beaujon, Department of Hepatology, Assistance Publique des Hopitaux de Paris, APHP, Clichy (France); Vilgrain, Valerie [Hopital Beaujon, Department of Radiology, Assistance Publique des Hopitaux de Paris, APHP, Clichy (France); Universite Paris-7 Denis Diderot, Paris (France); INSERM Centre de recherche Biomedicale Bichat Beaujon, Paris (France)

    2010-07-15

    To prospectively assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) and MR imaging in incidental solid focal liver lesions not characterised on ultrasound. Forty-seven patients with 50 lesions underwent MR imaging and CEUS: 24 focal nodular hyperplasias (FNH), 11 adenomas, 10 haemangiomas, 1 focal fatty change and 4 malignant lesions were identified. Two experienced radiologists randomly reviewed contrast-enhanced MR imaging and CEUS data, and provided the most likely diagnosis. Sensitivity (Se), specificity (Sp), likelihood ratios (LR) and kappa value were calculated. A histotype diagnosis was obtained in 66-52% with MR imaging and 52-53% with CEUS, respectively, for both readers. Se, Sp and LR for haemangioma were 100-100, 100-100 and 78-78 with MR imaging and 89-89, 100-100 and 68-70 with CEUS; for FNH with MR imaging they were 88-63, 96-100 and 23-34 and 74-67, 88-96 and 6-17 with CEUS. If the diagnosis of haemangioma was uncertain with CEUS, MR imaging always confirmed the diagnosis. If the diagnosis of FNH was uncertain with either CEUS or MR imaging, the other imaging technique confirmed the diagnosis in approximately half the cases. Both CEUS and MR imaging have a high diagnostic performance in incidental focal liver lesions and are complementary when diagnosis is uncertain. (orig.)

  11. Contribution of magnetic resonance imaging of the wrist and hand to forensic age assessment.

    Science.gov (United States)

    Serin, Jeanne; Rérolle, Camille; Pucheux, Julien; Dedouit, Fabrice; Telmon, Norbert; Savall, Frédéric; Saint-Martin, Pauline

    2016-07-01

    Forensic age estimation of living individuals is a controversial subject because of the imprecision of the available methods which leads to errors. Moreover, young persons are exposed to radiation, without diagnostic or therapeutic advantage. Recently, non-invasive imaging techniques such as magnetic resonance imaging (MRI) have been studied in this context. The aim of this work was to study if the analysis of wrist/hand MRI enabled determination of whether a subject was 18 years old. Two observers retrospectively analyzed metaphyseal-epiphyseal fusion of the distal epiphysis of the radius and the ulna and the base of the first metacarpus in wrist/hand MRI of living people between 9 and 25 years of age. A three-stage scoring system was applied to all epiphyses. Intra- and inter-observer variability was excellent. Staging of the distal radial epiphysis allowed the subjects to be correctly evaluated with regard to the 18-year-old threshold in more than 85 % of cases. Analysis of the radius alone was as good as the analysis of the three epiphyses together. Evaluation of the metaphyseal-epiphyseal fusion of the distal radius in wrist MRI gave good results in forensic age estimation. Wrist MRI could meet ethical expectations with regard to the link between the benefit and risk of practicing radiologic examination on individuals in this context.

  12. Performance of a Brazilian population sample in the Boston Diagnostic Aphasia Examination: A pilot study

    Directory of Open Access Journals (Sweden)

    M. Radanovic

    2002-03-01

    Full Text Available Brazilian researchers and health professionals often face the challenge of having to use tests developed in foreign languages and standardized for populations of other countries, especially in the fields of Neuropsychology and Neurolinguistics. This fact promotes a feeling that some scoring systems may be inadequate for our sociocultural reality. In the present study, we describe the performance of a Brazilian population sample submitted to a translated and adapted version of the Boston Diagnostic Aphasia Examination (BDAE. Sixty normal volunteers (21 men and 39 women, all Portuguese native speakers, ranging in age from 15 to 78 years (average 43.7 and with an educational level of 2 to 16 years (average 9.9, were tested using a translated and adapted Portuguese version of the BDAE. Cut-off scores are suggested for our population and the performance of the Brazilian sample is compared to that of American and Colombian samples, with the results being closely similar in all tasks. We also performed a correlation analysis between age, gender and educational level and the influence of these variables on the performance of the subjects. We found no statistically significant differences between genders. Educational level correlated positively with performance, especially in the subtests involving reading and writing. There was a negative correlation between age and performance in two subtests (Visual Confrontation Naming and Sentences to Dictation, but a coexisting effect of educational level could not be ruled out.

  13. Performance of a Brazilian population sample in the Boston Diagnostic Aphasia Examination: a pilot study.

    Science.gov (United States)

    Radanovic, M; Mansur, L L

    2002-03-01

    Brazilian researchers and health professionals often face the challenge of having to use tests developed in foreign languages and standardized for populations of other countries, especially in the fields of Neuropsychology and Neurolinguistics. This fact promotes a feeling that some scoring systems may be inadequate for our sociocultural reality. In the present study, we describe the performance of a Brazilian population sample submitted to a translated and adapted version of the Boston Diagnostic Aphasia Examination (BDAE). Sixty normal volunteers (21 men and 39 women), all Portuguese native speakers, ranging in age from 15 to 78 years (average 43.7) and with an educational level of 2 to 16 years (average 9.9), were tested using a translated and adapted Portuguese version of the BDAE. Cut-off scores are suggested for our population and the performance of the Brazilian sample is compared to that of American and Colombian samples, with the results being closely similar in all tasks. We also performed a correlation analysis between age, gender and educational level and the influence of these variables on the performance of the subjects. We found no statistically significant differences between genders. Educational level correlated positively with performance, especially in the subtests involving reading and writing. There was a negative correlation between age and performance in two subtests (Visual Confrontation Naming and Sentences to Dictation), but a coexisting effect of educational level could not be ruled out.

  14. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg....../ml), 0.5 ml Lidocaine (5mg/ml) and 0.15 ml gadolinium (Omniscan 0.5 mmol/ml). The drug solution was placed in the central proximal part of the wrist between the distal radius and the lunate bone. Coronal and axial MRI sequences were performed after the injection to visualize the distribution. Carpal...... with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased...

  15. Post-stroke wrist rehabilitation assisted with an intention-driven functional electrical stimulation (FES)-robot system.

    Science.gov (United States)

    Hu, X L; Tong, K Y; Li, R; Chen, M; Xue, J J; Ho, S K; Chen, P N

    2011-01-01

    In this work, a novel FES-robot system was developed for wrist rehabilitation training after stroke. The FES-robot system could be continuously controlled by electromyography (EMG) from the residual wrist muscles to facilitate wrist flexion and extension tracking tasks on a horizontal plane by providing assistance from both FES and robot parts. The system performance with five different assistive combinations from the FES and robot parts was evaluated by subjects with chronic stroke (n=5). The results suggested that the assistance from the robot part mainly improved the movement accuracy in the tracking tasks; and the assistance from the FES part mainly suppressed the excessive muscular activities from the elbow joint. The best combination was when the assistances from FES and robot was 1:1, and the results showed better wrist tracking performance with less muscle co-contraction from the elbow joint. © 2011 IEEE

  16. Diagnostic performance of interleukin-6 and interleukin-8 for bacterial meningitis: a meta-analysis

    Science.gov (United States)

    Yao, Rong; Cao, Yu; Chen, Yao; Zeng, Zhi

    2015-01-01

    This study aimed to summarize the overall diagnostic performance of interleukin-6 and interleukin-8 in cerebrospinal fluid for bacterial meningitis through meta-analysis due to inconclusive results reported. Literature search was performed in PubMed and Embase to identify eligible studies. Data were retrieved and sensitivity, specificity, positive likelihood ratio/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled. Summary receiver operating characteristic curve and the area under the curve (AUC) were calculated to evaluate their overall test performances. Thirteen studies were included for present meta-analysis. The summary estimates for interleukin-6 in diagnosing bacterial meningitis were: sensitivity, 0.91 (95% CI 0.81-0.96); specificity, 0.93 (95% CI 0.84-0.97); PLR, 12.38 (95% CI 5.42-28.29); NLR, 0.10 (95% CI 0.04-0.21); DOR, 129.76 (95% CI 41.48-405.88); and AUC 0.97 (95% CI 0.95-0.98). The corresponding summary performance estimates for interleukin-8 were as follows: sensitivity, 0.95 (95% CI 0.71-0.99); specificity, 0.89 (95% CI 0.77-0.95); PLR, 8.50 (95% CI, 3.83-18.86); NLR, 0.06 (95% CI 0.01-0.40); DOR, 154.25 (95% CI 14.56-1634.33); and AUC 0.95 (95% CI 0.93-0.97). Measurements of interleukin-6 and interleukin-8 play a valuable role in diagnosing bacterial meningitis. Nevertheless, their results should be interpreted in parallel with the results of routine tests and clinical symptoms. PMID:26221243

  17. Tennis Racket Vibrations and Shock Transmission to the Wrist during Forehand Drive.

    Science.gov (United States)

    Rogowski, Isabelle; Creveaux, Thomas; Triquigneaux, Sylvain; Macé, Pierre; Gauthier, Fabien; Sevrez, Violaine

    2015-01-01

    This study aimed to investigate the effects of two different racket models and two different forehand drive velocities on the three-dimensional vibration behavior of the racket and shock transmission to the player's wrist under real playing conditions. Nine tennis players performed a series of crosscourt flat forehand drives at two velocities, using a lightly and a highly vibrant racket. Two accelerometers were fixed on the racket frame and the player's wrist. The analysis of vibration signals in both time and frequency domains showed no interaction effect of velocity and racket conditions either on the racket vibration behavior or on shock transmission. An increase in playing velocity enlarged the amount of vibrations at the racket and wrist, but weakly altered their frequency content. As compared to a racket perceived as highly vibrating, a racket perceived as lightly vibrating damped longer in the out-of-plane axis of the racket and shorter on the other axis of the racket and on the wrist, and displayed a lower amount of energy in the high frequency of the vibration signal at the racket and wrist. These findings indicated that the playing velocity must be controlled when investigating the vibration loads due to the racket under real playing conditions. Similarly, a reduced perception of vibration by the tennis player would be linked to decreased amplitude of the racket vibration signal, which may concentrate the signal energy in the low frequencies.

  18. Preliminary analysis of non-dominant proprioceptive acuity and interlimb asymmetry in the human wrist.

    Science.gov (United States)

    Contu, Sara; Cappello, Leonardo; Konczak, Jurgen; Masia, Lorenzo

    2015-08-01

    Proprioception provides information about limb configuration which are essential for planning and controlling its posture and movement. Asymmetries in the way dominant and non-dominant limbs exploit proprioceptive information have been previously evaluated, with contradictory results due to the difference in the employed methodology. A measure of proprioceptive acuity that does not reflect the influence of one limb on the other consists in the evaluation of the psychophysical threshold. This metric, evaluated separately for each limb and involving only passive movements, reflects a reliable measure of proprioceptive acuity. The aim of this work is to first evaluate the proprioceptive acuity of the non-dominant wrist joint in flexion/extension and adduction/abduction and to compare these results to the acuity of the dominant wrist. Data were collected during a unidirectional 2-alternative-forcedchoice test performed by six right-handed subjects. We found acuity of 1.31°, 1.26°, 1.33° and 1.63° respectively for abduction, adduction, extension and flexion of the non-dominant wrist. Acuity of the dominant wrist was assessed for five of the subjects for abduction and flexion and resulted lower (mean values were respectively 1.64° and 2.14°). The preliminary results suggest a leading role of the non-dominant wrist in the processing of the proprioceptive feedback.

  19. Excellent Intra and Inter-Observer Reproducibility of Wrist Circumference Measurements in Obese Children and Adolescents.

    Directory of Open Access Journals (Sweden)

    Giuseppe Campagna

    Full Text Available In a previous study, we found that wrist circumference, in particular its bone component, was associated with insulin resistance in a population of overweight/obese children. The aim of the present study was to evaluate the intra- and inter-operator variability in wrist circumference measurement in a population of obese children and adolescents. One hundred and two (54 male and 48 female obese children and adolescents were consecutively enrolled. In all subjects wrist circumferences were measured by two different operators two times to assess intra- and inter-operator variability. Statistical analysis was performed using SAS v.9.4 and JMP v.12. Measurements of wrist circumference showed excellent inter-operator reliability with Intra class Correlation Coefficients (ICC of 0.96 and ICC of 0.97 for the first and the second measurement, respectively. The intra-operator reliability was, also, very strong with a Concordance Correlation Coefficient (CCC of 0.98 for both operators. The high reproducibility demonstrated in our results suggests that wrist circumference measurement, being safe, non-invasive and repeatable can be easily used in out-patient settings to identify youths with increased risk of insulin-resistance. This can avoid testing the entire population of overweight/obese children for insulin resistance parameters.

  20. HIV misdiagnosis in sub-Saharan Africa: performance of diagnostic algorithms at six testing sites.

    Science.gov (United States)

    Kosack, Cara S; Shanks, Leslie; Beelaert, Greet; Benson, Tumwesigye; Savane, Aboubacar; Ng'ang'a, Anne; Andre, Bita; Zahinda, Jean-Paul Bn; Fransen, Katrien; Page, Anne-Laure

    2017-07-03

    We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries. In this prospective multisite diagnostic evaluation study (Conakry, Guinea; Kitgum, Uganda; Arua, Uganda; Homa Bay, Kenya; Doula, Cameroun and Baraka, Democratic Republic of Congo), samples from clients (greater than equal to five years of age) testing for HIV were collected and compared to a state-of-the-art algorithm from the AIDS reference laboratory at the Institute of Tropical Medicine, Belgium. The reference algorithm consisted of an enzyme-linked immuno-sorbent assay, a line-immunoassay, a single antigen-enzyme immunoassay and a DNA polymerase chain reaction test. Between August 2011 and January 2015, over 14,000 clients were tested for HIV at 6 HIV counselling and testing sites. Of those, 2786 (median age: 30; 38.1% males) were included in the study. Sensitivity of the testing algorithms ranged from 89.5% in Arua to 100% in Douala and Conakry, while specificity ranged from 98.3% in Doula to 100% in Conakry. Overall, 24 (0.9%) clients, and as many as 8 per site (1.7%), were misdiagnosed, with 16 false-positive and 8 false-negative results. Six false-negative specimens were retested with the on-site algorithm on the same sample and were found to be positive. Conversely, 13 false-positive specimens were retested: 8 remained false-positive with the on-site algorithm. The performance of algorithms at several sites failed to meet expectations and thresholds set by the World Health Organization, with unacceptably high rates of false results. Alongside the careful selection of rapid diagnostic tests and the validation of algorithms, strictly observing correct procedures can reduce the risk of false results. In the meantime, to identify false-positive diagnoses at initial testing, patients should be retested upon initiating antiretroviral therapy.

  1. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

    Energy Technology Data Exchange (ETDEWEB)

    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  2. Diagnostic performance of reformatted isotropic thin-section helical CT images in the detection of superior semicircular canal dehiscence.

    Science.gov (United States)

    Sparacia, Gianvincenzo; Iaia, Alberto

    2017-06-01

    Purpose The purpose of this article is to assess the diagnostic performance of computed tomography (CT) reformatted images for detection of superior semicircular canal (SSC) dehiscence. Material and methods Forty-two patients, with sound- and/or pressure-induced vestibular symptoms, and 42 control participants underwent helical CT examination with a highly collimated beam (0.5 mm). Reformatted images of the vestibular labyrinth were obtained in the standard axial and coronal planes (group A images), and in a plane parallel and perpendicular to the SSC (group B images). Diagnostic performance obtained by evaluating the group A images alone and the group B images alone was analyzed by using the area under the receiver operating characteristic curve (AUC). Results The diagnostic performance of group A images was AUC = 0.929 with an overall accuracy of 92.9%. The diagnostic performance of group B images was AUC = 0.988 with an overall accuracy of 98.8%. The evaluation of group B images alone showed an improved diagnostic performance over the group A images alone. Conclusion Thin-section 0.5-mm collimation CT with reformatted images oriented in the plane parallel and perpendicular to the SSC improves diagnostic accuracy in assessing for SSC dehiscence in comparison to CT images with reconstructions limited to traditional axial and coronal planes.

  3. Robot-aided assessment of wrist proprioception

    Directory of Open Access Journals (Sweden)

    Leonardo eCappello

    2015-04-01

    Full Text Available Introduction. Impaired proprioception severely affects the control of gross and fine motor function. However, clinical assessment of proprioceptive deficits and its impact on motor function has been difficult to elucidate. Recent advances in haptic robotic interfaces designed for sensorimotor rehabilitation enabled the use of such devices for the assessment of proprioceptive function.Purpose. This study evaluated the feasibility of a wrist robot system to determine proprioceptive discrimination thresholds for two different DoFs of the wrist. Specifically, we sought to accomplish three aims: first, to establish data validity; second, to show that the system is sensitive to detect small differences in acuity; third, to establish test-retest reliability over repeated testing.Methodology. Eleven healthy adult subjects experienced two passive wrist movements and had to verbally indicate which movement had the larger amplitude. Based on a subject’s response data a psychometric function was fitted and the wrist acuity threshold was established at the 75% correct response level. A subset of five subjects repeated the experimentation three times (T1, T2 and T3 to determine the test-retest reliability.Results. Mean threshold for wrist flexion was 2.15°± 0.43° and 1.52°± 0.36° for abduction. Encoder resolutions were 0.0075° (flexion-extension and 0.0032° (abduction-adduction. Motor resolutions were 0.2° (flexion-extension and 0.3° (abduction-adduction. Reliability coefficients were rT2-T1=0.986 and rT3-T2=0.971.Conclusions. We currently lack established norm data on the proprioceptive acuity of the wrist to establish direct validity. However, the magnitude of our reported thresholds are physiological plausible and well in line with available threshold data obtained at the elbow joint. Moreover, system has high resolution and is sensitive enough to detect small differences in acuity. Finally, the system produces reliable data over repeated

  4. Development of GEM detector for plasma diagnostics application: simulations addressing optimization of its performance

    Science.gov (United States)

    Chernyshova, M.; Malinowski, K.; Kowalska-Strzęciwilk, E.; Czarski, T.; Linczuk, P.; Wojeński, A.; Krawczyk, R. D.

    2017-12-01

    The advanced Soft X-ray (SXR) diagnostics setup devoted to studies of the SXR plasma emissivity is at the moment a highly relevant and important for ITER/DEMO application. Especially focusing on the energy range of tungsten emission lines, as plasma contamination by W and its transport in the plasma must be understood and monitored for W plasma-facing material. The Gas Electron Multiplier, with a spatial and energy-resolved photon detecting chamber, based SXR radiation detection system under development by our group may become such a diagnostic setup considering and solving many physical, technical and technological aspects. This work presents the results of simulations aimed to optimize a design of the detector's internal chamber and its performance. The study of the effect of electrodes alignment allowed choosing the gap distances which maximizes electron transmission and choosing the optimal magnitudes of the applied electric fields. Finally, the optimal readout structure design was identified suitable to collect a total formed charge effectively, basing on the range of the simulated electron cloud at the readout plane which was in the order of ~ 2 mm.

  5. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

    Science.gov (United States)

    Santana, Cesar A.; Garcia, Ernest V.; Faber, Tracy L.; Sirineni, Gopi K. R.; Esteves, Fabio P.; Sanyal, Rupan; Halkar, Raghuveer; Ornelas, Mario; Verdes, Liudmila; Lerakis, Stamatios; Ramos, Julie J.; Aguadé-Bruix, Santiago; Cuéllar, Hugo; Candell-Riera, Jaume; Raggi, Paolo

    2011-01-01

    Background We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery. PMID:19156478

  6. Diagnostic performance and safety of a three-dimensional 14-core systematic biopsy method.

    Science.gov (United States)

    Takeshita, Hideki; Kawakami, Satoru; Numao, Noboru; Sakura, Mizuaki; Tatokoro, Manabu; Yamamoto, Shinya; Kijima, Toshiki; Komai, Yoshinobu; Saito, Kazutaka; Koga, Fumitaka; Fujii, Yasuhisa; Fukui, Iwao; Kihara, Kazunori

    2015-03-01

    To investigate the diagnostic performance and safety of a three-dimensional 14-core biopsy (3D14PBx) method, which is a combination of the transrectal six-core and transperineal eight-core biopsy methods. Between December 2005 and August 2010, 1103 men underwent 3D14PBx at our institutions and were analysed prospectively. Biopsy criteria included a PSA level of 2.5-20 ng/mL or abnormal digital rectal examination (DRE) findings, or both. The primary endpoint of the study was diagnostic performance and the secondary endpoint was safety. We applied recursive partitioning to the entire study cohort to delineate the unique contribution of each sampling site to overall and clinically significant cancer detection. Prostate cancer was detected in 503 of the 1103 patients (45.6%). Age, family history of prostate cancer, DRE, PSA, percentage of free PSA and prostate volume were associated with the positive biopsy results significantly and independently. Of the 503 cancers detected, 39 (7.8%) were clinically locally advanced (≥cT3a), 348 (69%) had a biopsy Gleason score (GS) of ≥7, and 463 (92%) met the definition of biopsy-based significant cancer. Recursive partitioning analysis showed that each sampling site contributed uniquely to both the overall and the biopsy-based significant cancer detection rate of the 3D14PBx method. The overall cancer-positive rate of each sampling site ranged from 14.5% in the transrectal far lateral base to 22.8% in the transrectal far lateral apex. As of August 2010, 210 patients (42%) had undergone radical prostatectomy, of whom 55 (26%) were found to have pathologically non-organ-confined disease, 174 (83%) had prostatectomy GS ≥7 and 185 (88%) met the definition of prostatectomy-based significant cancer. This is the first prospective analysis of the diagnostic performance of an extended biopsy method, which is a simplified version of the somewhat redundant super-extended three-dimensional 26-core biopsy. As expected, each sampling

  7. Differentiating between analytical and diagnostic performance evaluation with a focus on the method comparison study and identification of bias.

    Science.gov (United States)

    Flatland, Bente; Friedrichs, Kristen R; Klenner, Stefanie

    2014-12-01

    Prior to introduction of a new method to the diagnostic laboratory, analytical performance must be validated to ensure operation within the manufacturer's specifications and/or within predetermined quality requirements. In addition, the new method may require diagnostic performance assessment to ensure it differentiates between diseased and nondiseased individuals as intended. These 2 phases of assessment, while complementary, are not equivalent and require a different set of experiments, statistical analyses, and interpretation. Studies of analytical performance typically include a method comparison experiment, the purpose of which is to identify bias (inaccuracy) of the "test" (or "index") method (new method) relative to a "comparative method" (established method). Analysis of method comparison data is facilitated by commercial software programs that present the statistical significance of identified bias; however, the clinical relevance of any bias also should be considered. Studies of diagnostic performance should not be pursued until analytical performance is fully characterized and may not be required for well-established tests or for those for which results are nonspecific (ie, not referable to a specific disease or condition). Diagnostic performance assessment may include assessment of sensitivity, specificity, predictive values, odds ratios, and/or likelihood ratios. The purpose of this review is to clarify differences between the assessment of analytical and diagnostic performance, and to explore the method comparison study and bias assessment from a perspective not addressed in prior veterinary articles. © 2014 American Society for Veterinary Clinical Pathology.

  8. Gyroscope vs. accelerometer measurements of motion from wrist PPG during physical exercise

    Directory of Open Access Journals (Sweden)

    Alexander J. Casson

    2016-12-01

    Full Text Available Many wearable devices include PPG (photoplethysmography sensors for non-invasive heart rate monitoring. However, PPG signals are heavily corrupted by motion interference, and rely on simultaneous motion measurements to remove the interference. Accelerometers are used commonly, but cannot differentiate between acceleration due to movement and acceleration due to gravity. This paper compares measurements of motion using accelerometers and gyroscopes to give a more complete estimate of wrist motion. Results show the two sensor signals are very different, with low correlations present. When used in a wrist PPG heart rate algorithm gyroscope motion estimates obtain better performance in half of the cases.

  9. Radiological intervention of the hand and wrist

    Science.gov (United States)

    Chopra, Annu; Rowbotham, Emma L

    2016-01-01

    The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image-guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image-guided intervention of the hand and wrist was conducted. During this search, it became clear that there is little consensus regarding all aspects of image-guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence-based reference point which can be utilized by radiologists and to describe the most commonly employed techniques. PMID:26313500

  10. Viability of Hand and Wrist Photogoniometry.

    Science.gov (United States)

    Meals, Clifton G; Saunders, Rebecca J; Desale, Sameer; Means, Kenneth R

    2017-04-01

    No goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general. Two independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol. Interrater and intrarater correlation were calculated, and these measurements were compared with measurements made by a third independent examiner with a manual goniometer. The photo-based measurements were reliable within and between observers; however, only a minority of these measurements were in agreement with manually collected values. At present, photogoniometry is not an acceptable alternative to manual goniometry for determining wrist and digit range of motion in general. Joint-specific photogoniometry should be the subject of future study, as should relevant imaging and software technology.

  11. A Diagnostic Comparison of Turkish and Korean Students’ Mathematics Performances on the TIMSS 2011 Assessment

    Directory of Open Access Journals (Sweden)

    Sedat Şen

    2015-11-01

    Full Text Available The purpose of the present study was to analyze an international large-scale data set using a cognitive assessment approach. Although some researchers question the usefulness of international large-scale assessments (e.g., TIMSS, participating countries have continued to use the results from these large-scale assessments to improve their curricula and teaching methods. Despite the common reporting practice—single-score—in these large scale assessments gives useful insights about students’ overall performances, they still lack diagnostic information. Cognitive diagnosis models (CDMs were developed to provide more feedback on students’ cognitive strengths and weaknesses. This study retrofitted the TIMSS 2011 eighth grade mathematics assessment by applying a specific CDM called the DINA (the deterministic, inputs, noisy, “and” gate model to data from South Korea and Turkey. Results of the DINA model were used to make a detailed comparison between students of these two countries.

  12. External validation of clinical decision rules for children with wrist trauma.

    Science.gov (United States)

    Mulders, Marjolein A M; Walenkamp, Monique M J; Dubois, Bente F H; Slaar, Annelie; Goslings, J Carel; Schep, Niels W L

    2017-05-01

    Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules. We included all studies that proposed a clinical prediction or decision rule in children presenting at the emergency department with acute wrist trauma. We performed external validation within a cohort of 379 children. We also calculated the sensitivity, specificity, negative predictive value and positive predictive value of each decision rule. We included three clinical decision rules. The sensitivity and specificity of all clinical decision rules after external validation were between 94% and 99%, and 11% and 26%, respectively. After external validation 7% to 17% less radiographs would be ordered and 1.4% to 5.7% of all fractures would be missed. Compared to the Amsterdam Pediatric Wrist Rules only one of the three other rules had a higher sensitivity; however both the specificity and the reduction in requested radiographs were lower in the other three rules. The sensitivity of the three non-validated clinical decision rules is high. However the specificity and the reduction in number of requested radiographs are low. In contrast, the validated Amsterdam Pediatric Wrist Rules has an acceptable sensitivity and the greatest reduction in radiographs, at 22%, without missing any clinically relevant fractures.

  13. Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon?

    Science.gov (United States)

    Allam, Abdallah El-Sayed; Al-Ashkar, Doaa Shawky; Negm, Ahmed A; Eltawab, Basma Aly; Wu, Wei-Ting; Chang, Ke-Vin

    2017-01-01

    De Quervain disease (DQVD) is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times). After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist.

  14. Dry Arthroscopic Excision of Dorsal Wrist Ganglion

    OpenAIRE

    Gray, Jason; Zuhlke, Todd; Eizember, Shane; Srinivasan, Ramesh

    2017-01-01

    Ganglions are common soft tissue masses of the hand. High recurrence rates are associated with nonsurgical treatment; thus, excision is often indicated. Arthroscopic excision and open excision have similar recurrence rates; however, the latter is associated with prolonged healing time and increased scarring. Recently, dry wrist arthroscopic techniques have been used. This technique allows easier confirmation of complete ganglion removal, easier conversion to open surgery, earlier return of mo...

  15. Diagnostic Performance of a Saliva Urea Nitrogen Dipstick to Detect Kidney Disease in Malawi.

    Science.gov (United States)

    Evans, Rhys; Calice-Silva, Viviane; Raimann, Jochen G; Hemmila, Ulla; Craik, Alison; Mtekateka, Mwayi; Hamilton, Fergus; Kawale, Zuze; Dobbie, Hamish; Dreyer, Gavin; Levin, Nathan; Kotanko, Peter; Pecoits-Filho, Roberto

    2017-03-01

    Kidney disease (KD), including acute kidney injury, is common, severe and leads to significant mortality in the developing world. However, simple tools to facilitate diagnosis and guide treatment are lacking. We studied the diagnostic performance of saliva urea nitrogen (SUN) measured by dipstick to diagnose KD in a low-resource setting. Medical admissions to a tertiary hospital in Malawi had serum creatinine tested at presentation; SUN was measured using a dipstick. Patients with serum creatinine above normal range underwent serial measurements of SUN and blood urea nitrogen for up to 7 days. Hospital outcome was recorded in all patients. A total of 742 patients were included (age 41 ± 17·3 years, 56.1% male); 146 (19.7%) had KD, including 114 (15.4%) with acute kidney injury. SUN >14 mg/dl had a sensitivity of 0.72 and a specificity of 0.87 to diagnose KD; specificity increased to 0.97 when SUN levels were combined with self-reported urine output. The diagnostic performance of SUN was comparable with the one of blood urea nitrogen (SUN area under curve, 0.82; 95% confidence interval, 0.78-0.87; blood urea nitrogen area under curve, 0.82; 95% confidence interval, 0.59-1.0). SUN >14 mg/dl on admission was an independent predictor of all-cause mortality (hazard ratio = 2.43 [95% confidence interval, 1.63-3.62]). SUN measured by dipstick can be used to identify patients with KD in a low-resource setting. SUN is an independent predictor of mortality in this population.

  16. Diagnostic performance of shear wave elastography of the breast according to scanning orientation.

    Science.gov (United States)

    Kim, Solip; Choi, SeonHyeong; Choi, Yoonjung; Kook, Shin-Ho; Park, Hee Jin; Chung, Eun Chul

    2014-10-01

    To evaluate the influence of the scanning orientation on diagnostic performance measured by the mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio on ultrasound-based shear wave elastography in differentiating breast cancers from benign lesions. In this study, a total of 260 breast masses from 235 consecutive patients were observed from March 2012 to November 2012. For each lesion, the mean elasticity value, maximum elasticity value, and fat-to-lesion ratio were measured along two orthogonal directions, and all values were compared with pathologic results. There were 59 malignant and 201 benign lesions. Malignant masses showed higher mean elasticity, maximum elasticity, and fat-to-lesion ratio values than benign lesions (P elasticity on both views, 0.870; mean elasticity on the transverse view, 0.866; maximum elasticity on both views, 0.865; maximum elasticity on the transverse view, 0.864; mean elasticity on the longitudinal view, 0.849; fat-to-lesion ratio on both views, 0.849; maximum elasticity on the longitudinal view, 0.845; fat-to-lesion ratio on the transverse view, 0.841; and fat-to-lesion ratio on the longitudinal view, 0.814. Intraclass correlation coefficients for agreement between the scanning directions were as follows: mean elasticity, 0.852; maximum elasticity, 0.842; fat-to-lesion ratio, 0.746, for masses; and mean elasticity, 0.392, for anterior mammary fat. Mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio values were helpful in differentiating benign and malignant breast masses. The scanning orientation did not significantly affect the diagnostic performance of shear wave elastography for breast masses. © 2014 by the American Institute of Ultrasound in Medicine.

  17. SU-F-E-01: Pitfalls: Reliability and Performance of Diagnostic X-Sources

    Energy Technology Data Exchange (ETDEWEB)

    Behling, R [Philips Medical Systems DMC GmbHHamburg (United States)

    2016-06-15

    Purpose: Performance and reliability of medical X-ray tubes for imaging are crucial from an ethical, clinical and economic perspective. This lecture will deliver insight into the aspects to consider during the decision making process to invest in X-ray imaging equipment. Outdated metric still hampers realistic product comparison. It is time to change this and to comply with latest standards, which consider current technology. Failure modes and ways to avoid down-time of the equipment shall be discussed. In view of the increasing number of interventional procedures and the hazards associated with ionizing radiation, toxic contrast agents, and the combination thereof, the aspect of system reliability is of paramount importance. Methods: A comprehensive picture of trends for different modalities (CT, angiography, general radiology) has been drawn and led to the development of novel X-ray tube technology. Results: Recent X-ray tubes feature enhanced reliability and unprecedented performance. Relevant metrics for product comparison still have to be implemented in practice. Conclusion: The speed of scientific and industrial development of new diagnostic and therapeutic X-ray sources remains tremendous. Still, users suffer from gaps between desire and reality in day-to-day diagnostic routine. X-ray sources are still limiting cutting-edge medical procedures. Side-effects of wear and tear, limitations of the clinical work flow, costs, the characteristics of the X-ray spectrum and others topics need to be further addressed. New applications and modalities, like detection-based color-resolved X-ray and phase-contrast / dark-field imaging will impact the course of new developments of X-ray sources. The author is employee of Royal Philips.

  18. Diagnostic Performance of Magnifying Endoscopy for Helicobacter pylori Infection: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Qingqing Qi

    Full Text Available Diagnosis of Helicobacter pylori (H. pylori infection using magnifying endoscopy offers advantages over conventional invasive and noninvasive tests.This meta-analysis aimed to assess the diagnostic performance of magnifying endoscopy in the prediction of H. pylori infection.A literature search of the PubMed, Medline, EMBASE, Science Direct and the Cochrane Library databases was performed. A random-effects model was used to calculate the diagnostic efficiency of magnifying endoscopy for H. pylori infection. A summary receiver operator characteristic curve was plotted, and the area under the curve (AUC was calculated.A total of 18 studies involving 1897 patients were included. The pooled sensitivity and specificity of magnifying endoscopy to predict H. pylori infection were 0.89 [95% confidence interval (CI 0.87-0.91] and 0.82 (95%CI 0.79-0.85, respectively, with an AUC of 0.9461. When targeting the gastric antrum, the pooled sensitivity and specificity were 0.82 (95%CI 0.78-0.86 and 0.72 (95%CI 0.66-0.78, respectively. When targeting the gastric corpus, the pooled sensitivity and specificity were 0.92 (95%CI 0.90-0.94 and 0.86 (95%CI 0.82-0.88, respectively. The pooled sensitivity and specificity using magnifying white light endoscopy were 0.90 (95%CI 0.87-0.91 and 0.81 (95%CI 0.77-0.84, respectively. The pooled sensitivity and specificity using magnifying chromoendoscopy were 0.87 (95%CI 0.83-0.91 and 0.85 (95%CI 0.80-0.88, respectively. The "pit plus vascular pattern" classification in the gastric corpus observed by magnifying endoscopy was able to accurately predict the status of H. pylori infection, as indicated by a pooled sensitivity and specificity of 0.96 (95%CI 0.94-0.97 and 0.91 (95%CI 0.87-0.93, respectively, with an AUC of 0.9872.Magnifying endoscopy was able to accurately predict the status of H. pylori infection, either in magnifying white light endoscopy or magnifying chromoendoscopy mode. The "pit plus vascular pattern

  19. The effects of wrist motion and hand orientation on muscle forces: A physiologic wrist simulator study.

    Science.gov (United States)

    Shah, Darshan S; Middleton, Claire; Gurdezi, Sabahat; Horwitz, Maxim D; Kedgley, Angela E

    2017-07-26

    Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback - hybrid control and cascade control - were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower's motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces (pforces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction (p=0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction (p=0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  20. Decoupling the Wrist: A Cadaveric Experiment Examining Wrist Kinematics Following Midcarpal Fusion and Scaphoid Excision.

    Science.gov (United States)

    Nichols, Jennifer A; Bednar, Michael S; Havey, Robert M; Murray, Wendy M

    2017-02-01

    At the wrist, kinematic coupling (the relationship between flexion-extension and radial-ulnar deviation) facilitates function. Although the midcarpal joint is critical for kinematic coupling, many surgeries, such as 4-corner fusion (4CF) and scaphoidexcision 4-corner fusion (SE4CF), modify the midcarpal joint. This study examines how 4CF and SE4CF influence kinematic coupling by quantifying wrist axes of rotation. Wrist axes of rotation were quantified in 8 cadaveric specimens using an optimization algorithm, which fit a 2-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for 3 conditions (nonimpaired, 4CF, SE4CF). The calculated axes of rotation were compared using spherical statistics. The angle between the axes of rotation was used to assess coupling, as the nonimpaired wrist has skew axes (ie, angle between axes approximately 60°). Following 4CF and SE4CF, the axes are closer to orthogonal than those of the nonimpaired wrist. The mean angle (±95% confidence interval) between the axes was 92.6° ± 25.2° and 99.8° ± 22.0° for 4CF and SE4CF, respectively. The axes of rotation defined in this study can be used to define joint models, which will facilitate more accurate computational and experimental studies of these procedures.

  1. Comparison of static wrist splint with static wrist and metacarpophalangeal splint in carpal tunnel syndrome.

    Science.gov (United States)

    Bulut, Gul Tugba; Caglar, Nil Sayiner; Aytekin, Ebru; Ozgonenel, Levent; Tutun, Sule; Demir, Saliha Eroglu

    2015-01-01

    The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.

  2. Results of a prospective clinical study on the diagnostic performance of standard magnetic resonance imaging in comparison to a combination of 3T MRI and additional CT imaging in Kienböck's disease.

    Science.gov (United States)

    Stahl, Stephane; Hentschel, Pascal; Ketelsen, Dominik; Grosse, Ulrich; Held, Manuel; Wahler, Theodora; Syha, Roland; Schaller, Hans-Eberhard; Nikolaou, Konstantin; Grözinger, Gerd

    2017-05-01

    This prospective clinical study examined standard wrist magnetic resonance imaging (MRI) examinations and the incremental value of computed tomography (CT) in the diagnosis of Kienböck's disease (KD) with regard to reliability and precision in the different diagnostic steps during diagnostic work-up. Sixty-four consecutive patients referred between January 2009 and January 2014 with positive initial suspicion of KD according to external standard wrist MRI were prospectively included (step one). Institutional review board approval was obtained. Clinical examination by two handsurgeons were followed by wrist radiographs (step two), ultrathin-section CT, and 3T contrast-enhanced MRI (step three). Final diagnosis was established in a consensus conference involving all examiners and all examinations results available from step three. In 12/64 patients, initial suspicion was discarded at step two and in 34/64 patients, the initial suspicion of KD was finally discarded at step three. The final external MRI positive predictive value was 47%. The most common differential diagnoses at step three were intraosseous cysts (n=15), lunate pseudarthrosis (n=13), and ulnar impaction syndrome (n=5). A correlation between radiograph-based diagnoses (step two) with final diagnosis (step three) showed that initial suspicion of stage I KD had the lowest sensitivity for correct diagnosis (2/11). Technical factors associated with a false positive external MRI KD diagnosis were not found. Standard wrist MRI should be complemented with thin-section CT, and interdisciplinary interpretation of images and clinical data, to increase diagnostic accuracy in patients with suspected KD. Copyright © 2017. Published by Elsevier B.V.

  3. Synovitis of the wrist joint caused by an intraarticular perforation of an osteoid osteoma of the scaphoid

    Directory of Open Access Journals (Sweden)

    Praveen Bhardwaj

    2012-01-01

    Full Text Available Uncommon location and atypical presentation of the osteoid osteomas of the scaphoid can pose a diagnostic challenge. Because of its intraarticular location, scaphoid osteoid osteoma can present with synovitis which is the more commonly reported presentation for other intraarticular locations like in hip and elbow and only rarely reported at the wrist. We report a case of perforation of the osteoid osteoma into the wrist joint, resulting in exuberant synovitis. The clinical significance of this report is to reinforce that synovitis can be a presentation of osteoid osteoma and it should be considered in the differential diagnosis of monoarticular arthritis. Prolonged synovitis may cause damage to the other joint surfaces of the wrist and hence carpal osteoid osteoma should be considered for early surgical excision.

  4. A laboratory study of the effects of wrist splint orthoses on forearm muscle activity and upper extremity posture.

    Science.gov (United States)

    Shu, Yu; Mirka, Gary A

    2006-01-01

    To evaluate the effects of wrist splint orthoses (WSOs) on forearm muscle activity and upper extremity/torso postures. WSOs are ubiquitous in industry, but the literature as to their biomechanical effects is limited. Study 1: Participants performed single-plane wrist exertions with or without a WSO while the electromyographic (EMG) activity of the flexor carpi radialis, flexor carpi ulnaris, and extensor carpi ulnaris was captured. Study 2: Participants performed simple computer jumper installation tasks with or without a WSO while upper extremity/torso postures were recorded. Study 1: A significant interaction between WSOs and wrist angle was observed in the response of forearm muscles (e.g., normalized EMG of the flexor carpi radialis increased from 4.2% to 15.9% as flexion increased from 0 degree to 36 degrees in the orthosis conditions, whereas in the no-orthosis condition it remained approximately 5% at all wrist flexion angles). Study 2: WSOs were found to effect wrist, torso, and shoulder postures, with the orthoses creating a 48% decrease (36 degrees vs. 18.6 degrees) in wrist flexion and 80% decrease (15 degrees vs. -3 degrees) in ulnar deviation but at a cost of increased shoulder abduction of 22% (36.5 degrees vs. 44.5 degrees) and increased lateral bend of torso of 30% (6 degrees vs. 7.8 degrees). WSOs increased forearm muscle activity at large wrist deviation angles and induced awkward shoulder postures in tasks requiring significant wrist deviation. Use of WSOs in occupational settings should be carefully considered relative to task requirements, as orthoses may do more harm than good.

  5. Substantia nigra fractional anisotropy is not a diagnostic biomarker of Parkinson's disease: A diagnostic performance study and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Hirata, Fabiana C.C.; Vieira, Gilson; Lucato, Leandro T.; Leite, Claudia C.; Pastorello, Bruno F.; Otaduy, Maria C.G.; Chaim, Khallil T.; Campanholo, Kenia R. [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Sato, Joao R. [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Universidade Federal do ABC, Center of Mathematics, Computation and Cognition, Santo Andre (Brazil); Bor-Seng-Shu, Edson; Novaes, Natalia P. [Hospital Israelita Albert Einstein, Sao Paulo (Brazil); University of Sao Paulo, Department of Neurology, Sao Paulo (Brazil); Magalhaes Melo, Luciano; Goncalves, Marcia R.; Reis Barbosa, Egberto [University of Sao Paulo, Department of Neurology, Sao Paulo (Brazil); Pereira do Nascimento, Felipe Barjud; Amaro, Edson [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Hospital Israelita Albert Einstein, Sao Paulo (Brazil); Jacobsen Teixeira, Manoel [University of Sao Paulo, Department of Neurosurgery, Sao Paulo (Brazil); Cardoso, Ellison Fernando [University of Sao Paulo, LIM-44, Department of Radiology, Sao Paulo, SP (Brazil); Hospital Israelita Albert Einstein, Sao Paulo (Brazil); Institute of Mathematics and Statistics University of Sao Paulo (IME-USP), Sao Paulo (Brazil)

    2017-06-15

    Our goal was to estimate the diagnostic accuracy of substantia nigra fractional anisotropy (SN-FA) for Parkinson's disease (PD) diagnosis in a sample similar to the clinical setting, including patients with essential tremor (ET) and healthy controls (HC). We also performed a systematic review and meta-analysis to estimate mean change in SN-FA induced by PD and its diagnostic accuracy. Our sample consisted of 135 subjects: 72 PD, 21 ET and 42 HC. To address inter-scanner variability, two 3.0-T MRI scans were performed. MRI results of this sample were pooled into a meta-analysis that included 1,432 subjects (806 PD and 626 HC). A bivariate model was used to evaluate diagnostic accuracy measures. In our sample, we did not observe a significant effect of disease on SN-FA and it was uninformative for diagnosis. The results of the meta-analysis estimated a 0.03 decrease in mean SN-FA in PD relative to HC (CI: 0.01-0.05). However, the discriminatory capability of SN-FA to diagnose PD was low: pooled sensitivity and specificity were 72 % (CI: 68-75) and 63 % (CI: 58-70), respectively. There was high heterogeneity between studies (I{sup 2} = 91.9 %). SN-FA cannot be used as an isolated measure to diagnose PD. (orig.)

  6. Atypical Triggering at the Wrist due to Intratendinous Infiltration of Tophaceous Gout

    OpenAIRE

    Sano, Kazufumi; Kohakura, Yoshitake; Kimura, Kazumasa; Ozeki, Satoru

    2008-01-01

    This is a report of a 41-year-old male with triggering of the long finger flexor digitorum superficialis tendon at the wrist secondary to tophaceous gout. The tophus was severely infiltrating the tendon, and a tenotomy of the FDS tendon was performed. Preoperatively, the lesion could not be distinguished from a neoplasm.

  7. The effect of the Futuro wrist brace in pain conditions of the wrist.

    Science.gov (United States)

    Biddulph, S L

    1981-09-05

    In a study to assess the effects of the Futuro wrist brace (Adcock-Ingram) in 22 patients with osteoarthritis, rheumatoid arthritis, tenosynovitis and gout of the wrist, grip and pinch dynamometers were used to measure improvement in function. The study confirmed the efficacy of the wrist brace by demonstrating an average of 23.7% improvement in grip strength over the 10-day study, as well as a significant average improvement in pinch strength of 14.8% (P less than 0.05). In the subgroup of 8 rheumatoid arthritis patients a significant average increase in grip strength of 48.9% (P less than 0.025) was obtained. Both day and night pain was reduced and there was improvement in patients' ability to carry out their daily activities. The brace was found to be comfortable and easy to use.

  8. An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

    Science.gov (United States)

    Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

    The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

  9. Diagnostic Performance of Gray-scale Sonographic Findings for the Detection of Acute Pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hui Jin; Kim, Young Jun; Park, Hee Sun; Jeon, Hae Jeong; Park, Hyoung Keun; Paick, Sung Hyun; Kim, Hyeong Gon; Lho, Yong Soo; Jung, Sung Il [Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To evaluate the diagnostic performance of gray-scale renal sonographic findings for the diagnosis of acute pyelonephritis (APN) by using computed tomography as a reference standard. We retrospectively reviewed gray-scale renal sonographic findings of 48 patients for the detection of APN. All patients had clinical symptoms such as fever, flank pain, or dysuria and were confirmed as APN by contrast- enhanced CT. The presence of sonographic findings such as renal swelling, alteration of the parenchymal echogenicity, wall thickening of the renal pelvis, loss of the renal sinus fat echogenicity, and loss of the corticomedullary differentiation were evaluated. We also categorized all patients into mild APN or severe APN groups according to the volume of the morbid renal parenchyma on contrast-enhanced CT, and evaluated the aforementioned sonographic findings between the two groups. Overall diagnostic sensitivity, specificity, and accuracy of gray-scale renal ultrasonography (US) for the detection of APN were 32.5%, 72.0%, and 58.5%, respectively. The sensitivity and specificity of each sonographic finding were measured for each group. Renal swelling sensitivity and specificity were 33.8% and 70.8% for the mild APN group, but 45.8% and 66.7% for the severe APN group. Sensitivity and specificity for alteration of the parenchymal echogenicity were 41.7% and 79.2% for the mild APN group, but 58.3% and 66.7% for the severe APN group. The sensitivity and specificity for wall thickening of the renal pelvis was 37.5% and 95.8% for the mild APN group, but 50.0% and 95.8% for the severe APN group. The sensitivity and specificity of loss of the renal sinus fat echogenicity were 12.5% and 83.3% for the mild APN group, but 12.5% and 91.7% for the severe APN group. The sensitivity and specificity of the loss of the corticomedullary differentiation were 12.5% and 95.8% for the mild APN group, but 20.8% and 75.0% for the severe APN group. There was no significant difference of gray

  10. WRIST SALVAGE PROCEDURES ALTER MOMENT ARMS OF THE PRIMARY WRIST MUSCLES

    Science.gov (United States)

    Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.

    2015-01-01

    Background Proximal row carpectomy and scaphoid-excision four-corner fusion are salvage procedures that relieve pain by removing arthritic joint surfaces. While numerous studies have examined how these procedures affect joint motion, few have examined how they influence muscle mechanical actions. This study examines whether muscle moment arms change after these procedures. Methods Moment arms of primary wrist muscles were measured in 8 cadaveric specimens using the tendon excursion method. In each specimen, moment arms were measured for two degrees of freedom (flexion-extension and radial-ulnar deviation) and three conditions (nonimpaired, scaphoid-excision four-corner fusion, and proximal row carpectomy). For each muscle and degree of freedom, moment arm versus joint angle curves for the three conditions were statistically compared. Findings Wrist salvage procedures significantly alter moment arms of the primary wrist muscles. Proximal row carpectomy primarily alters flexion-extension moment arms, while scaphoid-excision four-corner fusion primarily alters radial-ulnar deviation moment arms. Both procedures also alter the balance between agonist and antagonist wrist muscles. Following proximal row carpectomy, wrist extensors have smaller moment arms in extended postures. Following scaphoid-excision four-corner fusion, radial deviators have larger moment arms throughout radial-ulnar deviation. Interpretation Different moment arms indicate that different forces are required to complete the same tasks in nonimpaired and surgically altered wrists. The altered muscle moment arms likely contribute to post-operative impairments. Understanding how salvage procedures alter muscle mechanical actions is a critical first step toward identifying the cause of post-operative impairments and is necessary to develop effective interventions to augment deficient muscles and improve overall function. PMID:25843482

  11. Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study.

    Science.gov (United States)

    Wang, Jane; Chang, King-Jen; Chen, Chin-Yu; Chien, Kuo-Liong; Tsai, Yuh-Show; Wu, Yuh-Ming; Teng, Yu-Chuan; Shih, Tiffany Ting-Fang

    2010-01-07

    The study was conducted to investigate the diagnostic performance of infrared (IR) imaging of the breast using an interpretive model derived from a scoring system. The study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8) with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring system that combines five IR signs. The ROC (receiver operating characteristic) curve and AUC (area under the ROC curve) were analyzed by the univariate logistic regression model for each IR sign and an age-adjusted multivariate logistic regression model including 5 IR signs. The cut-off values and corresponding sensitivity, specificity, Youden's Index (Index = sensitivity+specificity-1), positive predictive value (PPV), negative predictive value (NPV) were estimated from the age-adjusted multivariate model. The most optimal cut-off value was determined by the one with highest Youden's Index. For the univariate model, the AUC of the ROC curve from five IR signs ranged from 0.557 to 0.701, and the AUC of the ROC from the age-adjusted multivariate model was 0.828. From the ROC derived from the multivariate model, the sensitivity of the most optimal cut-off value would be 72.4% with the corresponding specificity 76.6% (Youden's Index = 0.49), PPV 81.3% and NPV 66.4%. We established an interpretive age-adjusted multivariate model for IR imaging of the breast. The cut-off values and the corresponding sensitivity and specificity can be inferred from the model in a subpopulation for diagnostic purpose. NCT00166998.

  12. Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study

    Directory of Open Access Journals (Sweden)

    Wu Yuh-Ming

    2010-01-01

    Full Text Available Abstract Background The study was conducted to investigate the diagnostic performance of infrared (IR imaging of the breast using an interpretive model derived from a scoring system. Methods The study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8 with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring system that combines five IR signs. The ROC (receiver operating characteristic curve and AUC (area under the ROC curve were analyzed by the univariate logistic regression model for each IR sign and an age-adjusted multivariate logistic regression model including 5 IR signs. The cut-off values and corresponding sensitivity, specificity, Youden's Index (Index = sensitivity+specificity-1, positive predictive value (PPV, negative predictive value (NPV were estimated from the age-adjusted multivariate model. The most optimal cut-off value was determined by the one with highest Youden's Index. Results For the univariate model, the AUC of the ROC curve from five IR signs ranged from 0.557 to 0.701, and the AUC of the ROC from the age-adjusted multivariate model was 0.828. From the ROC derived from the multivariate model, the sensitivity of the most optimal cut-off value would be 72.4% with the corresponding specificity 76.6% (Youden's Index = 0.49, PPV 81.3% and NPV 66.4%. Conclusions We established an interpretive age-adjusted multivariate model for IR imaging of the breast. The cut-off values and the corresponding sensitivity and specificity can be inferred from the model in a subpopulation for diagnostic purpose. Trial Registration NCT00166998.

  13. Diagnostic performance of line-immunoassay based algorithms for incident HIV-1 infection

    Directory of Open Access Journals (Sweden)

    Schüpbach Jörg

    2012-04-01

    Full Text Available Abstract Background Serologic testing algorithms for recent HIV seroconversion (STARHS provide important information for HIV surveillance. We have previously demonstrated that a patient's antibody reaction pattern in a confirmatory line immunoassay (INNO-LIA™ HIV I/II Score provides information on the duration of infection, which is unaffected by clinical, immunological and viral variables. In this report we have set out to determine the diagnostic performance of Inno-Lia algorithms for identifying incident infections in patients with known duration of infection and evaluated the algorithms in annual cohorts of HIV notifications. Methods Diagnostic sensitivity was determined in 527 treatment-naive patients infected for up to 12 months. Specificity was determined in 740 patients infected for longer than 12 months. Plasma was tested by Inno-Lia and classified as either incident ( Results The 10 best algorithms had a mean raw sensitivity of 59.4% and a mean specificity of 95.1%. Adjustment for overrepresentation of patients in the first quarter year of infection further reduced the sensitivity. In the preferred model, the mean adjusted sensitivity was 37.4%. Application of the 10 best algorithms to four annual cohorts of HIV-1 notifications totalling 2'595 patients yielded a mean IIR of 0.35 in 2005/6 (baseline and of 0.45, 0.42 and 0.35 in 2008, 2009 and 2010, respectively. The increase between baseline and 2008 and the ensuing decreases were highly significant. Other adjustment models yielded different absolute IIR, although the relative changes between the cohorts were identical for all models. Conclusions The method can be used for comparing IIR in annual cohorts of HIV notifications. The use of several different algorithms in combination, each with its own sensitivity and specificity to detect incident infection, is advisable as this reduces the impact of individual imperfections stemming primarily from relatively low sensitivities and

  14. Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

    Science.gov (United States)

    Zhou, Zhi-Rui; Wang, Chen-Chen; Sun, Xiang-Jie; Yang, Zhao-Zhi

    2016-01-01

    Background A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis. Methods Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors. Results The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98 (75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB. Conclusions CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis. PMID:28066593

  15. Elbow and wrist/hand symptoms among 6,943 computer operators: a 1-year follow-up study (the NUDATA study)

    DEFF Research Database (Denmark)

    Lassen, C. F.; Mikkelsen, S.; Kryger, Ann Isabel

    2004-01-01

    exposures and associations with elbow and wrist/hand pain were determined. Standardized clinical examinations were performed among symptomatic participants at baseline and at follow-up. RESULTS: For continuous duration of mouse time adjusted linear effects were statistically significant for all investigated...... pain conditions. For continuous duration of keyboard time the corresponding effects were statistically significant for wrist/hand pain conditions except incident 'severe' wrist/hand pain. There were no threshold effects above 0 hr per week (hr/w) of mouse exposure in association with pain conditions......, while keyboard exposure showed a threshold effect with 12-month wrist/hand pain at follow-up. Clinical diagnoses were not associated with exposure. CONCLUSIONS: Detailed examination of self-reported exposures showed that mouse and keyboard time predicted elbow and wrist/hand pain from low exposure...

  16. Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study.

    Science.gov (United States)

    Hamamoto, Yosuke; Ito, Hiromu; Furu, Moritoshi; Hashimoto, Motomu; Fujii, Takao; Ishikawa, Masahiro; Yamakawa, Noriyuki; Terao, Chikashi; Azukizawa, Masayuki; Iwata, Takahiro; Mimori, Tsuneyo; Matsuda, Shuichi

    2015-01-01

    To investigate clinical and radiological differences between joint destruction in the wrist and the feet in patients with RA. A cross-sectional clinical study was conducted in an RA cohort at a single institution. Clinical data included age, sex and duration of disease. Laboratory data included sero-positivity for anti-cyclic citrullinated peptide (CCP) antibody and RF. Radiological measurements included Larsen grades and the modified Sharp/van der Heijde method (SHS) for the hands/wrists and the feet. Statistical analyses were performed using the Kruskal-Wallis H-test, a dummy variable linear regression model and multivariate logistic regression analysis with 95% confidence interval and odds ratios. A total of 405 patients were enrolled, and 314 patients were analysed in this study. The duration of disease in the foot-dominant group was significantly less than that in the wrist-dominant group. When patients were subdivided by duration of disease, the Larsen grade of the feet was significantly higher than that of the wrist in the first quadrant subgroup, but this was reversed with increasing duration of disease. Anti-CCP status was a significant predictive factor for joint destruction in the wrist but not in the feet, while RF status was not predictive in either the wrist or the feet. Joint destruction in the feet started earlier than in the wrist, but the latter progresses faster with increasing duration of disease. Anti-CCP status predicts joint destruction in the wrist better than in the feet.

  17. The diagnostic performance of ultrasound in the detection of ectopic pregnancy.

    Science.gov (United States)

    Young, Lee; Barnard, Cecilia; Lewis, Elisabeth; Jones, Matthew; Furlan, Jana; Karatasiou, Angela; Necas, Martin

    2017-03-24

    Accurate diagnosis of ectopic pregnancy is essential in reducing maternal mortality and morbidity. Transvaginal ultrasound (TVUS) is the accepted imaging modality of choice for the diagnosis of ectopic pregnancy (EP). To assess the effectiveness of transvaginal ultrasound (TVUS) in the detection of EP in consecutive women presenting for ultrasound to a radiology department with a clinical suspicion of EP. Retrospective analysis of 585 women presenting for TVUS over a 2.5-year period was performed. Women were classified as having a confirmed EP on the basis of surgery and histology. Women with a suspected EP who were treated medically or expectantly were also included. Eighty-seven women had a confirmed EP and 29 women had a suspected EP. The sensitivity and specificity of ultrasound for the detection of confirmed EP was 88.5% and 96.5% on the initial TVUS and 93.1% and 95.7% with an additional rescan. TVUS in the radiology setting of a tertiary hospital has excellent diagnostic performance for the detection of EP.

  18. Diagnostic performance of computed tomography for detection of concomitant coronary disease in hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lei; Ma, Xiaohai; Zhang, Chen; Wang, Zhanhong; Fan, Zhanming [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); Ge, Hailong [Capital Medical University, Department of Cardiology, Beijing Anzhen Hospital, Beijing (China); Teraoka, Kunihiko [Tokyo Medical University, Department of Cardiology, Tokyo (Japan)

    2014-10-31

    To evaluate the diagnostic performance of computed tomography (CT) in patients with hypertrophic cardiomyopathy (HCM) and suspected coexistent coronary artery diseases (CADs). Sixty patients were enrolled in this study. Cardiac CT examination included CT coronary angiography (CTCA) and delayed enhancement CT. CT performance in evaluation of the coronary artery was assessed and compared with that of catheter-based coronary angiography (CA). The left ventricle (LV) wall thickness, functional indices and myocardial delayed enhancement (MDE) were measured via cardiac magnetic resonance (CMR) and CT images. Compared with catheter-based CA, CTCA produced a 100 % (24/24) sensitivity, a 94.4 % (34/36) specificity, a 92.3 % (24/26) positive predictive value and a 100 % (34/34) negative predictive value. CT-measured LV wall thickness and functional indices were correlated with those measured via CMR (P < 0.01), though the CT-measured values were smaller than the CMR-measured values. Bland-Altman analysis showed the volume of the focal MDE determined via CT was slightly smaller than that determined using CMR (mean difference: 0.3 cm{sup 3}). For patients with HCM and suspected coexistent CAD, this comprehensive cardiac CT protocol can be helpful in ruling out coronary stenosis and can provide information regarding morphology, function and tissue characterization of the LV myocardium. (orig.)

  19. Performance Evaluation and Implementation of FPGA Based SGSF in Smart Diagnostic Applications.

    Science.gov (United States)

    Agarwal, Shivangi; Rani, Asha; Singh, Vijander; Mittal, A P

    2016-03-01

    The main objective of the paper is to implement Savitzky Golay Smoothing Filter (SGSF) so as to apply in pre-processing of real time smart medical diagnostic systems. As very important information of EEG and ECG waveforms lies in the peak of the signal, hence it becomes absolutely necessary to filter noise and artifacts from the signal. The implemented filter should be able to reject the noise efficiently along with the least distortion from the original signal. The shape preserving characteristics of the filter are determined by introducing different noise levels in the signal. The designed filter is tested on synthetic signals of EEG and ECG by adding different types of noise and the performance is analysed on various parameters, i.e., SNR, SSNR, SNRI, MSE, COR and signal distortion of the final output. The smoothing performance comparison of SGSF with the most commonly used Moving Average Filter (MAF) proves that SGSF is more efficient. Hence it is suggested that MAF can be replaced by SGSF. For real time issues, it is further implemented on reconfigurable architectures so as to achieve high speed, low cost, low power consumption and less area. Therefore SGSF is realized on FPGA platform to combine the advantages of both. Real time EEG and ECG signals are also considered for experimentation. The experimental results show that the proposed methodology (FPGA-SGSF) significantly reduces the processing time and preserves the actual features of the signal.

  20. Beyond complications: Comparison of procedural differences and diagnostic success between nurse practitioners and radiologists performing image-guided renal biopsies.

    Science.gov (United States)

    Nandwana, Sadhna B; Walls, Deborah G; Ibraheem, Oluwayemisi; Murphy, Frederick; Tridandapani, Srini; Cox, Kelly

    2016-10-01

    Radiology-trained nurse practitioners (NPs) may perform image-guided medical renal biopsies with computed tomography (CT). This study evaluates the procedural differences and diagnostic success between biopsies performed by NPs compared to radiologists. A retrospective study was performed on patients who underwent nontargeted, CT-guided renal biopsy between 2009 and 2014. Provider type (NP or radiologist), number of core specimens obtained, sedation medication dose, CT dose index (CTDI), and diagnostic success were recorded. Categorical and continuous variables were analyzed using χ 2 and Student's two-tailed t-test, respectively, comparing NPs with radiologists. A total of 386 patients were included; radiologists performed 215 biopsies and NPs performed 171 biopsies. There was no significant difference in diagnostic success, amount of tissue harvested (number of cores), radiation dose, or sedation dosage between NPs and radiologists performing CT-guided renal biopsies. Only 4% were nondiagnostic (n = 7, radiologists; n = 9, NPs; p = .325). Overall mean number of cores obtained was 3.7, mean CTDI was 176.5 mGy, mean fentanyl dose was 86.3 μg, and mean midazolam was dose 1.54 mg without a statistically significant difference between provider types. NPs perform image-guided medical renal biopsies in a similar fashion to radiologists with respect to diagnostic success, amount of tissue harvested, total radiation dose exposure, and administration of sedation. ©2016 American Association of Nurse Practitioners.

  1. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  2. Robot Control Using Electromyography (EMG Signals of the Wrist

    Directory of Open Access Journals (Sweden)

    C. DaSalla

    2005-01-01

    Full Text Available The aim of this paper is to design a human–interface system, using EMG signals elicited by various wrist movements, to control a robot. EMG signals are normalized and based on joint torque. A three-layer neural network is used to estimate posture of the wrist and forearm from EMG signals. After training the neural network and obtaining appropriate weights, the subject was able to control the robot in real time using wrist and forearm movements.

  3. Position-dependent characterization of passive wrist stiffness.

    Science.gov (United States)

    Pando, Autumn L; Lee, Hyunglae; Drake, Will B; Hogan, Neville; Charles, Steven K

    2014-08-01

    Because the dynamics of wrist rotations are dominated by stiffness, understanding wrist rotations requires a thorough characterization of wrist stiffness in multiple degrees of freedom. The only prior measurement of multivariable wrist stiffness was confined to approximately one-seventh of the wrist range of motion (ROM). Here, we present a precise nonlinear characterization of passive wrist joint stiffness over a range three times greater, which covers approximately 70% of the functional ROM of the wrist. We measured the torque-displacement vector field in 24 directions and fit the data using thin-plate spline smoothing optimized with generalized cross validation. To assess anisotropy and nonlinearity, we subsequently derived several different approximations of the stiffness due to this multivariable vector field. The directional variation of stiffness was more pronounced than reported previously. A linear approximation (obtained by multiple linear regression over the entire field) was significantly more anisotropic (eigenvalue ratio of 2.69 ± 0.52 versus 1.58 ± 0.39; ) though less misaligned with the anatomical wrist axes (12.1 ± 4.6° versus 21.2 ± 9.2°; ). We also found that stiffness over this range exhibited considerable nonlinearity-the error associated with a linear approximation was 20-30%. The nonlinear characterization over this greater range confirmed significantly greater stiffness in radial deviation compared to ulnar deviation. This study provides a characterization of passive wrist stiffness better suited to investigations of natural wrist rotations, which cover much of the wrist's ROM. It also provides a baseline for the study of neurological and/or orthopedic disorders that result in abnormal wrist stiffness.

  4. Exposures of the wrist and distal radioulnar joint.

    Science.gov (United States)

    Bickel, Kyle D

    2014-11-01

    This article reviews the superficial, skeletal, and ligamentous anatomy of the wrist. Standard and alternative exposures of the wrist joint and the distal radioulnar joint are discussed, emphasizing the importance of avoiding nerve injury. Standard exposure of the wrist joint is used in the treatment of carpal ligament injuries, fractures, and dislocations. Case presentations illustrate these techniques. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Wrist immobilization after carpal tunnel release: a prospective study

    OpenAIRE

    Martins Roberto S.; Siqueira Mario G.; Simplício Hougelli

    2006-01-01

    This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26) the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26) no wrist immobilization was used. Clinical assessment...

  6. IMU-Based Wrist Rotation Control of a Transradial Myoelectric Prosthesis.

    Science.gov (United States)

    Bennett, Daniel A; Goldfarb, Michael

    2017-03-15

    This paper describes a control method intended to fa-cilitate improved control of a myoelectric prosthesis containing a wrist rotator. Rather than exclusively utilize electromyogram (EMG) for the control of all myoelectric components (e.g., a hand and a wrist), the proposed controller utilizes inertial measurement (from 6-axis inertial measurement unit, or IMU) to sense upper arm ab/adduction, and uses this input to command a wrist rotation velocity. As such, the controller essentially substitutes shoulder ab/adduction in place of agonist/antagonist EMG to control wrist angular velocity, which preserves EMG for control of the hand (or other arm components). As a preliminary assessment of efficacy, the control method was implemented on a transradial prosthesis prototype with a powered wrist rotator and hand, and experimen-tally assessed on five able-bodied subjects who wore the prototype using an able-bodied adaptor and one transradial amputee subject while performing assessments representative of activities of daily living (ADLs). The assessments compared the (timed) perfor-mance of the combined EMG/IMU-based control method with a (conventional) sequential EMG control approach. Results of the assessment indicate that able-bodied subjects were able to perform the tasks 33% faster on average with the EMG/IMU-based method, relative to a conventional sequential EMG method. The same assessment was subsequently conducted using a single transradial amputee subject, which resulted in similar perfor-mance trends, although with a somewhat lessened effect size - spe-cifically, the amputee subject was on average 22% faster in per-forming tasks with the IMU-based controller.

  7. A cable-driven wrist robotic rehabilitator using a novel torque-field controller for human motion training.

    Science.gov (United States)

    Chen, Weihai; Cui, Xiang; Zhang, Jianbin; Wang, Jianhua

    2015-06-01

    Rehabilitation technologies have great potentials in assisted motion training for stroke patients. Considering that wrist motion plays an important role in arm dexterous manipulation of activities of daily living, this paper focuses on developing a cable-driven wrist robotic rehabilitator (CDWRR) for motion training or assistance to subjects with motor disabilities. The CDWRR utilizes the wrist skeletal joints and arm segments as the supporting structure and takes advantage of cable-driven parallel design to build the system, which brings the properties of flexibility, low-cost, and low-weight. The controller of the CDWRR is designed typically based on a virtual torque-field, which is to plan "assist-as-needed" torques for the spherical motion of wrist responding to the orientation deviation in wrist motion training. The torque-field controller can be customized to different levels of rehabilitation training requirements by tuning the field parameters. Additionally, a rapidly convergent parameter self-identification algorithm is developed to obtain the uncertain parameters automatically for the floating wearable structure of the CDWRR. Finally, experiments on a healthy subject are carried out to demonstrate the performance of the controller and the feasibility of the CDWRR on wrist motion training or assistance.

  8. A cable-driven wrist robotic rehabilitator using a novel torque-field controller for human motion training

    Science.gov (United States)

    Chen, Weihai; Cui, Xiang; Zhang, Jianbin; Wang, Jianhua

    2015-06-01

    Rehabilitation technologies have great potentials in assisted motion training for stroke patients. Considering that wrist motion plays an important role in arm dexterous manipulation of activities of daily living, this paper focuses on developing a cable-driven wrist robotic rehabilitator (CDWRR) for motion training or assistance to subjects with motor disabilities. The CDWRR utilizes the wrist skeletal joints and arm segments as the supporting structure and takes advantage of cable-driven parallel design to build the system, which brings the properties of flexibility, low-cost, and low-weight. The controller of the CDWRR is designed typically based on a virtual torque-field, which is to plan "assist-as-needed" torques for the spherical motion of wrist responding to the orientation deviation in wrist motion training. The torque-field controller can be customized to different levels of rehabilitation training requirements by tuning the field parameters. Additionally, a rapidly convergent parameter self-identification algorithm is developed to obtain the uncertain parameters automatically for the floating wearable structure of the CDWRR. Finally, experiments on a healthy subject are carried out to demonstrate the performance of the controller and the feasibility of the CDWRR on wrist motion training or assistance.

  9. Biodynamics of the wrist: radiologic approach to scapholunate instability.

    Science.gov (United States)

    Schuhl, J F; Leroy, B; Comtet, J J

    1985-11-01

    A study of 126 normal wrists has allowed us to determine the normal laxity of the scapholunate complex (36 degrees) by measuring and comparing the range of movement of each of these two bones on sagittal views on x-ray films. There was no difference between dominant and nondominant hands. A study of eight cadaver wrists and 13 pathologic wrists has shown greater SL in the presence of scapholunate ligament lesions. The measurement of SL on dynamic sagittal views on x-ray films can detect a pathologic laxity between these two bones. A minimal 15 degrees difference between a normal and a pathologic wrist is reliable.

  10. Wrist flexion strength after excision of the pisiform bone.

    Science.gov (United States)

    Arner, M; Hagberg, L

    1984-01-01

    Diseases of the pisiform triquetral (P-T) joint and the pisiform itself are often treated with excision of the pisiform bone. The flexor carpi ulnaris (FCU) tendon inserts on the volar aspect of the pisiform, suggesting a loss of strength in wrist flexion following excision of the bone. Isometric and dynamic, isokinetical measurements were made using a strain-gauge dynamometer (Cybex II). Slight postoperative reduction of wrist flexion strength, compared with the contralateral wrist, was noted but not of clinical significance. It is concluded that one should not refrain from excision of the pisiform bone for fear of considerable strength loss in wrist joint flexion.

  11. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

    Energy Technology Data Exchange (ETDEWEB)

    Medina, L.S. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Miami Children' s Hospital, Department of Radiology, Miami, FL (United States); Yaylali, Ilker [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); Zurakowski, David [Harvard Medical School, Boston Children' s Hospital, Boston, MA (United States); Ruiz, Jennifer; Altman, Nolan R. [Miami Children' s Hospital, Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami, FL (United States); Grossman, John A.I. [Miami Children' s Hospital, Brachial Plexus and Peripheral Nerve Surgery Program, Miami, FL (United States); New York University, Hospital for Joint Disease, New York, NY (United States)

    2006-12-15

    Detailed evaluation of a brachial plexus birth injury is important for treatment planning. To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine

  12. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients-a randomized controlled trial

    DEFF Research Database (Denmark)

    Todsen, Tobias; Jensen, Morten Lind; Tolsgaard, Martin Grønnebæk

    2016-01-01

    on patients. METHODS: Thirty-one physicians were randomized to participate in a focused Ultrasonography course or control circumstances before they examined 4 patients with different abdominal conditions by ultrasonography. Performance scores and diagnostic accuracy were compared using independent samples t...... test and binary logistic regression, respectively. RESULTS: There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014...

  13. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist.

    Science.gov (United States)

    Hagert, Elisabet

    2010-01-01

    Narrative review. Recent years have brought new research findings on the subject of wrist joint proprioception, which entails an understanding of the wrist as part of a sensorimotor system where afferent information from nerve endings in the wrist joint affects the neuromuscular control of the joint. An understanding of proprioception is also essential to adequately rehabilitate patients after wrist injuries. The aim of this narrative review was to give the reader a background of proprioception as it relates to neuromuscular control and joint stability, what is presently known in relation to the wrist joint and how these findings may be applied to the field of wrist rehabilitation. 5. Copyright (c) 2010 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  14. Diagnostic performance of interferon-gamma releasing assay in HIV-infected patients in China.

    Directory of Open Access Journals (Sweden)

    Yanhua Yu

    Full Text Available BACKGROUND: Active tuberculosis infection represents a very common and significant threat to HIV-infected patients. But measures to accurately detect it are limited. OBJECTIVE: To compare and analyze the diagnostic efficacy of T-SPOT.TB alone and in combination with TST in HIV-infected patients in China. METHOD: TST (tuberculin skin test and T-SPOT.TB were performed on 131 HIV-infected patients admitted in Beijing You'an Hospital and Beijing Ditan Hospital between Oct, 2010 and Jul, 2012, who were initially diagnosed as suspected ATB (active TB. The patients were further categorized into ATB and Not ATB based on clinical and cultural evidences. The performance of TST and T-SPOT.TB were analyzed and compared. RESULTS: The sensitivity and specificity of T-SPOT.TB were 41.3% and 94.6%, respectively, both higher than TST (12.9% and 91.8%. By combining T-SPOT.TB and TST, the sensitivity did not increase, but specificity was elevated to 100%. TST, T-SPOT.TB and their combinations all performed better in patients with extra-pulmonary diseases than with pulmonary disorders. False-positive T-SPOT.TB results were found to be associated with history of prior TB. In addition, concomitant bacterial infections and low CD4 counts were associated with increased ATB risk. CONCLUSIONS: T-SPOT.TB is superior in screening ATB in HIV-infected patients in China over traditional TST. Additional TST would help to confirm a positive T-SPOT.TB result. Both tests work better for patients with extra-pulmonary conditions.

  15. Dynamic contrast-enhanced magnetic resonance imaging of the wrist in early arthritis

    Directory of Open Access Journals (Sweden)

    M.A. Cimmino

    2011-09-01

    Full Text Available Objectives: MRI has been proposed as the imaging method of choice to evaluate the long-term outcome in patients with early arthritis. The role of dynamic MRI, performed at presentation, in predicting the outcome of patients with early arthritis has been addressed in the present study. Methods: 39 patients with early arthritis, involving at least one wrist, were studied with clinical visits and laboratory investigations, every 3 months. Dynamic MRI was performed with a low-field (0.2T, extremity-dedicated machine (Artoscan, Esaote, Genova, Italy equipped with a permanent magnet and with a dedicated hand and wrist coil. During the intravenous injection of Gd-DTPA, twenty consecutive fast images of 3 slices of the wrist were acquired. The synovial contrast enhancement ratio was calculated both as rate of early enhancement (REE per second during the first 55” and as relative enhancement (RE at t seconds. Results: In our cohort of patients, REE and RE were significantly lower than those observed in a historical cohort of 36 patients with active rheumatoid arthritis. In univariate analysis, low RE predicted complete remission of arthritis. In multivariate analysis, fulfillment of RA criteria during follow-up was predicted by high RE. The need for immunosuppressive treatment at the end of follow-up was predicted by both low RE and high REE. Conclusions: Dynamic MRI may be used to predict several outcomes of early arthritis involving the wrist

  16. Training wrist extensor function and detecting unwanted movement strategies in an EMG-controlled visuomotor task.

    Science.gov (United States)

    Lyu, Mingxing; Lambelet, Charles; Woolley, Daniel; Zhang, Xue; Chen, Weihai; Ding, Xilun; Gassert, Roger; Wenderoth, Nicole

    2017-07-01

    Stroke patients often suffer from severe upper limb paresis. Rehabilitation treatment typically targets motor impairments as early as possible, however, muscular contractions, particularly in the wrist and fingers, are often too weak to produce overt movements, making the initial phase of rehabilitation training difficult. Here we propose a new training tool whereby electromyographic (EMG) activity is measured in the wrist extensors and serves as a proxy of voluntary corticomotor drive. We used the Myo armband to develop a proportional EMG controller which allowed volunteers to perform a simple visuomotor task by modulating wrist extensor activity. In this preliminary study six healthy participants practiced the task for one session (144 trials), which resulted in a significant reduction of the average trial time required to move and hold a cursor in different target zones (p classifier to distinguish between the desired movement strategy and unwanted alternatives. Validation of the classifier indicated that accuracy for detecting rest, wrist extension and unwanted strategies was 92.5 + 6.9% (M + SD) across all participants. When performing the motor task the classification algorithm flagged 4.3 + 3.5% of the trials as 'unwanted strategies', even in healthy subjects. We also report initial feedback from a survey submitted to two chronic stroke patients to inquire about feasibility and acceptance of the general setup by patients.

  17. Single parameter wrist ultrasonography as a first-line screening examination in suspected carpal tunnel syndrome patients.

    Science.gov (United States)

    Kurca, E; Nosal, V; Grofik, M; Sivak, S; Turcanova-Koprusakova, M; Kucera, P

    2008-01-01

    Carpal tunnel syndrome (CTS) is the most common form of peripheral nerve entrapment. Electromyography with selected nerve conduction studies (NCS) is an accepted diagnostic tool in CTS patients. Ultrasonography presents a widely available and low cost investigation method and its position in CTS diagnostics needs further clarification with concrete recommendations for clinical practice. A prospective study of 37 patients with 74 wrists (59 wrists with suspected CTS) was done. Normative data were obtained from a control group of 25 healthy persons (50 wrists) age and sex matched. All persons underwent ultrasonographic examination (median nerve cross-sectional area at carpal tunnel entrance measurement--CSA) and median NCS studies (distal motor and sensory latency measurement--DML and DSL). CSA has a sensitivity of 93% (CI 84-97%) and specificity of 96% (CI 87-99%) in our patients group. Conventional first-line NCS studies results in our patients groupare as follows: DML sensitivity 58% (CI 45-69%) and specificity 100% (CI 93-100%); DSL sensitivity 88% (CI 78-94%) and specificity 94% (CI 84-98%). We recommend the use of single-parameter wrist ultrasonography as a first-line screening laboratory method in suspected CTS diagnosis (Ref. 14). Full Text (Free, PDF) www.bmj.sk.

  18. Robot-assisted assessment of wrist proprioception: does wrist proprioceptive acuity follow Weber's law?

    Science.gov (United States)

    Contu, Sara; Marini, Francesca; Cappello, Leonardo; Masia, Lorenzo

    2016-08-01

    Proprioception is essential for planning and controlling limb posture and movement. In our recent work, we introduced a standardized robot-aided method for measuring proprioceptive discrimination thresholds at the wrist to obtain reliable and accurate measures of proprioceptive acuity. Weber's law defines discrimination thresholds as a constant ratio between the just noticeable difference and the reference or standard stimulus. Reporting Weber's fractions thus provides the possibility of comparing results with the reports of others collected worldwide. This work aims to determine that Weber's Law holds for proprioceptive discrimination thresholds and to provide Weber's fraction for wrist joint proprioception. To this end, eight healthy subjects experienced two passive wrist movements of different amplitude and verbally indicated which was larger. An adaptive psychophysical procedure established the amplitude of the largest stimulus according to participants' responses. This comparison stimulus was then compared to a standard stimulus amplitude of 10°, 20°, 30° or 40°. The discrimination thresholds for each standard stimulus were established at the 75% correct response level. The obtained thresholds followed Weber's Law indicating that larger amplitudes were associated with higher discrimination thresholds. Based on a linear regression function the overall Weber's fraction, defined as the slope of the line, was computed to be 0.09. This result expands the present limited knowledge on wrist proprioception showing that its proprioceptive acuity follows Weber's law.

  19. Motor control impairment of the contralateral wrist in patients with unilateral chronic wrist pain

    NARCIS (Netherlands)

    Smeulders, MJC; Kreulen, M; Hage, JJ; Ritt, MJPF; Mulder, T

    Objective: Assessment of the quality of fine motor control in patients with unilateral chronic wrist pain seldom focuses on the possibility that control of movements is effector independent at the cerebral level. This mechanism may be involved in an impairment of motor function in the unaffected

  20. Unusual Wrist Tremor: Unilateral Isometric Tremor?

    Science.gov (United States)

    Zesiewicz, Theresa; Vu, Tuan; Carranza, Michael A.; Appelbaum, Rachel; Snyder, Madeline; Staffetti, Joseph S.; Allison, Kevin G.; Shimberg, William R.; Louis, Elan D.

    2014-01-01

    Background Tremors may be difficult to classify. Case Report An 83-year-old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water) of approximately 1 lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor. Discussion This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics. PMID:24455450

  1. Wrist-worn pervasive gaze interaction

    DEFF Research Database (Denmark)

    Hansen, John Paulin; Lund, Haakon; Biermann, Florian

    2016-01-01

    This paper addresses gaze interaction for smart home control, conducted from a wrist-worn unit. First we asked ten people to enact the gaze movements they would propose for e.g. opening a door or adjusting the room temperature. On basis of their suggestions we built and tested different versions...... selection. Their subjective evaluations were positive with regard to the speed of the interaction. We conclude that gaze gesture input seems feasible for fast and brief remote control of smart home technology provided that robustness of tracking is improved....

  2. Prosthesis of the wrist-joint

    Energy Technology Data Exchange (ETDEWEB)

    Feldmeier, C.

    1983-02-25

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

  3. Novel approach for assessing performance of PCR cyclers used for diagnostic testing.

    Science.gov (United States)

    Schoder, D; Schmalwieser, A; Schauberger, G; Hoorfar, J; Kuhn, M; Wagner, M

    2005-06-01

    As part of a large international project for validation and standardization of PCR, the influence of thermocyclers on PCR was tested. Six brand-new, Peltier technology-driven 96-well thermocyclers were subjected to a novel and stringent in-tube (not block) physical testing. The temperature was directly monitored in PCR tubes containing 50 microl of distilled water at 13 different block positions. The certified temperature accuracy of the measurement system was +/-0.3 degrees C. Finally, the results of the physical testing were compared to those of an amplification efficiency study running an in-house PCR assay. The cyclers did not perform within the manufacturer's specification. Premature timing, under- and overshooting, and spatial variation of heat transfer were found to be the critical factors. The physical testing allowed us to distinguish accurate from less-accurate (2/6) cyclers. The lack of thermal homogeneities became most evident at the denaturation level during the first 15 s. At the time point zero, the accurate cyclers showed temperature deviations of 0.5 to 1.5 degrees C, whereas less-accurate cyclers failed to reach the set temperature by 13 to 20 degrees C. Consequently, the two less-accurate cyclers could not gain positive PCR results by running an in-house PCR assay. However, by modifying the original temperature protocol by increasing the denaturation temperature and time, the amplification efficiency of these two cyclers could be improved significantly. The results have implication for laboratories using diagnostic PCR testing.

  4. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose.

    Science.gov (United States)

    Haggerty, Jay E; Smith, Ethan A; Kunisaki, Shaun M; Dillman, Jonathan R

    2015-07-01

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (reconstruction method. CTDIvol was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose.

  5. Low cut-off values increase diagnostic performance of protein S assays.

    Science.gov (United States)

    Mulder, René; Ten Kate, Min Ki; Kluin-Nelemans, Hanneke C; Mulder, André B

    2010-09-01

    Conflicting data have been reported on the accuracy of protein S (PS) assays for detection of hereditary PS deficiency. In this study we assessed the diagnostic performance of two total PS antigen assays, four free PS assays and three PS activity assays in a group of 28 heterozygous carriers of mutations in PROS1 and 165 control subjects. Several control groups were formed, one of healthy volunteers and - because PS levels are influenced by oral contraception and pregnancy, and assays measuring PS activity may be influenced by the presence of the factor V Leiden mutation -, we also investigated the influences of these factors. All nine PS assays detected significantly reduced PS levels in subjects with a PROS1 mutation. Eight out of nine PS assays showed a 100% sensitivity and 100% specificity to detect heterozygous carriers of mutations in PROS1 with values far below the lower limit of the reference values obtained from healthy volunteers. Low specificities were found in subjects with a factor V Leiden mutation and in pregnant women. At lower cut-off levels, equal to the highest PS value found in heterozygous carriers of mutations in PROS1, the specificity considerably increased in these subjects. When using low cut-off levels equal to the highest PS value found in heterozygous carriers of mutations in PROS1, ensuring 100% sensitivity, the specificity in all study groups increases considerably, by which misclassification can be maximally avoided.

  6. Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

    Directory of Open Access Journals (Sweden)

    Yasser E Nassef

    2013-11-01

    Full Text Available The aim of the present study was to identify specific markers that mirror liver fibrosis progression as an alternative to biopsy when biopsy is contraindicated, especially in children. After liver biopsies were performed, serum samples from 30 hepatitis C virus (HCV paediatric patients (8-14 years were analysed and compared with samples from 30 healthy subjects. All subjects were tested for the presence of serum anti-HCV antibodies. Direct biomarkers for liver fibrosis, including transforming growth factor-β1, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1, hyaluronic acid (HA, procollagen type III amino-terminal peptide (PIIINP and osteopontin (OPN, were measured. The indirect biomarkers aspartate and alanine aminotransferases, albumin and bilirubin were also tested. The results revealed a significant increase in the serum marker levels in HCV-infected children compared with the healthy group, whereas albumin levels exhibited a significant decrease. Significantly higher levels of PIIINP, TIMP-1, OPN and HA were detected in HCV-infected children with moderate to severe fibrosis compared with children with mild fibrosis (p < 0.05. The diagnostic accuracy of these direct biomarkers, represented by sensitivity, specificity and positive predictive value, emphasises the utility of PIIINP, TIMP-1, OPN and HA as indicators of liver fibrosis among HCV-infected children.

  7. Comparison of muscle activity of wrist extensors and kinematics of wrist joint during wrist extension in automobile assembly line workers with and without lateral epicondylitis.

    Science.gov (United States)

    Choung, Sung-Dae; Park, Kyue-Nam; Kim, Si-Hyun; Kwon, Oh-Yun

    2016-09-27

    Overuse of the extensor carpi radialis (ECR) may play a role in the development of lateral epicondylitis (LE). However, no studies have investigated the muscle activity ratio between the ECR and extensor carpi ulnaris (ECU) associated with the kinematics during wrist extension in workers with LE. We compared the ratio (ECR/ECU) of muscle activity between the ECR and ECU and the kinematics of the wrist during wrist extension between workers with and without LE. Fifteen automobile assembly line workers with LE and 15 workers without LE participated in this study. The ratio of muscle activity was measured using surface electromyography, and wrist kinematics were measured by a three-dimensional motion analysis system while the workers extended their wrists actively to the maximum range to which they did not feel uncomfortable. Significantly greater ratios of muscle activity, ranges of radial deviation, and combined motion of radial deviation and extension (CMDE) were shown in workers with LE compared to those without LE. Also, the range of wrist extension was significantly lower in workers with LE than in those without LE. Quantifying the ratio of muscle activity with altered kinematics of wrist extension may help researchers to understand why overuse of ECR is occurring and explain LE development in automobile assembly line workers.

  8. Diagnostic performance of Schistosoma real-time PCR in urine samples from Kenyan children infected with Schistosoma haematobium

    DEFF Research Database (Denmark)

    Vinkeles Melchers, Natalie V. S.; van Dam, Govert J.; Shaproski, David

    2014-01-01

    tool for detection of S. haematobium infections, with less day-to-day variation and higher sensitivity compared to microscopy. The superior performance of PCR before, and two and 18 months post-treatment provides a compelling argument for PCR as an accurate and reproducible tool for monitoring......BACKGROUND: In an effort to enhance accuracy of diagnosis of Schistosoma haematobium, this study explores day-to-day variability and diagnostic performance of real-time PCR for detection and quantification of Schistosoma DNA compared to other diagnostic tools in an endemic area before and after......, respectively. Based on the 'gold standard', PCR showed high sensitivity (>92%) as compared to >31% sensitivity for microscopy, both pre- and post-treatment. CONCLUSIONS/SIGNIFICANCE: Detection and quantification of Schistosoma DNA in urine by real-time PCR was shown to be a powerful and specific diagnostic...

  9. An Integrated Architecture for On-Board Aircraft Engine Performance Trend Monitoring and Gas Path Fault Diagnostics

    Science.gov (United States)

    Simon, Donald L.

    2010-01-01

    Aircraft engine performance trend monitoring and gas path fault diagnostics are closely related technologies that assist operators in managing the health of their gas turbine engine assets. Trend monitoring is the process of monitoring the gradual performance change that an aircraft engine will naturally incur over time due to turbomachinery deterioration, while gas path diagnostics is the process of detecting and isolating the occurrence of any faults impacting engine flow-path performance. Today, performance trend monitoring and gas path fault diagnostic functions are performed by a combination of on-board and off-board strategies. On-board engine control computers contain logic that monitors for anomalous engine operation in real-time. Off-board ground stations are used to conduct fleet-wide engine trend monitoring and fault diagnostics based on data collected from each engine each flight. Continuing advances in avionics are enabling the migration of portions of the ground-based functionality on-board, giving rise to more sophisticated on-board engine health management capabilities. This paper reviews the conventional engine performance trend monitoring and gas path fault diagnostic architecture commonly applied today, and presents a proposed enhanced on-board architecture for future applications. The enhanced architecture gains real-time access to an expanded quantity of engine parameters, and provides advanced on-board model-based estimation capabilities. The benefits of the enhanced architecture include the real-time continuous monitoring of engine health, the early diagnosis of fault conditions, and the estimation of unmeasured engine performance parameters. A future vision to advance the enhanced architecture is also presented and discussed

  10. Molecular cloning, characterization and diagnostic performance of the Schistosoma bovis 22.6 antigen.

    Science.gov (United States)

    de la Torre-Escudero, Eduardo; Manzano-Román, Raúl; Pérez-Sánchez, Ricardo; Barrera, Inmaculada; Siles-Lucas, Mar; Oleaga, Ana

    2012-12-21

    Animal schistosomiasis caused by Schistosoma bovis is a veterinary problem in many areas of the world. It affects a large number of animals and causes important economic losses in livestock production. The 22.6 kDa antigen is a tegumental protein of unknown function, restricted to schistosomes. In S. bovis it has been identified in the tegument and in an excretion-secretion extract, consisting of several, non-glycosylated isoforms that are recognised by the sera of animals infected with S. bovis. The aims of the present work were to clone, sequence, express and characterize at molecular level the S. bovis 22.6 antigen (Sb22.6), as well as to assess the usefulness of the corresponding recombinant protein as a diagnostic antigen in ELISA tests for the detection of free-range cattle farms infested with S. bovis. Immunolocalization studies revealed that Sb22.6 is expressed in the tegument and some internal tissues of the adult worms, but it is not exposed on the surface of the adult worms and schistosomula. The reactivity of the recombinant Sb22.6 (rSb22.6) in ELISA against antibodies in sera from S. bovis experimentally infected hamsters and sera from free-range cattle from a S. bovis endemic area showed that the recombinant protein and the soluble extract of adult worms (SbC) exhibited a similar diagnostic performance. In addition, rSb22.6 did not show cross-reactions with antibodies against Fasciola hepatica, also a frequent trematode parasite in cattle. The rSb22.6 antigen can be readily produced in large amounts and in a highly reproducible fashion, avoiding the types of problem that arise upon using crude extracts such as the SbC. In conclusion, this protein represents a promising epidemiological tool for the surveillance of S. bovis and may help to implement control measures in the areas and farms were the parasite is present. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Multiparametric MRI of the prostate: diagnostic performance and interreader agreement of two scoring systems.

    Science.gov (United States)

    Lin, Wei-Ching; Muglia, Valdair F; Silva, Gyl E B; Chodraui Filho, Salomão; Reis, Rodolfo B; Westphalen, Antonio C

    2016-06-01

    To compare the diagnostic accuracies and interreader agreements of the Prostate Imaging Reporting and Data System (PI-RADS) v. 2 and University of California San Francisco (UCSF) multiparametric prostate MRI scale for diagnosing clinically significant prostate cancer. This institutional review board-approved retrospective study included 49 males who had 1.5 T endorectal MRI and prostatectomy. Two radiologists scored suspicious lesions on MRI using PI-RADS v. 2 and the UCSF scale. Percent agreement, 2 × 2 tables and the area under the receiver operating characteristic curves (Az) were used to assess and compare the individual and overall scores of these scales. Interreader agreements were estimated with kappa statistics. Reader 1 (R1) detected 78 lesions, and Reader 2 (R2) detected 80 lesions. Both identified 52 of 65 significant cancers. The Az for PI-RADS v. 2 and UCSF scale for R1 were 0.68 and 0.69 [T2 weighted imaging (T2WI)], 0.75 and 0.68 [diffusion-weighted imaging (DWI)] and 0.64 and 0.72 (overall score), respectively, and were 0.72 and 0.75 (T2WI), 0.73 and 0.67 (DWI) and 0.66 and 0.75 (overall score) for R2. The dynamic contrast-enhanced percent agreements between scales were 100% (R1) and 95% (R2). PI-RADS v. 2 DWI of R1 performed better than UCSF DWI (Az = 0.75 vs Az = 0.68; p = 0.05); no other differences were found. The interreader agreements were higher for PI-RADS v. 2 (T2WI: 0.56 vs 0.42; DWI: 0.60 vs 0.46; overall: 0.61 vs 0.42). The UCSF approach to derive the overall PI-RADS v. 2 scores increased the Az for the identification of significant cancer (R1 to 0.76, p weighing system for the integration of PI-RADS v. 2 individual parameter scores improved the accuracy its overall score. PI-RADS v. 2 is moderately accurate for the identification of clinically significant prostate cancer, but the utilization of alternative approaches to derive the overall PI-RADS v. 2 score, including the one used by the UCSF system, may improve its

  12. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.

    Science.gov (United States)

    Waldt, Simone; Burkart, Andreas; Lange, Peter; Imhoff, Andreas B; Rummeny, Ernst J; Woertler, Klaus

    2004-05-01

    The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.

  13. Pulmonary mycobacterial disease: diagnostic performance of low-dose digital tomosynthesis as compared with chest radiography.

    Science.gov (United States)

    Kim, Eun Young; Chung, Myung Jin; Lee, Ho Yun; Koh, Won-Jung; Jung, Hye Na; Lee, Kyung Soo

    2010-10-01

    To compare the diagnostic performance of a low-radiation-dose digital tomosynthesis (DTS) technique with that of conventional radiography in the detection of lung lesions in patients with pulmonary mycobacterial disease. The institutional review board approved this study, and all patients provided informed consent. In this study, 100 patients (65 study patients, 35 control patients) underwent multidetector computed tomography (CT), chest radiography, and low-dose DTS (effective doses: 3.4, 0.02, and 0.05 mSv, respectively). Two radiologists evaluated radiographs and DTS images for the presence of parenchymal lesions and the number of cavities in each patient; CT served as the reference standard. Wilcoxon signed rank and McNemar tests and κ statistics were used. The accuracies of DTS and radiography in depicting mycobacterial disease were 97% and 89%, respectively, for observer 1 (P = .039) and 99% and 93%, respectively, for observer 2 (P = .031). The accuracies of DTS and radiography in depicting each lesion type were, respectively, 95% and 77% for bronchiolitis, 92% and 76% for nodules, 86% and 79% for consolidation, and 93% and 70% for cavities. Interobserver agreement with DTS (κ = 0.62-0.94) was superior to that with radiography (κ = 0.46-0.62). Of a total of 141 cavities found with CT, means of 27 (19%) cavities at chest radiography and 108 (77%) cavities at DTS (P performed with a low-dose technique is superior to radiography for the detection of lung lesions in patients with pulmonary mycobacterial disease.

  14. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Haggerty, Jay E.; Smith, Ethan A.; Dillman, Jonathan R. [University of Michigan Health System, Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Kunisaki, Shaun M. [University of Michigan Health System, Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2015-07-15

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (<1 year) with congenital lung lesions was performed. CT examinations were reviewed to document the type of lung lesion, vascular anatomy, image noise measurements and image reconstruction method. CTDI{sub vol} was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P < 0.0001). Mean SSDE was different among groups (P = 0.003; FBP = 7.35 mGy, ASiR = 1.89 mGy, MBIR = 1.49 mGy). Congenital lung lesions can be adequately characterized in infants using iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose. (orig.)

  15. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, S.; Meuwly, J.Y.; Meuli, R.; Schnyder, P.; Denys, A. [Universitaire Vaudois - CHUV, Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier, Lausanne (Switzerland); Chevallier, P. [Hopital Archet II, Imagerie Medicale, Nice (France); Bessoud, B. [Hopital Kremlin-Bicetre, Radiologie Generale, Kremlin-Bicetre (France); Felley, C. [University Hospital, CHUV, Service de Gastroenterologie, Lausanne (Switzerland)

    2007-11-15

    The diagnostic performance of magnetic resonance imaging (MRI) for detection of intestinal fistulas, other than perianal, in patients with known complicated inflammatory bowel conditions (CIBC) was investigated. Our study group consisted of 20 patients (12 women, mean age 43 years) with CIBC, including Crohn's disease (n=13), colonic diverticulitis (n=3), colitis after radiotherapy (n=3) and of postoperative origin (n=1). Eleven surgically proven enteral fistulas were known in ten (50%) of these patients, being of enterovesical (n=3), enterocolic (n=2), enteroenteral (n=2), rectovaginal (n=2), rectovaginovesical (n=1) and of entercutaneous (n=1) localisation. The other ten patients (50%), used as the control group, showed MR features of CIBC, although without any fistulous tract. Multiplanar T1- and T2-weighted sequences had been performed, including gadolinium-enhanced acquisition with fat saturation (1.5 T). MR findings were independently blindly and retrospectively reviewed by three radiologists for the presence and etiology of any fistula, as well as visualization and characterization of the fistulous tract. Results were compared with surgical findings (n=16) and clinical evolution (n=4). Interobserver agreement was calculated. Interobserver agreement kappa for fistula detection was 0.71. Overall sensitivity, specificity and accuracy for fistula detection were 78.6%, 75% and 77.2%, respectively. Sensitivity for fistula characterization was 80.6%, with visualization of the fistulous tract in all cases, whereby T1-weighted gadolinium-enhanced fat-saturated images were considered the most useful sequences. Gadolinium-enhanced MRI is a reliable and reproducible tool for detection of enteral fistulas secondary to inflammatory conditions. (orig.)

  16. Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation

    Energy Technology Data Exchange (ETDEWEB)

    Sizemore, Alecia W. [Indiana University School of Medicine, Department of Radiology, Indianapolis, IN (United States); University of Virginia School of Medicine, Department of Radiology, Charlottesville, VA (United States); Rabbani, Kaneez Z. [Indiana University School of Medicine, Department of Medicine, Indianapolis, IN (United States); Ladd, Alan [Indiana University School of Medicine, Division of Pediatric Surgery, Riley Hospital, Indianapolis, IN (United States); Applegate, Kimberly E. [Indiana University School of Medicine, Section of Pediatric Radiology, Department of Radiology, Indianapolis, IN (United States); Riley Hospital for Children, Department of Radiology, Indianapolis, IN (United States)

    2008-05-15

    Malrotation is a congenital disorder of abnormal intestinal rotation and fixation that predisposes infants to potentially life-threatening midgut volvulus. Upper gastrointestinal tract (UGI) examination is sometimes equivocal and can lead to inaccurate diagnosis. To determine the diagnostic performance of UGI examinations in children who subsequently underwent a Ladd procedure for suspected malrotation or volvulus. We reviewed all children up to 21 years old who had undergone both a UGI examination and a Ladd procedure for possible malrotation across 9 years. Children were excluded if they had not undergone either a UGI examination or a Ladd procedure and if congenital abdominal wall defects were present. Of 229 patients identified, 166 (59% male, median age 67 days) were included. Excluded were 47 without a UGI series, 12 with omphalocele or gastroschisis, 1 without verifiable operative data, 1 who had not undergone a Ladd procedure, and 2 older than 21 years. Of the 166 patients, 40% were neonates and 73% were <12 months old, and 31% presented with bilious vomiting and 15% with abdominal distention. Of 163 patients with surgically verified malrotation, 156 had a positive UGI examination, a sensitivity of 96%. There were two patients with a false-positive UGI examination and seven with false-negative examination. Jejunal position was normal in six of the seven with a false-negative examination and abnormal in the two with a false-positive examination. Of 38 patients with surgically verified volvulus, 30 showed volvulus on the UGI series. Five required bowel resection and three died. Jejunal position can lead to inaccurate UGI series interpretation. Meticulous technique and periodic assessment of performance will help more accurately diagnose difficult or equivocal cases. (orig.)

  17. 78 FR 36307 - Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity...

    Science.gov (United States)

    2013-06-17

    ... AFFAIRS Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity... disability benefits related to a claimant's diagnosis of wrist conditions. DATES: Written comments and... . Please refer to ``OMB Control No. 2900-NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any...

  18. 78 FR 36643 - Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity...

    Science.gov (United States)

    2013-06-18

    ... AFFAIRS Proposed Information Collection (Wrist Conditions Disability Benefits Questionnaire) Activity... disability benefits related to a claimant's diagnosis of wrist conditions. DATES: Written comments and... . Please refer to ``OMB Control No. 2900--NEW (Wrist Conditions Disability Benefits Questionnaire)'' in any...

  19. Diagnostic yield of kidney biopsies performed in a suburban, satellite hospital

    Directory of Open Access Journals (Sweden)

    Che Rosle Draman

    2013-01-01

    Full Text Available Kidney biopsy is indicated to confirm the clinical diagnosis or to evaluate prognosis of a renal problem. It is a reliable and safe procedure, especially with real-time ultrasound guidance. This is a single-center, retrospective review of the biopsies performed in Hospital Tengku Ampuan Afzan, Pahang from 2000 to 2010. The demographic data, clinical parameters, and histological reports were extracted from clinic records and analyzed to determine the diagnostic adequacy of biopsy samples for both lupus and non-lupus patients. A total of 219 biopsies were performed throughout the period and only 74 were included in this review. Their mean age was 22.5 ± 10.5 years. 59.5% of the biopsies were performed on female patients. Malays comprised 79.7% (n = 59 of them, followed by Chinese (18.9%, n=14 and Indian (1.4%, n=1. About one-third of the biopsies(n = 25 were performed on patients with lupus nephritis and two-thirds (n = 49 on non-lupus nephritis patients. At the time of biopsy, their serum creatinine values were normal, serum albumin 28.4 ± 10 g/L and total cholesterol 8.9 ± 4.6 mmol/L (mean ± SD. The urine dipstick was 3+ for both proteinuria and hematuria and daily protein excretion was 3.6 ± 3.2 g. Sixty-seven specimens were considered adequate and only six (8% were inadequate for histological interpretations. The mean number of glomeruli in the biopsy specimens was 16 ± 9.9 (range: 0-47 glomeruli. In non-lupus patients, focal segmental glomerulosclerosis was the commonest histological diagnosis (n = 15, 30.6%, followed by minimal change disease (n = 13, 26.5% and mesangial proliferative glomerulonephritis (n = 7, 14.3%. Membranous nephropathy was diagnosed in four (8.2% and membranoproliferative glomerulonephritis in two (4.1% specimens. Both post-infectious glomerulonephritis and advanced glomerulosclerosis were found in one specimen each. Among the lupus nephritis patients (n = 25, 88% of them were females (P <0.05 and lupus nephritis

  20. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: A systematic review and meta-analysis

    NARCIS (Netherlands)

    M.C. de Jong (Marcus); T.S.S. Genders (Tessa); R.J.M. van Geuns (Robert Jan); A. Moelker (Adriaan); M.G.M. Hunink (Myriam)

    2012-01-01

    textabstractObjectives To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. Methods We searched Medline and Embase for

  1. Performance of Different Diagnostic Criteria for Familial Mediterranean Fever in Children with Periodic Fevers : Results from a Multicenter International Registry

    NARCIS (Netherlands)

    Demirkaya, Erkan; Saglam, Celal; Turker, Turker; Koné-Paut, Isabelle; Woo, Pat; Doglio, Matteo; Amaryan, Gayane; Frenkel, Joost; Uziel, Yosef; Insalaco, Antonella; Cantarini, Luca; Hofer, Michael; Boiu, Sorina; Duzova, Ali; Modesto, Consuelo; Bryant, Annette; Rigante, Donato; Papadopoulou-Alataki, Efimia; Guillaume-Czitrom, Severine; Kuemmerle-Deschner, Jasmine; Neven, Bénédicte; Lachmann, Helen; Martini, Alberto; Ruperto, Nicolino; Gattorno, Marco; Ozen, Seza

    2015-01-01

    OBJECTIVE: Our aims were to validate the pediatric diagnostic criteria in a large international registry and to compare them with the performance of previous criteria for the diagnosis of familial Mediterranean fever (FMF). METHODS: Pediatric patients with FMF from the Eurofever registry were used

  2. The Effect of Self-Explanation of Pathophysiological Mechanisms of Diseases on Medical Students' Diagnostic Performance

    Science.gov (United States)

    Peixoto, José Maria; Mamede, Sílvia; de Faria, Rosa Malena Delbone; Moura, Alexandre Sampaio; Santos, Silvana Maria Elói; Schmidt, Henk G.

    2017-01-01

    Self-explanation while diagnosing clinical cases fosters medical students' diagnostic performance. In previous studies on self-explanation, students were free to self-explain any aspect of the case, and mostly clinical knowledge was used. Elaboration on knowledge of pathophysiological mechanisms of diseases has been largely unexplored in studies…

  3. Diagnostic Performance of Computed Tomography for Preoperative Staging of Patients with Non-endometrioid Carcinomas of the Uterine Corpus

    NARCIS (Netherlands)

    Lakhman, Y.; Katz, S.S.; Goldman, D.A.; Yakar, D.; Vargas, H.A.; Sosa, R.E.; Micco, M.; Soslow, R.A.; Hricak, H.; Abu-Rustum, N.R.; Sala, E.

    2016-01-01

    PURPOSE: The aim of this study was to assess the diagnostic performance of computed tomography (CT) for initial staging of non-endometrioid carcinomas of the uterine corpus. MATERIALS AND METHODS: Waiving informed consent, the Institutional Review Board approved this Health Insurance Portability and

  4. Comparing Diagnostic Ability of Basic Emotional States in Children with High Performance Autism Disorder with Normal Peers

    Directory of Open Access Journals (Sweden)

    Fatemeh Jalili

    2012-04-01

    Full Text Available Background: Study on weaknesses and diagnostic strategies of autistic children in social interactions as well as how we can diagnose different emotions in the face may be an efficient step towards their therapy and communication improvement. The objective of this study was to compare diagnostic ability of basic emotions in children with high-performance autism with normal peers.Materials and Method: In this comparative profile study, two groups of 16 individuals: children with high-performance autistic disorder and their normal peers were selected by available sample method in terms of age, sex and life location. Neuropsychology diagnostic test of different emotions in Benton face (changed version was used to determine diagnostic ability of emotions (happy, sad and angry. Statistical analysis was performed using SPSS software and descriptive statistics and t-test were done for both independent groups.Results: Results showed that the ability of both tested groups is equal in diagnosing emotional states of joy, anger and neutral condition in face while viewing face picture and there was not any significant difference between groups but in diagnosing emotional grief state, the performance of autistics is lower and there was significant difference with normal peer group.Conclusion: The autistic children with high function are equal in ability with normal children in case of recognizing the happiness, anger and neutral facial excitement. However, they are less competent in recognizing the sadness and facial excitement than normal children

  5. Diagnostic yield of kidney biopsies performed in a suburban, satellite hospital

    National Research Council Canada - National Science Library

    Draman, Che Rosle; Seman, Mohd Ramli; Mohd Noor, Fariz Safhan; Kelsom, W M

    2013-01-01

    .... The demographic data, clinical parameters, and histological reports were extracted from clinic records and analyzed to determine the diagnostic adequacy of biopsy samples for both lupus and non-lupus patients...

  6. Force variability during isometric wrist flexion in highly skilled and sedentary individuals.

    Science.gov (United States)

    Salonikidis, Konstantinos; Amiridis, Ioannis G; Oxyzoglou, Nikolaos; de Villareal, Eduardo Saez Saez; Zafeiridis, Andreas; Kellis, Eleftherios

    2009-12-01

    The association of expertness in specific motor activities with a higher ability to sustain a constant application of force, regardless of muscle length, has been hypothesized. Ten highly skilled (HS group) young tennis and handball athletes and 10 sedentary (S group) individuals performed maximal and submaximal (5, 10, 20, 50, and 75% of the MVC) isometric wrist flexions on an isokinetic dynamometer (Kin-Com, Chattanooga). The wrist joint was fixed at five different angles (230, 210, 180, 150, and 1300). For each position the percentages of the maximal isometric force were calculated and participants were asked to maintain the respective force level for 5 s. Electromyographic (EMG) activation of the Flexor Carpi Ulnaris and Extensor Digitorum muscles was recorded using bipolar surface electrodes. No significant differences were observed in maximal isometric strength between HS and S groups. Participants of HS group showed significantly (P wrist angles. The CV and SD values remained unaltered regardless of wrist angle. No difference in normalized agonist and antagonist EMG activity was observed between the two groups. It is concluded that long-term practice could be associated with decreased isometric force variability independently from muscular length and coactivation of the antagonist muscles.

  7. Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke.

    Science.gov (United States)

    Hu, Xiao-Ling; Tong, Raymond Kai-yu; Ho, Newmen S K; Xue, Jing-jing; Rong, Wei; Li, Leonard S W

    2015-09-01

    Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke. To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training. This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training. The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P robot group (P robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress. © The Author(s) 2014.

  8. Wrist Hypothermia Related to Continuous Work with a Computer Mouse: A Digital Infrared Imaging Pilot Study

    Directory of Open Access Journals (Sweden)

    Jelena Reste

    2015-08-01

    Full Text Available Computer work is characterized by sedentary static workload with low-intensity energy metabolism. The aim of our study was to evaluate the dynamics of skin surface temperature in the hand during prolonged computer mouse work under different ergonomic setups. Digital infrared imaging of the right forearm and wrist was performed during three hours of continuous computer work (measured at the start and every 15 minutes thereafter in a laboratory with controlled ambient conditions. Four people participated in the study. Three different ergonomic computer mouse setups were tested on three different days (horizontal computer mouse without mouse pad; horizontal computer mouse with mouse pad and padded wrist support; vertical computer mouse without mouse pad. The study revealed a significantly strong negative correlation between the temperature of the dorsal surface of the wrist and time spent working with a computer mouse. Hand skin temperature decreased markedly after one hour of continuous computer mouse work. Vertical computer mouse work preserved more stable and higher temperatures of the wrist (>30 °C, while continuous use of a horizontal mouse for more than two hours caused an extremely low temperature (<28 °C in distal parts of the hand. The preliminary observational findings indicate the significant effect of the duration and ergonomics of computer mouse work on the development of hand hypothermia.

  9. Wrist stability after experimental traumatic triangular fibrocartilage complex lesions

    DEFF Research Database (Denmark)

    Munk, Bo; Jensen, Steen Lund; Olsen, Bo Sanderhoff

    2005-01-01

    The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions.......The aim of this study was to evaluate changes in stability of the wrist after experimental traumatic triangular fibrocartilage complex lesions....

  10. Development and performance of a diagnostic/prognostic scoring system for breakthrough pain

    Directory of Open Access Journals (Sweden)

    Samolsky Dekel BG

    2017-05-01

    Full Text Available Boaz Gedaliahu Samolsky Dekel,1–3 Marco Palma,4 Maria Cristina Sorella,1–3 Alberto Gori,3 Alessio Vasarri,3 Rita Maria Melotti1–3 1Department of Medicine and Surgery Sciences, University of Bologna, 2Department of Emergency-Urgency, Bologna’s University Teaching Hospital, Policlinic S. Orsola-Malpighi, 3University of Bologna, Post Graduate School of Anaesthesia and Intensive Care, 4Collegio Superiore, Istituto di Studi Superiori – ISS, University of Bologna, Bologna, Italy Objectives: Variable prevalence and treatment of breakthrough pain (BTP in different clinical contexts are partially due to the lack of reliable/validated diagnostic tools with prognostic capability. We report the statistical basis and performance analysis of a novel BTP scoring system based on the naïve Bayes classifier (NBC approach and an 11-item IQ-BTP validated questionnaire. This system aims at classifying potential BTP presence in three likelihood classes: “High,” “Intermediate,” and “Low.”Methods: Out of a training set of n=120 mixed chronic pain patients, predictors associated with the BTP likelihood variables (Pearson’s χ2 and/or Fisher’s exact test were employed for the NBC planning. Adjusting the binary classification to a three–likelihood classes case enabled the building of a scoring algorithm and to retrieve the score of each predictor’s answer options and the Patient’s Global Score (PGS. The latter medians were used to establish the NBC thresholds, needed to evaluate the scoring system performance (leave-one-out cross-validation.Results: Medians of PGS in the “High,” “Intermediate,” and “Low” likelihood classes were 3.44, 1.53, and −2.84, respectively. Leading predictors for the model (based on score differences were flair frequency (∆S=1.31, duration (∆S=5.25, and predictability (∆S=1.17. Percentages of correct classification were 63.6% for the “High” and of 100.0% for either the “Intermediate” and

  11. Performance assessment and adoption processes of an information monitoring and diagnostic system prototype

    Energy Technology Data Exchange (ETDEWEB)

    Piette, Mary Ann

    1999-10-01

    This report addresses the problem that buildings do not perform as well as anticipated during design. We partnered with an innovative building operator to evaluate a prototype Information Monitoring and Diagnostic System (IMDS). The IMDS consists of high-quality measurements archived each minute, a data visualization tool, and a web-based capability. The operators recommend similar technology be adopted in other buildings. The IMDS has been used to identify and correct a series of control problems. It has also allowed the operators to make more effective use of the building control system, freeing up time to take care of other tenant needs. They believe they have significantly improved building comfort, potentially improving tenant health, and productivity. The reduction in hours to operate the building are worth about $20,000 per year, which could pay for the IMDS in about five years. A control system retrofit based on findings from the IMDS is expected to reduce energy use by 20 percent over the next year, worth over $30,000 per year. The main conclusion of the model-based chiller fault detection work is that steady-state models can be used as reference models to monitor chiller operation and detect faults. The ability of the IMDS to measure cooling load and chiller power to one-percent accuracy with a one-minute sampling interval permits detection of additional faults. Evolutionary programming techniques were also evaluated, showing promise in the detection of patterns in building data. We also evaluated two technology adoption processes, radical and routine. In routine adoption, managers enhance features of existing products that are already well understood. In radical adoption, innovative building managers introduce novel technology into their organizations without using the rigorous payback criteria used in routine innovations.

  12. Performance of commercially available serological diagnostic tests to detect Leishmania infantum infection on experimentally infected dogs.

    Science.gov (United States)

    Rodríguez-Cortés, Alhelí; Ojeda, Ana; Todolí, Felicitat; Alberola, Jordi

    2013-01-31

    Leishmania infantum (syn. Leishmania chagasi) is the etiological agent of a widespread serious zoonotic disease that affects both humans and dogs. Prevalence and incidence of the canine infection are important parameters to determine the risk and the ways to control this reemergent zoonosis. Unfortunately, there is not a gold standard test for Leishmania infection. Our aim was to assess the operative validity of commercial tests used to detect antibodies to Leishmania in serum samples from experimental infections. Three ELISA tests (LEISCAN(®) Leishmania ELISA Test, INGEZIM(®) LEISHMANIA, and INGEZIM(®) LEISHMANIA VET), three immunochromatographic tests (INGEZIM(®) LEISHMACROM, SNAP(®) Leishmania, and WITNESS(®) Leishmania), and one IFAT were evaluated. LEISCAN(®) Leishmania ELISA test achieved the highest sensitivity and accuracy (both 0.98). Specificity was 1 for all tests except for IFAT. All tests but IFAT obtained a positive predictive value of 1, while the maximum negative predictive value was achieved by LEISCAN(®) Leishmania ELISA Test (0.93). The best positive likelihood ratio was obtained by INGEZIM(®) LEISHMANIA VET (30.26), while the best negative likelihood ratio was obtained by LEISCAN(®) Leishmania ELISA Test (0.02). The highest diagnostic odds ratio was achieved by LEISCAN(®) Leishmania ELISA Test (729.00). The largest area under the ROC curve was obtained by LEISCAN(®) Leishmania ELISA Test (0.981). Quantitative ELISA based tests performmed better than qualitative tests ("Rapid Tests"), and the test best suited to detect Leishmania in infected dogs and to provide clinically useful information was LEISCAN(®) Leishmania ELISA Test. This and other results point also to the need of revising the status of IFAT as a gold standard for the diagnosis of leishmaniasis. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Urinary orosomucoid: a novel, early biomarker of sepsis with promising diagnostic performance.

    Science.gov (United States)

    Kustán, Péter; Szirmay, Balázs; Horváth-Szalai, Zoltán; Ludány, Andrea; Kovács, Gábor L; Miseta, Attila; Kőszegi, Tamás; Mühl, Diána

    2017-02-01

    In order to help clinical decision making, we investigated the diagnostic and prognostic ability of urinary orosomucoid (u-ORM) as a new sepsis biomarker, and compared its performance to classical inflammatory parameters. We monitored u-ORM in septic (n=43) and SIRS (n=13) patients in a 5-day follow-up study vs. control patients (n=30). U-ORM was measured by a newly developed turbidimetric assay. U-ORM values were referred to urinary creatinine and expressed as u-ORM/u-CREAT (mg/mmol). Significantly higher (pORM/u-CREAT levels were found in sepsis than in SIRS. Both intensive care unit (ICU) groups showed strongly elevated values compared to controls (pORM/u-CREAT levels were 19.2 in sepsis, 2.1 in SIRS and 0.2 mg/mmol in controls. The area under the receiver operating characteristic curve for distinguishing SIRS from sepsis was found to be 0.954 for u-ORM/u-CREAT, superior to serum ORM and hsCRP. U-ORM levels did not change during the 5-day follow-up and were independent of the severity of sepsis however, we found extremely elevated u-ORM/u-CREAT values in dialyzed septic patients (52.2 mg/mmol as median). The early and relevant increase of u-ORM in sepsis suggests that it might be a promising novel marker of sepsis and could be a valuable part of routine laboratory and clinical practice.

  14. Diagnostic performance of pressure drop coefficient in relation to fractional flow reserve and coronary flow reserve.

    Science.gov (United States)

    Kolli, Kranthi K; Arif, Imran; Peelukhana, Srikara V; Succop, Paul; Back, Lloyd H; Helmy, Tarek A; Leesar, Massoud A; Effat, Mohamed A; Banerjee, Rupak K

    2014-05-01

    Functional assessment of coronary lesion severity during cardiac catheterization is conducted using diagnostic parameters like fractional flow reserve (FFR; pressure derived) and coronary flow reserve (CFR; flow derived). However, the complex hemodynamics of stenosis might not be sufficiently explained by either pressure or flow alone, particularly in the case of intermediate stenosis. CDP (ratio of pressure drop across a stenosis to distal dynamic pressure), a non-dimensional index derived from fundamental fluid dynamic principles based on a combination of intracoronary pressure and flow, may improve the functional assessment of coronary lesion severity. We performed a meta-analysis of seven studies, retrieved from MEDLINE and PubMed, comparing the results of FFR and CFR of the same lesions. Two studies reported functional measurements (pressure and flow) obtained in individual patients. Five studies reported two-dimensional plots of FFR vs. CFR. The FFR and CFR data were digitized and corresponding functional measurements were extracted using the reported mean values of hemodynamic data from each of the five studies. The receiver operating characteristic (ROC) curve was used to identify the optimal cut-off point of CDP, which corresponds to the clinically used cut-off values (FFR = 0.80, FFR = 0.75, and CFR = 2.0). CDP correlated significantly with FFR (r = 0.78; P27.1 and CDP >27.9, respectively. CDP, a functional parameter based on both intracoronary pressure and flow measurements, has close agreement (area under the ROC curve = 89%) with FFR, the most frequently used method for evaluation of coronary stenosis severity.

  15. Diagnostic performance of radiographers as compared to radiologists in magnetic resonance colonography

    Energy Technology Data Exchange (ETDEWEB)

    Zijta, F.M., E-mail: f.m.zijta@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Florie, J., E-mail: j.florie@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Jensch, S., E-mail: s.jensch@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Bipat, S., E-mail: s.bipat@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Nievelstein, R.A.J., E-mail: R.A.J.Nievelstein@umcutrecht.n [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Poulus, M., E-mail: M.Poulus@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Thomassen-de Graaf, M.A., E-mail: TomassenM@zgv.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Montauban van Swijndregt, A.D., E-mail: A.D.MontaubanvanSwijndregt@olvg.n [Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Stoker, J., E-mail: j.stoker@amc.uva.n [Department of Radiology, Academic Medical Center, Amsterdam (Netherlands)

    2010-08-15

    Purpose: To evaluate the diagnostic performance of radiographers compared to radiologists in the detection of colorectal lesions in MR colonography. Material and methods: 159 patients at increased risk of colorectal cancer were included. Four different experienced observers, one MR radiologist, one radiologist in training and two radiographers evaluated all MR colonography examinations. The protocol included T1-weighted and T2-weighted sequences in prone and supine position. Colonoscopy was used as reference standard. Mean sensitivity rates with 95% confidence intervals (CIs) were determined on a per-patient and per-polyp basis, segmented by size ({>=}6 mm and {>=}10 mm). Specificity was calculated on a per-patient basis. The McNemar and chi-square ({chi}{sup 2}) test was used to determine significant differences. Results: At colonoscopy 74 patients (47%) had normal findings; 23 patients had 40 polyps with a size {>=}6 mm. In 10 patients at least 1 polyp {>=}10 mm was found (20 polyps in total). Similar sensitivities for patients with lesions {>=}10 mm were found for radiologists and radiographers (65% (95%CI: 44-86%) vs. 50% (95%CI: 28-72%)) (p = n.s.). For lesions {>=}10 mm combined per-patient specificity for radiologists and radiographers was 96% (95%CI: 94-98%) and 73% (95%CI: 68-79%) (p < 0.0001). Combined per-patient sensitivity for lesions {>=}6 mm differed significantly between both groups of observers (57% (95%CI: 42-71%) vs. 33% (95%CI: 19-46%)) (p = 0.03). Conclusion: Radiographers have comparable sensitivity but lower specificity relative to radiologists in the detection of colorectal lesions {>=}10 mm at MR colonography. Adequate training in evaluating MR colonography is necessary, especially for readers with no prior experience with colonography.

  16. Diagnostic performance of bone metabolic indexes for the detection of stroke.

    Science.gov (United States)

    Tan, Li Ming; Wang, Lu; Chen, Juan-Juan; Li, Hua; Luo, Wen-Bo

    2017-01-01

    To explore the diagnostic performance of 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), bone alkaline phosphatase (BALP), and osteocalcin (OC) in predicting stroke.  Methods: This retrospective survey was conducted in The Second Affiliated Hospital to Nanchang University, Nanchang, Jiangxi Province, China. involved 121 cerebral infarction patients and 103 cerebral hemorrhage patients as the experimental groups, 100 volunteers as the healthy control group and 80 brain trauma patients as the disease control group. The 25(OH)D, PTH, BALP, and OC levels of all participants were measured by electrochemiluminescence immunoassay.  Results: The serum concentration of 25(OH)D in stroke patients was appreciably lower than that of the control groups (p less than 0.05), and subsequently, the deficiency level of 25(OH)D in the stroke population was considerably higher than that of the control groups (p less than 0.05). The serum concentrations of PTH and OC in stroke patients exceeded those found in the control groups (p less than 0.05), and the abnormal level in the stroke patients was also higher than that of the control. Compared with the control group, BALP concentrations in cerebral infarction patients were increased significantly. Additionally, abnormal levels of BALP in stroke patients were found to be higher than those in the control groups. However, concentrations and abnormal levels of BALP in cerebral hemorrhage patients were not found to be significantly different than those found in cerebral infarction and the control groups, There were no substantial differences between the 2 control groups. Conclusion: Lack of 25(OH)D and excessive PTH, BALP, and OC could indicate a high risk of stroke.

  17. Iodide and albumin kinetics in normal canine wrists and knees

    Energy Technology Data Exchange (ETDEWEB)

    Simkin, P.A.; Benedict, R.S. (Univ. of Washington, Seattle (USA))

    1990-01-01

    The clearance rates of free iodide and of radioiodinated serum albumin were measured in the knee and wrist joints of 9 normal adult dogs. Iodide clearance from the knee was 3 times greater than that from the wrist. In contrast, radioiodinated serum albumin clearance from the knee was only slightly greater than that from the wrist. Interpreted as respective indices of effective synovial plasma flow and lymphatic drainage, these values indicate that the filtration fraction is normally greater in microvessels of the wrist than in those of the knee. These findings complement the results of companion studies of Starling forces that indicate a higher pressure microvascular bed in the wrist than in the knee.

  18. Effect of submaximal isometric wrist extension training on grip strength.

    Science.gov (United States)

    Shimose, Ryota; Matsunaga, Atsuhiko; Muro, Masuo

    2011-03-01

    Gripping force is produced by co-contraction of forearm flexors and extensors. Activation of extensors is important for stabilizing the wrist during gripping. However, forearm muscle function is complicated and the neurophysiological mechanism responsible for the gain in gripping force is unclear. Therefore, the purpose of this study was to investigate whether increasing forearm extensor activation with isometric wrist extension training has an effect on gripping force. Thirteen healthy subjects participated in this study. Maximal voluntary contraction of gripping was measured using a piezosensor (MVC(grip)) and EMG of forearm muscles at every wrist angle (from 70° flexion to 80° extension with 10° intervals) were measured simultaneously at baseline, 4 weeks, and 8 weeks after training. Training consisted of 30 repetitions equal to 70% MVC of isometric wrist extension for 8 weeks (5/week) on the right side. Gripping force was measured on both sides using a grip dynamometer without wrist angle restriction. Gripping force, EMG, maximal wrist extension force, and wrist angle-gripping force curve were investigated after training. After training, maximal wrist extension force increased significantly. Gripping force on the trained side also increased significantly. The training changed wrist angle at peak of MVC(grip). EMG activation of forearm extensors increased and that of flexors decreased during gripping. These results suggest that wrist extension training leads to an increase in gripping force and changes the balance of EMG activation between forearm flexors and extensors during gripping. Therefore, this training method should be useful as a therapeutic strategy for increasing grip strength.

  19. The relationship between wrist position, grasp size, and grip strength.

    Science.gov (United States)

    O'Driscoll, S W; Horii, E; Ness, R; Cahalan, T D; Richards, R R; An, K N

    1992-01-01

    In the first part of this study, the position assumed by a normal wrist during unconstrained maximal grip and the relationship between wrist position and grip strength were investigated in 20 healthy subjects. Grip strength and wrist position were recorded in the self-selected position and then again while the subjects voluntarily deviated the wrist randomly into flexion, extension, or radial or ulnar deviation of 10 to 15 degrees. The self-selected position was 35 degrees of extension and 7 degrees of ulnar deviation. Grip strength was significantly less in any position of deviation from this self-selected position, even after accounting for fatigue. With the wrist in only 15 degrees of extension or in neutral radio-ulnar deviation, grip strength was reduced to two thirds to three fourths of normal. Sex did not affect wrist position. The dominant wrists were within 5 degrees of the nondominant ones but were relatively less extended and in more ulnar deviation. Grip strength is significantly reduced when wrist position deviates from this self-selected optimum position. In the second part of the study, the effect of grasp size on this self-selected position was studied in 21 subjects. The degree of wrist extension was inversely and linearly related to how large a setting on the Jamar dynamometer was used. This was true regardless of hand size, although the effect was more significant for smaller hands. Radial and ulnar deviations were not affected by handle position. A minimum of 25 degrees of wrist extension was required for optimum grip strength.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Age-Related Decline of Wrist Position Sense and its Relationship to Specific Physical Training.

    Science.gov (United States)

    Van de Winckel, Ann; Tseng, Yu-Ting; Chantigian, Daniel; Lorant, Kaitlyn; Zarandi, Zinat; Buchanan, Jeffrey; Zeffiro, Thomas A; Larson, Mia; Olson-Kellogg, Becky; Konczak, Jürgen; Keller-Ross, Manda L

    2017-01-01

    Perception of limb and body positions is known as proprioception. Sensory feedback, especially from proprioceptive receptors, is essential for motor control. Aging is associated with a decline in position sense at proximal joints, but there is inconclusive evidence of distal joints being equally affected by aging. In addition, there is initial evidence that physical activity attenuates age-related decline in proprioception. Our objectives were, first, to establish wrist proprioceptive acuity in a large group of seniors and compare their perception to young adults, and second, to determine if specific types of training or regular physical activity are associated with preserved wrist proprioception. We recruited community-dwelling seniors (n = 107, mean age, 70 ± 5 years, range, 65-84 years) without cognitive decline (Mini Mental State Examination-brief version ≥13/16) and young adult students (n = 51, mean age, 20 ± 1 years, range, 19-26 years). Participants performed contralateral and ipsilateral wrist position sense matching tasks with a bimanual wrist manipulandum to a 15° flexion reference position. Systematic error or proprioceptive bias was computed as the mean difference between matched and reference position. The respective standard deviation over five trials constituted a measure of random error or proprioceptive precision. Current levels of physical activity and previous sport, musical, or dance training were obtained through a questionnaire. We employed longitudinal mixed effects linear models to calculate the effects of trial number, sex, type of matching task and age on wrist proprioceptive bias and precision. The main results were that relative proprioceptive bias was greater in older when compared to young adults (mean difference: 36% ipsilateral, 88% contralateral, p physical activity levels did not affect bias or precision. Our findings demonstrate that aging is associated with a decline in proprioceptive bias in distal arm joints, but age does

  1. Performance tests of a new fast digitiser for beam diagnostic applications

    CERN Document Server

    Angoletta, M E

    2002-01-01

    A new type of PCI-based fast digitisers has been deployed to implement new beam diagnostic systems and as a prototype for a new family of applications. The modules selected for the first tests and applications are the Acqiris DC265 fast digitiser boards, characterised by a high sampling speed, a large amount of memory per channel (2 MSamples per channel as the chosen option) and a PCI bus interface. This note details the tests carried out, and the results obtained, to ascertain the DC265 board and crate suitability to general beam diagnostics applications.

  2. Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad.

    LENUS (Irish Health Repository)

    Mc Laughlin, Patrick

    2012-04-01

    Tablet devices have recently been used in radiological image interpretation because they have a display resolution comparable to desktop LCD monitors. We identified a need to examine tablet display performance prior to their use in preliminary interpretation of radiological images. We compared the spatial and contrast resolution of a commercially available tablet display with a diagnostic grade 2 megapixel monochrome LCD using a contrast detail phantom. We also recorded reporting discrepancies, using the ACR RADPEER system, between preliminary interpretation of 100 emergency CT brain examinations on the tablet display and formal review on a diagnostic LCD. The iPad display performed inferiorly to the diagnostic monochrome display without the ability to zoom. When the software zoom function was enabled on the tablet device, comparable contrast detail phantom scores of 163 vs 165 points were achieved. No reporting discrepancies were encountered during the interpretation of 43 normal examinations and five cases of acute intracranial hemorrhage. There were seven RADPEER2 (understandable) misses when using the iPad display and 12 with the diagnostic LCD. Use of software zoom in the tablet device improved its contrast detail phantom score. The tablet allowed satisfactory identification of acute CT brain findings, but additional research will be required to examine the cause of "understandable" reporting discrepancies that occur when using tablet devices.

  3. Diagnostic Performance of Three Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hyun Woo; Paeng, Jin Chul; Nahm, Francins Sahngun; Kim, Seog Gyun; Zehra, Tanzeel; Oh, So Won; Lee, Hyo Sang; Kang, Keon Wook; Chung, June Key; Lee, Myung Chul; Lee, Dong Soo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Although the three phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type 1 (CRPS 1), there is some controversy regarding the TPBS image criteria for CRPS 1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. The study included 140 patients with suspected CRPS 1 (CRPS 1, n=79; non CRPS, n=61; mean age 39{+-}15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS 1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI{sup eventscan)}. Quantitative analysis for lesion to contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Both increased and decreased periarticular DU were significant image findings for CRPS 1 (CRPS 1 positive rate=73% in the increased DU group, 75% in the decreased DU group). The TI{sup eventscand}id not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS 1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS 1 were 80% and 72%, respectively. Optimally modified TPBS image criteria for CRPS 1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS 1 even with the most recent consensus clinical diagnostic criteria.

  4. Unusual Wrist Tremor: Unilateral Isometric Tremor?

    Directory of Open Access Journals (Sweden)

    Theresa A. Zesiewicz

    2014-01-01

    Full Text Available Background: Tremors may be difficult to classify.Case Report: An 83‐year‐old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water of approximately 1 lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor.Discussion: This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics.

  5. A comparison of wrist isokinetic muscle strength in wheelchair table tennis and wheelchair basketball players

    Science.gov (United States)

    Akınoğlu, Bihter; Kocahan, Tuğba; Yıldırım, Necmiye Ün; Soylu, Çağlar; Apur, Ufuk; Hasanoğlu, Adnan

    2017-01-01

    Aim: The aim of this study was to compare isokinetic muscle strength of wrist flexor and extensor muscles in paralympic athletes. Methods: This study was carried out with the participation of 9 (4 females and 5 males) wheelchair (WC) table tennis players aged 24+3 and 8 male WC basketball players aged 26+3, met the criteria and voluntarly participate in the study. Body weight, height, body mass index and dominant extremity of the study subjects were recorded. İsokinetic measurement were performed with Isomed 2000® device. İsokinetic testing protocol; before the test all players performed the wrist flexion and extension isokinetic test with the 5 repeating at 90º/sec as a warm-up and comprehending the test. Then, wrist flexion and extension concentric-concentric strength measurements were performed with the 5 repeating at 60º/sec and with the 15 repeating at 240º/sec with the angle between 50 degrees of wrist flexion and 60 degrees of wrist extension and peak torque, peak torque/kg values and flexion/extension ratios were recorded. Mann-Whitney U test was used to compare isokinetic muscle strength quantitative variables in athletes. Findings: Isokinetic muscle strength of wrist flexors and extensors was higher in both sides in WC table tennis players with 60º/sec speed (p0,05). Wrist flexion/extension peak torque ratios were similar in both groups. When examining the athletes flexion/extension ratios, wrist extensor muscles were weaker than flexor muscles and flexor muscles were average twice stronger than extensor muscles in both sports (Table1). Table 1. Comparison of wrist flexion and extension isokinetic muscle strength, peak torque/kg and agonist/antagonist ratio of wc basketball and wc table tennis players Wheelchair table tennis(N=9)X±SD Wheelchair basketball(N=9)X±SD p* Flexion 60°/sec Dominant side PT(Nm) 23.41±11.13 8.87±1.65 0.001 PT/Kg (Nm/Kg) 0.39±0.13 0.42±0.10 0.499 Non-dominant side PT(Nm) 20.26±9.26 8.26±3.11 0.001 PT/Kg (Nm/Kg) 0

  6. Diagnostic performance of 18-F-FDG-PET-CT in adrenal lesions using histopathology as reference standard.

    Science.gov (United States)

    Altinmakas, Emre; Hobbs, Brian P; Ye, Hui; Grubbs, Elizabeth G; Perrier, Nancy D; Prieto, Victor G; Lee, Jeffrey E; Ng, Chaan S

    2017-02-01

    To determine the diagnostic performance of PET-CT in differentiating benign and malignant adrenal lesions when evaluating PET parameters individually as well as in combination with CT parameters, using histopathology as the reference standard. 18F-FDG-PET-CT scans of patients undertaken within 6 months prior to pathologic evaluation of their adrenal lesion(s) were evaluated. PET assessments consisted individually of maximum standardized uptake value of the adrenal lesion (A-SUVmax) and its ("normalized") ratio to the liver (R-SUVmax). The diagnostic performances of these two PET parameters were also assessed when combined with the Hounsfield density from the non-contrast CT component of the PET-CT (A-HU). Diagnostic performance was assessed by area under the curve (AUC) of the receiver operating characteristics. Multiple logistic regression analysis was used to evaluate the individual and combined parameters. The study cohort consisted of 61 adrenal lesions (59 patients). Malignant lesions (n = 52) had significantly higher median PET and CT parameters than benign lesions: A-SUVmax (11.4 vs. 6.1), R-SUVmax (3.3 vs. 1.7), and A-HU (37 vs. 24) [all p PET parameters individually was almost identical: 0.75 for A-SUVmax and 0.74 for R-SUVmax. On univariate analysis, thresholds of A-SUVmax >3.47 and R-SUVmax >0.83 yielded maximum accuracy (both 87%). The combination of these PET parameters individually with A-HU improved both AUC and accuracy (0.81% and 93%, respectively). The individual PET parameters A-SUVmax and R-SUVmax have similar diagnostic performance for differentiating malignant and benign adrenal lesions; their performance and accuracy improve when combined with the CT component (A-HU).

  7. Diagnostic Performance of Wells Score Combined With Point-of-care Lung and Venous Ultrasound in Suspected Pulmonary Embolism.

    Science.gov (United States)

    Nazerian, Peiman; Volpicelli, Giovanni; Gigli, Chiara; Becattini, Cecilia; Papa, Giuseppe Francesco Sferrazza; Grifoni, Stefano; Vanni, Simone

    2017-03-01

    Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated. We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Conventional Wells score (Ws) was adjudicated by the attending physician, and ultrasound was performed by one of 20 investigators. Signs of deep venous thrombosis (DVT) at venous ultrasound and signs of pulmonary infarcts or alternative diagnoses at lung ultrasound were considered to recalculate two items of the Ws: signs and symptoms of DVT and alternative diagnosis less likely than PE. The diagnostic performances of the ultrasound-enhanced Ws (USWs) and Ws were then compared after confirmation of the final diagnosis. A total of 446 patients were studied. PE was confirmed in 125 patients (28%). USWs performed significantly better than Ws, with a sensitivity of 69.6% versus 57.6% and a specificity of 88.2% versus 68.2%. In combination with D-dimer, USWs showed an optimal failure rate (0.8%) and a significantly superior efficiency than Ws (32.3% vs. 27.2%). A strategy based on lung and venous ultrasound combined with D-dimer would allow to avoid CT pulmonary angiography in 50.5% of patients with suspected PE, compared to 27.2% when the rule without ultrasound is applied. A pretest risk stratification enhanced by ultrasound of lung and venous performs better than Ws in the early diagnostic process of PE. © 2016 by the Society for Academic Emergency Medicine.

  8. Agreement and Diagnostic Performance of FITNESSGRAM®, International Obesity Task Force, and Hungarian National BMI Standards

    Science.gov (United States)

    Laurson, Kelly R.; Welk, Gregory J.; Marton, Orsolya; Kaj, Mónika; Csányi, Tamás

    2015-01-01

    Purpose: This study examined agreement between all 3 standards (as well as relative diagnostic associations with metabolic syndrome) using a representative sample of youth from the Hungarian National Youth Fitness Study. Method: Body mass index (BMI) was assessed in a field sample of 2,352 adolescents (ages 10-18.5 years) and metabolic syndrome…

  9. Comparison of the diagnostic performance of CT colonography interpreted by radiologists and radiographers

    DEFF Research Database (Denmark)

    Lauridsen, Carsten; Lefere, Philippe; Gerke, Oke

    2013-01-01

    sensitivity and specificity in polyp detection comparable with that of experienced radiologists. MAIN MESSAGES : • The diagnostic accuracy of trained radiographers was comparable to that of experienced radiologists. • The use of radiographers in reading CTC examinations is acceptable, however radiologists...

  10. 78 FR 18988 - Establishing the Performance Characteristics of In Vitro Diagnostic Devices for the Detection of...

    Science.gov (United States)

    2013-03-28

    ... Diagnostic Devices for the Detection of Antibodies to Borrelia burgdorferi; Guidance for Industry and Food... Borrelia burgdorferi.'' FDA is issuing this guidance to provide industry and Agency staff with... B. burgdorferi must conform to the general controls of the Federal Food, Drug, and Cosmetic Act and...

  11. Performance of different diagnostic criteria of overweight and obesity as predictors of metabolic syndrome in adolescents

    Directory of Open Access Journals (Sweden)

    Raphael Gonçalves de Oliveira

    2017-09-01

    Conclusions: Overweight and obesity using BMI showed a moderate association with MetS, regardless of the diagnostic criteria used. However, the IOTF criterion showed better predictive capacity for the presence of MetS than the WHO and the Conde and Monteiro criteria.

  12. Appraising and applying evidence about a diagnostic test during a performance-based assessment

    Directory of Open Access Journals (Sweden)

    Franklin Ellen

    2004-10-01

    Full Text Available Abstract Background The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions. Methods 4th year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an applicable diagnostic test and revised the patient's pretest probability given the test result. Results The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67. Only one out of 28 (3% medical students and none of the 15 residents were able to correctly complete the probability revision task (p = 1.00. Conclusions This study found that most students completing medical school are able to appraise an article about a diagnostic test but few are able to apply the information from the article to a patient. These findings raise questions about the clinical usefulness of the EBM skills possessed by graduating medical students within the area of diagnostic testing.

  13. Diagnostic model for assessing traceability system performance in fish processing plants

    NARCIS (Netherlands)

    Mgonja, J.T.; Luning, P.A.; Vorst, van der J.G.A.J.

    2013-01-01

    This paper introduces a diagnostic tool that can be used by fish processing companies to evaluate their own traceability systems in a systematic manner. The paper begins with discussions on the rationale of traceability systems in food manufacturing companies, followed by a detailed analysis of the

  14. T1 mapping cardiovascular magnetic resonance imaging to detect myocarditis-Impact of slice orientation on the diagnostic performance.

    Science.gov (United States)

    Bohnen, Sebastian; Radunski, Ulf K; Lund, Gunnar K; Tahir, Enver; Avanesov, Maxim; Stehning, Christian; Schnackenburg, Bernhard; Adam, Gerhard; Blankenberg, Stefan; Muellerleile, Kai

    2017-01-01

    T1 mapping is a promising diagnostic tool to improve the diagnostic accuracy of cardiovascular magnetic resonance (CMR) in patients with suspected myocarditis. However, there are currently no data on the potential influence of slice orientation on the diagnostic performance of CMR. Thus, we compared the diagnostic performance of global myocardial T1 and extracellular volume (ECV) values to differentiate patients with myocarditis from healthy individuals between different slice orientations. This study included 48 patients with clinically defined myocarditis and 13 healthy controls who underwent CMR at 1.5T. A modified Look-Locker inversion-recovery (MOLLI) sequence was used for T1 mapping before and 15min after administration of 0.075mmol/kg Gadolinium-BOPTA. T1 mapping was performed on three short and on three long axes slices, respectively. Native T1, post-contrast T1 and extracellular volume (ECV) -BOPTA maps were calculated using a dedicated plug-in written for the OsiriX software and compared between the mean value of three short-axes slices (3SAX), the central short-axis (1SAX), the mean value of three long-axes slices (3LAX), the four-chamber view (4CH), the three-chamber view (3CH) and the two-chamber view (2CH). There were significantly lower native T1 values on 3LAX (1081ms (1037-1131ms)) compared to 3SAX (1107ms (1069-1143ms), p=0.0022) in patients with myocarditis, but not in controls (1026ms (1009-1059ms) vs. 1039ms (1023-1055ms), p=0.2719). The areas under the curve (AUC) to discriminate between myocarditis and healthy controls by native myocardial T1 were 0.85 (pT1 and ECV-BOPTA on short axes slices provide a better diagnostic performance in myocarditis than long axes slices since long axes slices seem to underestimate native myocardial T1 in myocarditis. T1 mapping in suspected myocarditis can be restricted to a single mid-ventricular short-axis slice without a significant loss in diagnostic performance. Copyright © 2016 Elsevier Ireland Ltd. All

  15. Exploring medical diagnostic performance using interactive, multi-parameter sourced receiver operating characteristic scatter plots.

    Science.gov (United States)

    Moore, Hyatt E; Andlauer, Olivier; Simon, Noah; Mignot, Emmanuel

    2014-04-01

    Determining diagnostic criteria for specific disorders is often a tedious task that involves determining optimal diagnostic thresholds for symptoms and biomarkers using receiver-operating characteristic (ROC) statistics. To help this endeavor, we developed softROC, a user-friendly graphic-based tool that lets users visually explore possible ROC tradeoffs. The software requires MATLAB installation and an Excel file containing threshold symptoms/biological measures, with corresponding gold standard diagnoses for a set of patients. The software scans the input file for diagnostic and symptom/biomarkers columns, and populates the graphical-user-interface (GUI). Users select symptoms/biomarkers of interest using Boolean algebra as potential inputs to create diagnostic criteria outputs. The software evaluates subtests across the user-established range of cut-points and compares them to a gold standard in order to generate ROC and quality ROC scatter plots. These plots can be examined interactively to find optimal cut-points of interest for a given application (e.g. sensitivity versus specificity needs). Split-set validation can also be used to set up criteria and validate these in independent samples. Bootstrapping is used to produce confidence intervals. Additional statistics and measures are provided, such as the area under the ROC curve (AUC). As a testing set, softROC is used to investigate nocturnal polysomnogram measures as diagnostic features for narcolepsy. All measures can be outputted to a text file for offline analysis. The softROC toolbox, with clinical training data and tutorial instruction manual, is provided as supplementary material and can be obtained online at http://www.stanford.edu/~hyatt4/software/softroc or from the open source repository at http://www.github.com/informaton/softroc. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. [Four-Corner Arthrodesis of the Wrist with Dorsal Circular Plate - a Retrospective Monocentric Study].

    Science.gov (United States)

    Zatrapa, T; Veigl, D; Pech, J; Landor, I; Šimková, M

    2017-01-01

    PURPOSE OF THE STUDY Our study aimed to evaluate a group of patients who in the period from 2005 to 2014 underwent a four-corner arthrodesis of the wrist in our department. We also wanted to verify the hypothesis as to whether the use of conventional dorsal plate without the application of bone grafts leads to comparable results as the use of dorsal locking plates and routine application of bone grafts. MATERIAL AND METHODS Throughout the years 2005 to 2014 the four-corner arthrodesis of the wrist was performed in our department in a total of 62 patients, in two cases bilaterally. The indication was the diagnosis of SLAC/SNAC grade III. Normed RondoFix implant was used in all the cases. Following the surgery, the wrist was immobilized by a volar plaster splint for the period of 2 weeks and subsequently orthosis was applied for additional 4 weeks. The wrist mobilisation started in week seven when the orthosis was removed, the patients were allowed full load on the wrist 3 months after the surgery. Our group of patients was evaluated retrospectively, a total of 53 operated wrists in 51 patients were assessed. The assessment was carried out based on a radiograph of the wrist, range of motion, Mayo Modified Wrist Score, DASH Score and grip strength test. RESULTS The mean range of motion in sagittal plane was 63.7°, in frontal plane the mean value was 32.1°. According to the Mayo Modified Wrist Score 37 patients were rated "excellent" or "good". Due to the presence of moderate pain, the result in other 10 patients was assessed as "satisfactory". In a total of 4 patients the result was assessed as "weak", in two of them for a presence of non-union and in other two for severe pain under load. One of these patients underwent bilateral surgery and reported severe pain in both the wrists. Regarding DASH score, the best result equalled 0, the worst 65.83, with the mean of 20.5. The grip strength ranged from 8 to 54 kg, with the mean value of 27.5 kg. In two patients, a non

  17. Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve.

    Science.gov (United States)

    Papafaklis, Michail I; Muramatsu, Takashi; Ishibashi, Yuki; Bourantas, Christos V; Fotiadis, Dimitrios I; Brilakis, Emmanouil S; Garcia-Garcia, Héctor M; Escaned, Javier; Serruys, Patrick W; Michalis, Lampros K

    2018-03-01

    Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (pvirtual resting Pd/Pa and FFR (r=0.69, pVirtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  18. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis.

    Science.gov (United States)

    Kim, Mi Sung; Kwon, Heon-Ju; Kang, Kyung A; Do, In-Gu; Park, Hee-Jin; Kim, Eun Young; Hong, Hyun Pyo; Choi, Yoon Jung; Kim, Young Hwan

    2018-02-01

    To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.

  19. Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint.

    Science.gov (United States)

    Taylor, Kenneth F; Meyer, Vanessa M; Smith, Laurel B; Lustik, Michael B

    2015-01-01

    Randomized clinical trial. Contribution of the posterior interosseous nerve (PIN) and surrounding skin envelope to wrist proprioception is a topic of debate and the primary focus of this research. We performed a double-blinded, placebo control study in which subjects underwent baseline multiplanar testing of wrist proprioception. They were randomized to receive either anesthetic blockade of the PIN within the fourth dorsal compartment, or circumferential topical anesthetic blockade of skin surrounding the wrist. Corresponding opposite wrists underwent placebo intervention with saline injection or inert ultrasound gel. Subjects repeated proprioceptive testing. Eighty subjects, 45 male and 35 female, mean age 33 years (range, 19-64 years), completed testing. The percentage of measurements falling outside a ±18° range did not differ between pre-treatment and post-treatment PIN blockade or for circumferential skin anesthesia. Wrist proprioception appears to be a multifactorial phenomenon. Surgeons may sacrifice the PIN without concern for effect on joint proprioception. Level I. Copyright © 2015 Hanley & Belfus. All rights reserved.

  20. [Tremor Suppression on Multi-DoF Wrist Joint Based on Functional Electrical Stimulation: A Simulation Study].

    Science.gov (United States)

    Zhang, Wei; Zhang, Dingguo; Liu, Jianrong

    2015-04-01

    An automatic control system was designed to suppress pathological tremor on wrist joint with two degrees of freedom (DoF) using functional electrical stimulation (FES). The tremor occurring in the wrist flexion-extension and adduction-abduction was expected to be suppressed. A musculoskeletal model of wrist joint was developed to serve as the control plant, which covered four main muscles (extensor carpi radialis longus, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris). A second-order mechanical impedance model was used to describe the wrist skeletal dynamics. The core work was to design the controller and a hybrid control strategy was proposed, which combined inverse model based on feed forward control and linear quadratic regulator (LQR) optimal control. Performance of the system was tested under different input conditions (step signal, sinusoidal signal, and real data of a patient)., The results indicated that the proposed hybrid controller could attenuate over 94% of the tremor amplitude on multi-DoF wrist joint.

  1. Comparison of Diagnostic Performance of Semi-Quantitative Knee Ultrasound and Knee Radiography with MRI: Oulu Knee Osteoarthritis Study

    Science.gov (United States)

    Podlipská, Jana; Guermazi, Ali; Lehenkari, Petri; Niinimäki, Jaakko; Roemer, Frank W.; Arokoski, Jari P.; Kaukinen, Päivi; Liukkonen, Esa; Lammentausta, Eveliina; Nieminen, Miika T.; Tervonen, Osmo; Koski, Juhani M.; Saarakkala, Simo

    2016-01-01

    Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level. PMID:26926836

  2. Lymphoma and inflammation in the orbit: Diagnostic performance with diffusion-weighted imaging and dynamic contrast-enhanced MRI.

    Science.gov (United States)

    Sun, Bo; Song, Liyuan; Wang, Xinyan; Li, Jing; Xian, Junfang; Wang, Feifei; Tan, Pan

    2017-05-01

    To investigate the diagnostic performance of diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), and the combination of both in the differential diagnosis of lymphoma and inflammation in the orbit. This retrospective study was approved by the Institutional Review Board and the informed consent requirement was waived. A total of 53 patients underwent preoperative 3T MRI. Parameters of DWI and DCE MRI were evaluated in these 30 patients with orbital lymphoma and 23 patients with orbital inflammation. The diagnostic performance was evaluated using receiver operating characteristic curve analysis. Apparent diffusion coefficient (ADC) values and parameters derived from DCE MRI of orbital lymphoma and orbital inflammation differed significantly (ADC, T max , contrast index [CI], enhancement ratio [ER], and washout ratio [WR]: P inflammation (P = 0.016 for reviewer 1; P = 0.001 for reviewer 2). The combination of DWI and DCE MRI can improve diagnostic performance in differentiating lymphoma from inflammation in the orbit compared with DWI alone. 3 J. MAGN. RESON. IMAGING 2017;45:1438-1445. © 2016 International Society for Magnetic Resonance in Medicine.

  3. Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT

    Energy Technology Data Exchange (ETDEWEB)

    Yunaga, Hiroto; Ohta, Yasutoshi; Kitao, Shinichiro; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Yonago City, Tottori (Japan); Kaetsu, Yasuhiro [Kakogawa Higashi Hospital, Department of Cardiology, Kakogawa (Japan); Watanabe, Tomomi; Furuse, Yoshiyuki; Yamamoto, Kazuhiro [Tottori University, Division of Cardiology, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Yonago (Japan)

    2017-07-15

    Multi-detector-row computed tomography angiography (MDCTA) plays an important role in the assessment of patients with suspected coronary artery disease. However, MDCTA tends to overestimate stenosis in calcified coronary artery lesions. The aim of our study was to evaluate the diagnostic performance of calcification-suppressed material density (MD) images produced by using a single-detector single-source dual-energy computed tomography (ssDECT). We enrolled 67 patients with suspected or known coronary artery disease who underwent ssDECT with rapid kilovolt-switching (80 and 140 kVp). Coronary artery stenosis was evaluated on the basis of MD images and virtual monochromatic (VM) images. The diagnostic performance of the two methods for detecting coronary artery disease was compared with that of invasive coronary angiography as a reference standard. We evaluated 239 calcified segments. In all the segments, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting significant stenosis were respectively 88%, 88%, 75%, 95% and 88% for the MD images, 91%, 71%, 56%, 95% and 77% for the VM images. PPV was significantly higher on the MD images than on the VM images (P < 0.0001). Calcification-suppressed MD images improved PPV and diagnostic performance for calcified coronary artery lesions. (orig.)

  4. Performance and LHC beam stability issue related to Q/Q' diagnostics and feedback systems

    CERN Document Server

    Steinhagen, Ralph J

    2010-01-01

    The baseline tune (Q) and chromaticity (Q’) diagnostics and associated feedback systems played a crucial role during the LHC commissioning, in establishing circulating beam, the first ramps and their fill-to-fill feed-forward correction. Early on, they also allowed to identify issues such as the residual tune stability, beam spectrum interferences and beam-beam effects – all of which may impact beam lifetimes and thus need to be addressed in view of nominal LHC operation.

  5. Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

    Science.gov (United States)

    Rowe, Christopher; Vittinghoff, Eric; Santos, Glenn-Milo; Behar, Emily; Turner, Caitlin; Coffin, Phillip O

    2017-04-01

    Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and

  6. At Home Photography-Based Method for Measuring Wrist Range of Motion.

    Science.gov (United States)

    Trehan, Samir K; Rancy, Schneider K; Johnsen, Parker H; Hillstrom, Howard J; Lee, Steve K; Wolfe, Scott W

    2017-11-01

    Purpose  To determine the reliability of wrist range of motion (WROM) measurements based on digital photographs taken by patients at home compared with traditional measurements done in the office with a goniometer. Methods  Sixty-nine postoperative patients were enrolled in this study at least 3 months postoperatively. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by one of the two attending surgeons with a 1-degree resolution goniometer at the last postoperative office visit. Patients were provided an illustrated instruction sheet detailing how to take digital photographic images at home in six wrist positions (active and passive flexion/extension, and radial/ulnar deviation). Wrist position was measured from digital images by both the attending surgeons in a randomized, blinded fashion on two separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient to assess agreement between clinical and photography-based goniometry, as well as intra- and interobserver agreement. Results  Out of 69 enrolled patients, 30 (43%) patients sent digital images. Of the 180 digital photographs, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was "almost perfect" for passive wrist flexion/extension and "substantial" for active wrist flexion/extension and radial/ulnar deviation. Inter- and intraobserver agreement for the attending surgeons was "almost perfect" for all measurements. Discussion  This study validates a photography-based goniometry protocol allowing accurate and reliable WROM measurements without direct physician contact. Passive WROM was more accurately measured from photographs than active WROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients or their families take and submit their own

  7. Utility of DWI with quantitative ADC values in ovarian tumors: a meta-analysis of diagnostic test performance.

    Science.gov (United States)

    Pi, Shan; Cao, Rong; Qiang, Jin Wei; Guo, Yan Hui

    2018-01-01

    Background Diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) values are widely used in the differential diagnosis of ovarian tumors. Purpose To assess the diagnostic performance of quantitative ADC values in ovarian tumors. Material and Methods PubMed, Embase, the Cochrane Library, and local databases were searched for studies assessing ovarian tumors using quantitative ADC values. We quantitatively analyzed the diagnostic performances for two clinical problems: benign vs. malignant tumors and borderline vs. malignant tumors. We evaluated diagnostic performances by the pooled sensitivity and specificity values and by summary receiver operating characteristic (SROC) curves. Subgroup analyses were used to analyze study heterogeneity. Results From the 742 studies identified in the search results, 16 studies met our inclusion criteria. A total of ten studies evaluated malignant vs. benign ovarian tumors and six studies assessed malignant vs. borderline ovarian tumors. Regarding the diagnostic accuracy of quantitative ADC values for distinguishing between malignant and benign ovarian tumors, the pooled sensitivity and specificity values were 0.91 and 0.91, respectively. The area under the SROC curve (AUC) was 0.96. For differentiating borderline from malignant tumors, the pooled sensitivity and specificity values were 0.89 and 0.79, and the AUC was 0.91. The methodological quality of the included studies was moderate. Conclusion Quantitative ADC values could serve as useful preoperative markers for predicting the nature of ovarian tumors. Nevertheless, prospective trials focused on standardized imaging parameters are needed to evaluate the clinical value of quantitative ADC values in ovarian tumors.

  8. Hyperstaticity for ergonomie design of a wrist exoskeleton.

    Science.gov (United States)

    Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico

    2013-06-01

    Increasing the level of transparency in rehabilitation devices has been one of the main goals in robot-aided neurorehabilitation for the past two decades. This issue is particularly important to robotic structures that mimic the human counterpart's morphology and attach directly to the limb. Problems arise for complex joints such as the human wrist, which cannot be accurately matched with a traditional mechanical joint. In such cases, mechanical differences between human and robotic joint cause hyperstaticity (i.e. overconstraint) which, coupled with kinematic misalignments, leads to uncontrolled force/torque at the joint. This paper focuses on the prono-supination (PS) degree of freedom of the forearm. The overall force and torque in the wrist PS rotation is quantified by means of a wrist robot. A practical solution to avoid hyperstaticity and reduce the level of undesired force/torque in the wrist is presented, which is shown to reduce 75% of the force and 68% of the torque.

  9. Treatment of wrist deformities in children with arthrogryposis multiplex congenita

    Directory of Open Access Journals (Sweden)

    Evgeniya A Kochenova

    2016-03-01

    Conclusions: Patients with segmental lesions of the spinal cord at the С6-С7 and С5-С8 level were associated with restoration of active wrist extension up to the neutral position or more and were expected to achieve significant improvement of hand function. Patients with spinal cord lesions at the C5-Th1 level exhibited significant lesions of the muscles, along with bone deformities. Consequently, surgical treatment could only achieve functional wrist position with minimal improvement of hand function. Using differential approaches in the treatment of wrist contracture that are selected by determining the level of spinal cord lesion will enable physicians to predict the outcome and improve the function and appearance of the wrist.

  10. Pseudotumoral form of soft-tissue tuberculosis of the wrist.

    Science.gov (United States)

    Sbai, Mohamed Ali; Benzarti, Sofien; Msek, Hichem; Boussen, Monia; Khorbi, Adel

    2016-03-01

    Tuberculosis is a major public health problem in developing countries. Hand and wrist is a rare localization for extra-pulmonary tuberculosis, a pseudotumoral form of soft tissue tuberculosis of the wrist is exceptional. We report the case of a 45-year-old male presenting with a painful swelling of the dorsal aspect of the right wrist evolving for six months. Clinical study was evoking a ganglion cyst of the wrist. Intraoperatively a pseudotumoral mass with rice bodies was found, suggesting tuberculous tenosynovitis. The histopathological study revealed caseating giant cell granulomas with epithelioid cells. Cultures on Löwenstein-Jensen medium detected Mycobacterium tuberculosis. Synovectomy with removal of all the rice bodies followed by anti-tuberculous chemotherapy provided uneventful recovery. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  11. Finger motion capture from wrist-electrode contact resistance.

    Science.gov (United States)

    Yoshimoto, Shunsuke; Kawaguchi, Junki; Imura, Masataka; Oshiro, Osamu

    2015-01-01

    Hand motion capture is an important yet challenging topic for biomechanics and human computer interaction. We proposed a novel electrical sensing technology for capturing the finger angles from the variation of the wrist shape. The proposed device detects the signal related to the wrist-electrode contact resistances, which change according to the variation of the wrist shape accompanying finger movements. The developed sensing device consists of a wrist band, sixteen electrodes and a sensing circuit of contact resistances. We investigated the relationships between the finger angles and the system outputs by using a glove-type joint angle sensor. As a result, we confirmed high correlations of the system outputs with the finger angles for several electrodes. Therefore, we conclude that the proposed system can be used for the estimation of the finger joint angles.

  12. Application of the Blobo bluetooth ball in wrist rehabilitation training

    National Research Council Canada - National Science Library

    WEI-MIN HSIEH; YUH-SHYAN HWANG; SHIH-CHING CHEN; SUN-YEN TAN; CHIH-CHEN CHEN; YU-LUEN CHEN

    2016-01-01

    Abstract. [Purpose] The introduction of emerging technologies such as the wireless Blobo bluetooth ball with multimedia features can enhance wrist physical therapy training, making it more fun and enhancing its effects. [Methods...

  13. Alzheimer's Disease Diagnostic Performance of a Multi-Atlas Hippocampal Segmentation Method using the Harmonized Hippocampal Protocol

    DEFF Research Database (Denmark)

    Anker, Cecilie Benedicte; Sørensen, Lauge; Pai, Akshay

    registration, patch-based segmentation method (MRP) using 40 HHP segmentations in the atlas (12 NC, 11 MCI, 17 AD) was applied to segment the hippocampi. Static- and longitudinal FS (v5.1.0, default parameters) were also applied to segment the hippocampi. Atrophy rate calculated as percent volume change from...... baseline to month 12 was estimated for the three methods, and diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) of pairwise diagnostic group comparisons. RESULTS Mean (SD) atrophy rates were as follows (MRP / static FS / longitudinal FS): NC -0.......86 (2.46) / -1.39 (5.41) / -1.63 (2.54), MCI -2.38 (3.28) / -3.69 (5.48) / -3.25 (3.53), AD -4.23 (3.07) / -4.29 (5.32) / -4.83 (3.74). Diagnostic performances were as follows (AUC; MRP / static FS / longitudinal FS): NC vs. MCI 0.65 / 0.67 / 0.64, NC vs. AD 0.80 / 0.69 / 0.76, MCI vs. AD 0.66 / 0...

  14. Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jong, Marcus C. de; Genders, Tessa S.S. [Erasmus MC - University Medical Center Rotterdam, Departments of Epidemiology and Radiology, P.O. Box 2040, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Geuns, Robert-Jan van [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands); Moelker, Adriaan [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Hunink, M.G.M. [Erasmus MC - University Medical Center Rotterdam, Departments of Epidemiology and Radiology, P.O. Box 2040, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Harvard University, Department of Health Policy and Management, Harvard School of Public Health, Boston (United States)

    2012-09-15

    To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard. We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.26-4.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.28-3.25; P = 0.006) and that of ECHO (2.83; 95 % CI 2.29-3.37; P = 0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P = 0.52). Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance. (orig.)

  15. Comparison of diagnostic performance on approximal caries detection among Swedish and Chinese senior dental students using analogue and digital radiographs.

    Science.gov (United States)

    Minston, William; Li, Gang; Wennberg, Rikard; Näsström, Karin; Shi, Xie-Qi

    2013-01-01

    The objective was to investigate diagnostic performance on approximal caries detection among Swedish and Chinese dental students using analogue and digital radiographs in vitro. Additionally, to compare the diagnostic accuracy of two image modalities for approximal caries detection. 46 extracted premolars and molars were mounted in blocks and exposed with two intra-oral systems, one CCD based digital radiographs and one with conventional films. 10 Swedish and 10 Chinese senior dental students diagnosed the approximal sites of the teeth exposed with the digital and analogue images. A 5 point diagnosis confidence scale was applied for caries registration for all the observers. Subsequently, the teeth were sectioned and histo-pathologically analyzed in order to obtain a gold standard. The data were analyzed in terms of receiver operating characteristic (ROC) curves for evaluation of diagnostic accuracy of the two radiographic methods and for the two groups of students for enamel and dentinal caries detection, respectively. The area under the ROC curve was significantly higher for dentinal caries detection compared with enamel caries detection for both Chinese and Swedish students and for both imaging modalities (px-ray systems were equally accurate. Chinese and Swedish students showed similar outcomes in their performance for approximal caries detection.

  16. Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

    Directory of Open Access Journals (Sweden)

    Hye Mi Yoo

    2015-05-01

    Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

  17. Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome.

    Science.gov (United States)

    Imai, Shinji; Kodama, Narihito; Matsusue, Yoshitaka

    2008-01-01

    Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.

  18. Effect of breast cancer phenotype on diagnostic performance of MRI in the prediction to response to neoadjuvant treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bufi, Enida, E-mail: reagandus@alice.it [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy); Belli, Paolo; Di Matteo, Marialuisa [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy); Terribile, Daniela; Franceschini, Gianluca [Department of Surgery, Breast Unit, Catholic University, Rome (Italy); Nardone, Luigia [Department of Radiotherapy, Catholic University, Rome (Italy); Petrone, Gianluigi [Department of Pathology, Catholic University, Rome (Italy); Bonomo, Lorenzo [Department of Bioimaging and Radiological Sciences, Catholic University, Rome (Italy)

    2014-09-15

    Aim: The estimation of response to neoadjuvant chemotherapy (NAC) is useful in the surgical decision in breast cancer. We addressed the diagnostic reliability of conventional MRI, of diffusion weighted imaging (DWI) and of a merged criterion coupling morphological MRI and DWI. Diagnostic performance was analysed separately in different tumor subtypes, including HER2+ (human epidermal growth factor receptor 2)/HR+ (hormone receptor) (hybrid phenotype). Materials and methods: Two-hundred and twenty-five patients underwent MRI before and after NAC. The response to treatment was defined according to the RECIST classification and the evaluation of DWI with apparent diffusion coefficient (ADC). The complete pathological response – pCR was assessed (Mandard classification). Results: Tumor phenotypes were Luminal (63.6%), Triple Negative (16.4%), HER2+ (7.6%) or Hybrid (12.4%). After NAC, pCR was observed in 17.3% of cases. Average ADC was statistically higher after NAC (p < 0.001) among patients showing pCR vs. those who had not pCR. The RECIST classification showed adequate performance in predicting the pCR in Triple Negative (area under the receiver operating characteristic curve, ROC AUC = 0.9) and in the HER2+ subgroup (AUC = 0.826). Lower performance was found in the Luminal and Hybrid subgroups (AUC 0.693 and 0.611, respectively), where the ADC criterion yielded an improved performance (AUC = 0.787 and 0.722). The coupling of morphological and DWI criteria yielded maximally improved performance in the Luminal and Hybrid subgroups (AUC = 0.797 and 0.761). Conclusion: The diagnostic reliability of MRI in predicting the pCR to NAC depends on the tumor phenotype, particularly in the Luminal and Hybrid subgroups. In these cases, the coupling of morphological MRI evaluation and DWI assessment may facilitate the diagnosis.

  19. Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses?

    Science.gov (United States)

    Lee, Eun Jung; Jung, Hae Kyoung; Ko, Kyung Hee; Lee, Jong Tae; Yoon, Jung Hyun

    2013-07-01

    To evaluate which shear wave elastography (SWE) parameter proves most accurate in the differential diagnosis of solid breast masses. One hundred and fifty-six breast lesions in 139 consecutive women (mean age: 43.54 ± 9.94 years, range 21-88 years), who had been scheduled for ultrasound-guided breast biopsy, were included. Conventional ultrasound and SWE were performed in all women before biopsy procedures. Ultrasound BI-RADS final assessment and SWE parameters were recorded. Diagnostic performance of each SWE parameter was calculated and compared with those obtained when applying cut-off values of previously published data. Performance of conventional ultrasound and ultrasound combined with each parameter was also compared. Of the 156 breast masses, 120 (76.9 %) were benign and 36 (23.1 %) malignant. Maximum stiffness (Emax) with a cut-off of 82.3 kPa had the highest area under the receiver operating characteristics curve (Az) value compared with other SWE parameters, 0.860 (sensitivity 88.9 %, specificity 77.5 %, accuracy 80.1 %). Az values of conventional ultrasound combined with each SWE parameter showed lower (but not significantly) values than with conventional ultrasound alone. Maximum stiffness (82.3 kPa) provided the best diagnostic performance. However the overall diagnostic performance of ultrasound plus SWE was not significantly better than that of conventional ultrasound alone. • SWE offers new information over and above conventional breast ultrasound • Various SWE parameters were explored regarding distinction between benign and malignant lesions • An elasticity of 82.3 kPa appears optimal in differentiating solid breast masses • However, ultrasound plus SWE was not significantly better than conventional ultrasound alone.

  20. Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification

    DEFF Research Database (Denmark)

    Winther, Simon; Nissen, Louise; Schmidt, Samuel Emil

    2017-01-01

    OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study...... was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment...

  1. [Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

    Science.gov (United States)

    Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

    2017-11-10

    Background Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. Material and Methods A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. Results 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Conclusion Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

  2. Monte Carlo modeling of spatially complex wrist tissue for the optimization of optical pulse oximeters

    Science.gov (United States)

    Robinson, Mitchell; Butcher, Ryan; Coté, Gerard L.

    2017-02-01

    Monte Carlo modeling of photon propagation has been used in the examination of particular areas of the body to further enhance the understanding of light propagation through tissue. This work seeks to improve upon the established simulation methods through more accurate representations of the simulated tissues in the wrist as well as the characteristics of the light source. The Monte Carlo simulation program was developed using Matlab. Generation of different tissue domains, such as muscle, vasculature, and bone, was performed in Solidworks, where each domain was saved as a separate .stl file that was read into the program. The light source was altered to give considerations to both viewing angle of the simulated LED as well as the nominal diameter of the source. It is believed that the use of these more accurate models generates results that more closely match those seen in-vivo, and can be used to better guide the design of optical wrist-worn measurement devices.

  3. Measuring generalization of visuomotor perturbations in wrist movements using mobile phones.

    Science.gov (United States)

    Fernandes, Hugo Liberal; Albert, Mark Vincent; Kording, Konrad Paul

    2011-01-01

    Recent studies in motor control have shown that visuomotor rotations for reaching have narrow generalization functions: what we learn during movements in one direction only affects subsequent movements into close directions. Here we wanted to measure the generalization functions for wrist movement. To do so we had 7 subjects performing an experiment holding a mobile phone in their dominant hand. The mobile phone's built in acceleration sensor provided a convenient way to measure wrist movements and to run the behavioral protocol. Subjects moved a cursor on the screen by tilting the phone. Movements on the screen toward the training target were rotated and we then measured how learning of the rotation in the training direction affected subsequent movements in other directions. We find that generalization is local and similar to generalization patterns of visuomotor rotation for reaching.

  4. Measuring generalization of visuomotor perturbations in wrist movements using mobile phones.

    Directory of Open Access Journals (Sweden)

    Hugo Liberal Fernandes

    Full Text Available Recent studies in motor control have shown that visuomotor rotations for reaching have narrow generalization functions: what we learn during movements in one direction only affects subsequent movements into close directions. Here we wanted to measure the generalization functions for wrist movement. To do so we had 7 subjects performing an experiment holding a mobile phone in their dominant hand. The mobile phone's built in acceleration sensor provided a convenient way to measure wrist movements and to run the behavioral protocol. Subjects moved a cursor on the screen by tilting the phone. Movements on the screen toward the training target were rotated and we then measured how learning of the rotation in the training direction affected subsequent movements in other directions. We find that generalization is local and similar to generalization patterns of visuomotor rotation for reaching.

  5. Ultrasound-guided procedures around the wrist and hand: How to do

    Energy Technology Data Exchange (ETDEWEB)

    Orlandi, Davide; Corazza, Angelo [Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Silvestri, Enzo [Diagnostica per Immagini, Ospedale Evangelico Internazionale, Corso Solferino 29A, 16100 Genova (Italy); Serafini, Giovanni [Dipartimento di Diagnostica per Immagini, Ospedale Santa Corona, Via XXV Aprile 38, 17037 Pietra Ligure, Savona (Italy); Savarino, Edoardo Vincenzo [Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Via Giustiniani, Padova (Italy); Garlaschi, Giacomo [Dipartimento di Scienze per la Salute, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Mauri, Giovanni [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Cimmino, Marco Amedeo [Dipartimento di Medicina Interna, Università degli Studi di Genova, Via L.B. Alberti 4, 16132 Genova (Italy); Sconfienza, Luca Maria, E-mail: io@lucasconfienza.it [Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, Milano (Italy); Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Piazza Malan 2, San Donato Milanese, Milano (Italy)

    2014-07-15

    Ultrasound has emerged as a low-cost, radiation-free and effective imaging technique to detect joint abnormalities and to guide percutaneous procedures. Being superficial, wrist and hand tendons and joints represent a good target to perform such procedures using ultrasound guidance. This kind of approach allows for a clear and real-time visualization of the needles during their whole path. In this setting, the knowledge of technical aspects and tips is essential to act in the most accurate way on target tissues that can be as small as a few millimetres. The aim of this review is to summarize the local treatments of inflammatory and degenerative disease described in literature (such as treatment of De Quervain's tenosynovitis, trigger finger, trapezio-metacarpal joint osteoarthritis, etc.), emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the wrist and hand.

  6. Sensorimotor interventions and assessments for the hand and wrist: a scoping review.

    Science.gov (United States)

    Valdes, Kristin; Naughton, Nancy; Algar, Lori

    2014-01-01

    Scoping review. Sensorimotor deficits can impair function and may be present in individuals with common upper extremity conditions. To provide clinicians with an understanding of the usefulness of the assessments to evaluate sensorimotor function and the interventions reported in the literature to effect positive change in our patients with sensorimotor deficits affecting the hand and wrist. A systematic search produced seventeen studies involving sensorimotor retraining and assessment of sensorimotor performance for the upper extremity. Sensorimotor interventions and assessments found in the literature vary in regards to their effectiveness in restoring sensorimotor function in subjects with a number of conditions that affect hand and wrist function. There is a potential value of sensorimotor interventions for individuals with specific upper extremity conditions. There is a need for further studies to improve treatment of sensorimotor deficits and understanding of sensorimotor interventions. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  7. Wrist Camera Orientation for Effective Telerobotic Orbital Replaceable Unit (ORU) Changeout

    Science.gov (United States)

    Jones, Sharon Monica; Aldridge, Hal A.; Vazquez, Sixto L.

    1997-01-01

    The Hydraulic Manipulator Testbed (HMTB) is the kinematic replica of the Flight Telerobotic Servicer (FTS). One use of the HMTB is to evaluate advanced control techniques for accomplishing robotic maintenance tasks on board the Space Station. Most maintenance tasks involve the direct manipulation of the robot by a human operator when high-quality visual feedback is important for precise control. An experiment was conducted in the Systems Integration Branch at the Langley Research Center to compare several configurations of the manipulator wrist camera for providing visual feedback during an Orbital Replaceable Unit changeout task. Several variables were considered such as wrist camera angle, camera focal length, target location, lighting. Each study participant performed the maintenance task by using eight combinations of the variables based on a Latin square design. The results of this experiment and conclusions based on data collected are presented.

  8. Persistent Posttraumatic Wrist Pain - Tuberculosis Infection Should be in the Differential Diagnosis. A Rare Case Report.

    Science.gov (United States)

    Soman, Shardul Madhav; Patel, Bhavik Nandubhai; Shah, Pratik Dineshbhai

    2015-01-01

    It is uncommon for hand surgeons to diagnose and treat persistent post-traumatic radius fracture on the lines of tuberculosis infection even in developing countries especially when the clinical picture resembles more of a complex regional pain syndrome (CRPS). Although it works for many patients, some conditions that affect the wrist don't fall in this category and worsen with this treatment practice. We present a patient who had an extra articular distal radius fracture treated initially with percutaneous pinning and was treated as CRPS for the next ten months by local physician. He was eventually diagnosed with advanced tuberculosis of the wrist and a total wrist arthrodesis was performed. Only one such case was ever reported in literature. A 50-year-old male, came to our institute with the history of pain and fullness in the wrist since one year. One year ago he had developed an extra articular fracture of the distal radius which was initially treated with percutaneous pinning and a below elbow cast for six weeks. On removal of the cast one pin was found loose and the other removed eventually after two more weeks of immobilization. Patient continued to have pain with fullness around the wrist which was treated at local place with anti inflammatory agents and ice application. Patient had complaint of other constitutional symptoms. Initially patient had full range of motion which gradually decreased. X-ray showed characteristic signs suggesting of extensive tuberculosis of distal radius which was operated with wrist arthrodesis. Per operatively, fine rice granular granulation tissue was found, histopathological examination of which confirmed the diagnosis of tuberculosis. Though rare, every case of distal radius fracture complaining of chronic pain and signs suggestive of CRPS should have tuberculosis as one of the differential diagnosis, even if patient does not present any signs of tuberculosis or any primary focus is not identified. Even though skeletal

  9. Wrist actigraphic measures of sleep in space

    Science.gov (United States)

    Monk, T. H.; Buysse, D. J.; Rose, L. R.

    1999-01-01

    STUDY OBJECTIVES: To determine whether wrist actigraphy is useful as a tool for space-based sleep research. Specifically, to determine whether bedtimes and waketimes can be identified from the actigraphic record, and whether actigraphic measures of sleep in space are related to polysomnographic (PSG) ones. DESIGN AND SETTING: Actigraphy, sleep diary, and Polysomnographic (PSG) measures of sleep were obtained from four subjects in two 72h measurement blocks occurring 2d and 12d into a 17d Space Shuttle mission in orbiting the earth in microgravity. PATIENTS: Four healthy male astronauts aged 38y - 47y. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Sleep onset and offset at "night" could be quite clearly identified from the actigraphic record and were better estimated by actigraph than by diary. There was a high correlation between actigraphic and PSG estimates of sleep duration (r = 0.96) and sleep efficiency (r = 0.88), and a similarity in the mean estimates obtained. On a minute-by-minute basis, there was a good correlation between sleep stage and actigraphic movement counts, with a higher level of counts per minute recorded in epochs with lighter PSG sleep stages. There was also a high correlation (r = 0.90) between minutes of stage 0 (wake) occurring between bedtime and wake time, and number of non-zero actigraph epochs during the same interval. CONCLUSIONS: Actigraphy worked well in space both as a way of detecting bedtimes and waketimes, and as an indicant of sleep restlessness.

  10. Low-dose cerebral CT perfusion imaging (CTPI) of senile dementia: diagnostic performance.

    Science.gov (United States)

    Tang, Zhen; Chen, Feng; Huang, Jie; Shi, Linghua; Gong, H T; Fu, Hongmei; Qu, Zhengwan; Pi, Xiaoling

    2013-01-01

    To evaluate the clinical value of low-dose cerebral CTPI in the diagnosis of senile dementia, as an attempt to develop a new imaging method to diagnose this disease and measure its severity. 95 patients of senile dementia (52 with Alzheimer's disease (AD), 43 with vascular dementia (VD)) and 30 healthy subjects (control group) were underwent low-dose cerebral CTPI examinations with multi-slices spiral CT. The CTPI images were analyzed using perfusion software. Derived perfusion parameters including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) were measured. Diagnostic value of perfusion parameters was evaluated by receiver-operating characteristic (ROC) curve. The CBV and CBF of both of frontal lobe, temporal lobe, hippocampus and basal ganglial area in the patients with senile dementia were much lower than those in the healthy group. And MTT and TTP of the areas above-mentioned in the senile dementia group were higher than those in the control group. There was statistically significant difference between them (psenile dementia were 0.959, 0.920, 0.916, and diagnostic accuracy rate is higher. The areas under ROC curve of the left frontal MTT, the left basal ganglia CBV were 0.867 and 0.819, diagnosis accuracy medium. The results showed that cerebral CTPI is valuable for the diagnosis of senile dementia. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Effects of dynamic and static handgrip exercises on hand and wrist volume.

    Science.gov (United States)

    Yamauchi, Junichiro; Hargens, Alan

    2008-05-01

    It is not known how the mode of exercise, dynamic and static exercises, affects the limb volume. Therefore, the purpose of this study was to investigate hand and wrist volume (HWV) after dynamic and static handgrip exercise. Nine healthy subjects (age 31.8 +/- 7.3 years; height 172.0 +/- 5.7 cm; body mass 66.9 +/- 8.1 kg, mean +/- SD) volunteered for this study. HWV was measured with a hand and wrist volumeter before and immediately after dynamic and static exercises. Initially during rest, HWV was measured after the hand was passively hung for 5 min. Handgrip exercises with an ergonomic hand exerciser were performed at 20% of maximum voluntary contraction in right and left hands by static and dynamic exercises, respectively. Both dynamic and static handgrip exercises consisted of six sets of 30-s contractions with 10-s rest intervals between exercise bouts. The dynamic handgrip exercise was performed by repetitive contraction and relaxation of the hand at a maximum frequency. In order to determine intensity of handgrip exercises, maximum isometric handgrip strength of the right and left hand was measured with a handgrip dynamometer. Data are presented as mean +/- SD. After dynamic and static handgrip exercises, HWV increased significantly, and these increases represent 2.2 +/- 0.7% (P wrist tissues.

  12. Effectiveness of 1% diclofenac gel in the treatment of wrist extensor tenosynovitis in long distance kayakers.

    Science.gov (United States)

    May, Judith J; Lovell, Greg; Hopkins, Will G

    2007-02-01

    Anecdotally many athletes use non-steroidal anti-inflammatory gels during competition to allow continued participation. To determine if this clinical practice is useful a randomised placebo-controlled study was conducted at the 5-day 2004 Red Cross Murray River Marathon. Forty-two kayakers presented with wrist extensor tenosynovitis while competing in the single and double kayak events. All subjects received standard treatment of ice, stretches and massage for wrist tenosynovitis before being randomised into a placebo or 1% diclofenac gel group. Evaluation was done by using a visual analogue scale (0-10) for pain and by clinical grading (0-3). The main outcome measurements were reduction in pain and clinical grading, the requirement for a rescue medication (paracetamol or diclofenac tablets) and effect on performance times. Both groups had similar pain scores and clinical grading on the first and fifth days of pain. On the second to fourth days of pain there was clearly no benefit and possibly a detrimental effect on pain with diclofenac gel relative to placebo. However, diclofenac tablets were possibly beneficial for pain relative to paracetamol tablets. The effects of pain and the various treatments on performance time were either trivial (<0.5%) or small, but none was particularly clear. We conclude that standard treatment appears to be sufficient for the management of wrist extensor tenosynovitis during competition.

  13. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dornberger, Jenny E. [Unfallkrankenhaus Berlin, Department of Plastic Surgery and Burn Care, Berlin (Germany); Rademacher, Grit; Mutze, Sven [Unfallkrankenhaus Berlin, Institute of Radiology, Berlin (Germany); Eisenschenk, Andreas [Unfallkrankenhaus Berlin, Department of Hand-, Replantation- and Microsurgery, Berlin (Germany); University Medicine Greifswald, Department of Hand Surgery and Microsurgery, Greifswald (Germany); Stengel, Dirk [Unfallkrankenhaus Berlin, Centre for Clinical Research, Berlin (Germany); Charite Medical University Centre, Julius Wolff Institute, Centre for Musculoskeletal Surgery, Berlin (Germany)

    2015-12-15

    To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. (orig.)

  14. Diagnostic Performance of a Novel Method for Fractional Flow Reserve Computed from Noninvasive Computed Tomography Angiography (NOVEL-FLOW Study).

    Science.gov (United States)

    Chung, Ju-Hyun; Lee, Kyung Eun; Nam, Chang-Wook; Doh, Joon-Hyung; Kim, Hyung Il; Kwon, Soon-Sung; Shim, Eun Bo; Shin, Eun-Seok

    2017-08-01

    Coronary computed tomography angiography (CCTA)-derived fractional flow reserve from computed tomography (CT-FFR) may provide better diagnostic performance over CCTA alone, but the complexity of its method limits the use in clinical environment. The aim of the present study is to validate a newly developed vessel-length based computational fluid dynamics scheme for the computation of FFR based on CCTA data, compare them with invasively measured FFR, and evaluate its diagnostic performance with that of CCTA. One hundred seventeen patients from 4 medical institutions who had clinically indicated invasive coronary angiography for suspected coronary artery disease (CAD) were enrolled. Invasive FFR measurement was performed in 218 vessels and these measurements were regarded as the reference standard. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR on a per-vessel basis were 85.8%, 86.2%, 85.5%, 79.8%, and 90.3%, respectively, for CT-FFR ≤0.80, and 66.1%, 75.9%, 59.5%, 55.5%, and 78.8%, respectively, for CCTA ≥50%. A higher area under the receiver operating characteristic curve for CT-FFR was observed compared with CCTA (0.93 vs 0.74, p performed at a personal computer enhancing its applicability in clinical situation. The diagnostic accuracy of CT-FFR for the detection of functionally significant CAD was good and was superior to that of CCTA within a population of suspected CAD. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Comparison of the diagnostic performance of 2 core biopsy needles for EUS-guided tissue acquisition from solid pancreatic lesions.

    Science.gov (United States)

    Nayar, Manu K; Paranandi, Bharat; Dawwas, Muhammad F; Leeds, John S; Darne, Antony; Haugk, Beate; Majumdar, Debasis; Ahmed, Muna M; Oppong, Kofi W

    2017-05-01

    A new core biopsy needle with a novel tip, opposing bevel, and sheath design has recently been introduced for EUS-guided fine-needle biopsy (FNB). The diagnostic utility of this needle for differentiating solid pancreatic masses is currently unknown. The aim of this study was to compare the diagnostic performance and yield for tissue acquisition from solid pancreatic lesions of the opposing bevel needle with those of a reverse bevel EUS-FNB needle. Consecutive patients with solid pancreatic masses undergoing EUS-FNB using the opposing bevel (n = 101) and the reverse bevel (n = 100) core biopsy needles were included in the study. Final diagnosis was based on positive histology or at least 12 months of follow-up in cases with a negative biopsy. The primary outcome was the diagnostic performance of the 2 needles for malignant pancreatic masses. A secondary outcome was the diagnostic yield. Compared with the reverse bevel needle, using strict criteria the opposing bevel needle provided significantly higher sensitivity (71.1% vs 90.1%; P = .0006) and overall accuracy (74% vs 92%; I = 0.0006) for discriminating malignant from benign solid pancreatic masses. The proportion of samples classified as adequate for histologic analysis was 87% for the reverse bevel needle versus 99% for the opposing bevel needle (p = 0.002) Multivariate analysis controlling the needle gauge and site did not show any significant difference in accuracy and sensitivity between the 2 groups. There were no adverse events in either group. In this first, large, single-center preliminary cohort study, an EUS core biopsy needle with a novel tip, opposing bevel, and sheath design afforded substantially superior tissue yield and diagnostic performance compared with a reverse-bevel needle. If replicated by randomized controlled trials, our findings suggest that similarly designed needles could become the standard of care for EUS-guided tissue acquisition from solid pancreatic masses. Crown Copyright

  16. An evaluation of the Performance Diagnostic Checklist-Human Services to assess an employee performance problem in a center-based autism treatment facility.

    Science.gov (United States)

    Ditzian, Kyle; Wilder, David A; King, Allison; Tanz, Jeanine

    2015-01-01

    The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human services settings. We administered the PDC-HS to 3 supervisors to assess the variables that contributed to poor performance by 4 staff members when securing clients in therapy rooms at a treatment center for children with autism. The PDC-HS identified a lack of appropriate consequences as contributing to poor staff performance. We then evaluated a PDC-HS-indicated intervention as well as an intervention not suggested by PDC-HS results. The PDC-HS-indicated intervention (graphed feedback) was effective to increase performance; the non-PDC-HS-based intervention was ineffective. © Society for the Experimental Analysis of Behavior.

  17. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference.

    Science.gov (United States)

    Yamada, Yoshitake; Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Abe, Takayuki; Kuribayashi, Sachio; Ogawa, Kenji

    2013-08-01

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA-950) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA-950. • Tomosynthesis showed significantly better diagnostic performance for pulmonary emphysema than radiography. • Interobserver agreement for tomosynthesis was significantly higher than that for radiography. • Sensitivity increased with increasing LAA -950 in both tomosynthesis and radiography. • Tomosynthesis imparts a similar radiation dose to two projection chest radiography. • Radiation dose and cost of tomosynthesis are lower than those of MDCT.

  18. A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults

    OpenAIRE

    Thiele, Jill; Nimmo, Rachel; Rowell, Wendy; Quinn, Stephen; Jones, Graeme

    2009-01-01

    Abstract Background To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain. Methods Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the ...

  19. A Wrist-Worn Thermohaptic Device for Graceful Interruption

    Directory of Open Access Journals (Sweden)

    Shahram Jalaliniya

    2015-10-01

    Full Text Available Thermal haptics is a potential system output modality for wearable devices that promises to function at the periphery of human attention. When adequately combined with existing attention-governing mechanisms of the human mind, it could be used for interrupting the human agent at a time when the negative influence on the ongoing activity is minimal. In this article we present our self-mitigated interruption concept (essentially a symbiosis of artificial external stimuli tuned to existing human attention management mechanisms and perform a pilot study laying the ground for using a wrist-worn thermohaptic actuator for self-mitigating interruption. We then develope a prototype and perform an insightful pilot study. We frame our empirical thermohaptic experimental work in terms of Peripheral Interaction concepts and show how this new approach to Human-Computer Interaction relates to the Context-Aware-systems-inspired approach “Egocentric Interaction” aimed at supporting the design of envisioned Wearable Personal Assistants intended to, among other things, help human perception and cognition with the management of interruptions.

  20. The Influence of External Forces on Wrist Proprioception

    Directory of Open Access Journals (Sweden)

    Francesca Marini

    2017-08-01

    Full Text Available Proprioception combines information from cutaneous, joint, tendon, and muscle receptors for maintaining a reliable internal body image. However, it is still a matter of debate, in both neurophysiology and psychology, to what extent such body image is modified or distorted by a changing haptic environment. In particular, what is worth investigating is the contribution of external forces on our perception of body and joint configuration. The proprioceptive acuity of fifteen young participants was tested with a Joint Position Matching (JPM task, performed with the dominant wrist under five different external forces, in order to understand to what extent they affect proprioceptive acuity. Results show that accuracy and precision in target matching do not change in a significant manner as a function of the loading condition, suggesting that the multi-sensory integration process is indeed capable of discriminating different sub-modalities of proprioception, namely the joint position sense and the sense of force. Furthermore, results indicate a preference for target undershooting when movements are performed in a viscous or high resistive force field, rather than passive or null fields in which subjects did not show any predominance for under/over estimation of their position.

  1. Evening physical activity alters wrist temperature circadian rhythmicity.

    Science.gov (United States)

    Rubio-Sastre, Patricia; Gómez-Abellán, Purificación; Martinez-Nicolas, Antonio; Ordovás, José María; Madrid, Juan Antonio; Garaulet, Marta

    2014-03-01

    The adequate time to perform physical activity (PA) to maintain optimal circadian system health has not been defined. We studied the influence of morning and evening PA on circadian rhythmicity in 16 women with wrist temperature (WT). Participants performed controlled PA (45 min continuous-running) during 7 days in the morning (MPA) and evening (EPA) and results were compared with a no-exercise-week (C). EPA was characterized by a lower amplitude (evening: 0.028 ± 0.01 °C versus control: 0.038 ± 0.016 °C; p evening: 0.41 ± 0.47 versus morning: 1.04 ± 0.59); and achrophase delay (evening: 06:35 ± 02:14 h versus morning: 04:51 ± 01:11 h; p evening might not be as beneficial as in the morning.

  2. Structural Validity of the Dutch Version of the Patient-Rated Wrist Evaluation (PRWE-NL) in Patients With Hand and Wrist Injuries

    NARCIS (Netherlands)

    El Moumni, Mostafa; Van Eck, Merit E.; Wendt, Klaus W.; Reininga, Inge H. F.; Mokkink, Lidwine Brigitta

    Background. Hand and wrist injuries are one of the most common injuries seen in adults. The Patient-Rated Wrist Evaluation (PRWE) questionnaire has been developed as a patient report outcome measure of pain and disability to evaluate the outcome after hand and wrist injuries. Objective. The aims of

  3. Giant Cell Tumor of Distal Radius: En Bloc Resection and Partial Wrist Arthrodesis Using Non-Vascularized Fibular Autograft

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2017-05-01

    Full Text Available Background Despite several surgical techniques introduced for the treatment of distal radial giant cell tumor (GCT, most appropriate treatments remain to be discovered. Objectives The current study reported on the results of en bloc resection and partial wrist arthrodesis using non-vascularized fibular shaft. Methods Between 2004 and 2014, 7 patients with distal radial GCT (Campanacci grade III were treated by en bloc resection and partial wrist arthrodesis using non-vascularized fibular shaft. Arthrodesis was performed using an intramedullary pin. Patients were followed for 59 ± 38 months. At the last visit, active range of wrist motions, modified musculoskeletal tumor society (MSTS scoring system, instability and grip strength compared to contralateral side were measured. Also, time of union, need for further operations and recurrence of the tumor were evaluated. Results After 8.3 ± 0.5 months, complete union was achieved. The ranges of wrist flexion, wrist extension, ulnar deviation, radial deviation, supination, and pronation averaged 16.7 ± 2.6, 7.5 ± 6.1, 7.5 ± 6.1, 6.7 ± 5.2, 33.3 ± 6.8, and 30.8 ± 8.6 degrees, respectively. The mean modified MSTS score was 75.8 ± 8%. Grip strength was 53.3 ± 6.8% of the contralateral side. Graft-related complications did not occur. Recurrence occurred in 2 patients, including one bony recurrence at the graft-wrist junction and one soft tissue recurrence (28.6%. Conclusions Replacement of excised distal radius with non-vascularized fibular shaft autograft following en bloc resection and partial arthrodesis, using an intramedullary pin, could serve as an appropriate treatment of distal radial GCT.

  4. Magnetic resonance arthrography in chronic wrist pain. Artografia con Risonanza Magnetica (arto-RM) nelle malattie dolorose croniche del polso

    Energy Technology Data Exchange (ETDEWEB)

    Valeri, G.; Ferrara, C. (Ancona Univ. (Italy). Cattedra di Radiologia); Carloni, S. (Ancona Univ. (Italy). Cattedra di Ortopedia) (and others)

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures.

  5. Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hana; Youk, Ji Hyun, E-mail: jhyouk@yuhs.ac; Gweon, Hye Mi; Kim, Jeong-Ah; Son, Eun Ju

    2013-08-15

    Purpose: To compare the diagnostic performance of qualitative shear-wave elastography (SWE) according to three different color map opacities for breast masses Materials and methods: 101 patients aged 21–77 years with 113 breast masses underwent B-mode US and SWE under three different color map opacities (50%, 19% and 100%) before biopsy or surgery. Following SWE features were reviewed: visual pattern classification (pattern 1–4), color homogeneity (E{sub homo}) and six-point color score of maximum elasticity (E{sub col}). Combined with B-mode US and SWE, the likelihood of malignancy (LOM) was also scored. The area under the curve (AUC) was obtained by ROC curve analysis to assess the diagnostic performance under each color opacity. Results: A visual color pattern, E{sub homo}, E{sub col} and LOM scoring were significantly different between benign and malignant lesions under all color opacities (P < 0.001). For 50% opacity, AUCs of visual color pattern, E{sub col}, E{sub homo} and LOM scoring were 0.902, 0.951, 0.835 and 0.975. But, for each SWE feature, there was no significant difference in the AUC among three different color opacities. For all color opacities, visual color pattern and E{sub col} showed significantly higher AUC than E{sub homo}. In addition, a combined set of B-mode US and SWE showed significantly higher AUC than SWE alone for color patterns, E{sub homo}, but no significant difference was found in E{sub col}. Conclusion: Qualitative SWE was useful to differentiate benign from malignant breast lesion under all color opacities. The difference in color map opacity did not significantly influence diagnostic performance of SWE.

  6. C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

    Energy Technology Data Exchange (ETDEWEB)

    Guggenberger, Roman; Ulbrich, Erika J.; Kaelin, Pascal; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zuerich (Switzerland); Dietrich, Tobias J. [Balgrist University Hospital, Department of Radiology, Zurich (Switzerland); Scholz, Rosemarie; Koehler, Christoph; Elsaesser, Thilo [Siemens Healthcare GmbH, Business Area Advanced Therapies, Forchheim (Germany); Le Corroller, Thomas [Aix-Marseille Universite, CNRS, ISM UMR 7287, Marseille (France); Radiology Department, APHM, Marseille (France)

    2017-02-15

    To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard. Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated. Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between κ = 0.47-1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81-86 % and 89-99 %) for bone and acromioclavicular-joint pathologies. Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT. (orig.)

  7. Tomosynthesis for the early detection of pulmonary emphysema: diagnostic performance compared with chest radiography, using multidetector computed tomography as reference

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Yoshitake [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan); Jinzaki, Masahiro; Hashimoto, Masahiro; Shiomi, Eisuke; Kuribayashi, Sachio [Keio University School of Medicine, Department of Diagnostic Radiology, Tokyo (Japan); Abe, Takayuki [Keio University School of Medicine, Center for Clinical Research, Tokyo (Japan); Ogawa, Kenji [Nippon Koukan Hospital, Department of Radiology, Kawasaki-shi, Kanagawa (Japan)

    2013-08-15

    To compare the diagnostic performance of tomosynthesis with that of chest radiography for the detection of pulmonary emphysema, using multidetector computed tomography (MDCT) as reference. Forty-eight patients with and 63 without pulmonary emphysema underwent chest MDCT, tomosynthesis and radiography on the same day. Two blinded radiologists independently evaluated the tomosynthesis images and radiographs for the presence of pulmonary emphysema. Axial and coronal MDCT images served as the reference standard and the percentage lung volume with attenuation values of -950 HU or lower (LAA{sub -950}) was evaluated to determine the extent of emphysema. Receiver-operating characteristic (ROC) analysis and generalised estimating equations model were used. ROC analysis revealed significantly better performance (P < 0.0001) of tomosynthesis than radiography for the detection of pulmonary emphysema. The average sensitivity, specificity, positive predictive value and negative predictive value of tomosynthesis were 0.875, 0.968, 0.955 and 0.910, respectively, whereas the values for radiography were 0.479, 0.913, 0.815 and 0.697, respectively. For both tomosynthesis and radiography, the sensitivity increased with increasing LAA{sub -950}. The diagnostic performance of tomosynthesis was significantly superior to that of radiography for the detection of pulmonary emphysema. In both tomosynthesis and radiography, the sensitivity was affected by the LAA{sub -950}. (orig.)

  8. Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study.

    Directory of Open Access Journals (Sweden)

    Yosuke Hamamoto

    Full Text Available To investigate clinical and radiological differences between joint destruction in the wrist and the feet in patients with RA.A cross-sectional clinical study was conducted in an RA cohort at a single institution. Clinical data included age, sex and duration of disease. Laboratory data included sero-positivity for anti-cyclic citrullinated peptide (CCP antibody and RF. Radiological measurements included Larsen grades and the modified Sharp/van der Heijde method (SHS for the hands/wrists and the feet. Statistical analyses were performed using the Kruskal-Wallis H-test, a dummy variable linear regression model and multivariate logistic regression analysis with 95% confidence interval and odds ratios.A total of 405 patients were enrolled, and 314 patients were analysed in this study. The duration of disease in the foot-dominant group was significantly less than that in the wrist-dominant group. When patients were subdivided by duration of disease, the Larsen grade of the feet was significantly higher than that of the wrist in the first quadrant subgroup, but this was reversed with increasing duration of disease. Anti-CCP status was a significant predictive factor for joint destruction in the wrist but not in the feet, while RF status was not predictive in either the wrist or the feet.Joint destruction in the feet started earlier than in the wrist, but the latter progresses faster with increasing duration of disease. Anti-CCP status predicts joint destruction in the wrist better than in the feet.

  9. Machine learning for activity recognition: hip versus wrist data.

    Science.gov (United States)

    Trost, Stewart G; Zheng, Yonglei; Wong, Weng-Keen

    2014-11-01

    Wrist-worn accelerometers are associated with greater compliance. However, validated algorithms for predicting activity type from wrist-worn accelerometer data are lacking. This study compared the activity recognition rates of an activity classifier trained on acceleration signal collected on the wrist and hip. 52 children and adolescents (mean age 13.7  ±  3.1 year) completed 12 activity trials that were categorized into 7 activity classes: lying down, sitting, standing, walking, running, basketball, and dancing. During each trial, participants wore an ActiGraph GT3X+ tri-axial accelerometer on the right hip and the non-dominant wrist. Features were extracted from 10-s windows and inputted into a regularized logistic regression model using R (Glmnet + L1). Classification accuracy for the hip and wrist was 91.0% ± 3.1% and 88.4% ± 3.0%, respectively. The hip model exhibited excellent classification accuracy for sitting (91.3%), standing (95.8%), walking (95.8%), and running (96.8%); acceptable classification accuracy for lying down (88.3%) and basketball (81.9%); and modest accuracy for dance (64.1%). The wrist model exhibited excellent classification accuracy for sitting (93.0%), standing (91.7%), and walking (95.8%); acceptable classification accuracy for basketball (86.0%); and modest accuracy for running (78.8%), lying down (74.6%) and dance (69.4%).Potential Impact: Both the hip and wrist algorithms achieved acceptable classification accuracy, allowing researchers to use either placement for activity recognition.

  10. [Effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients].

    Science.gov (United States)

    Shen, Y M; Chen, X; Zhang, C; Wang, C; Qin, F J; Ma, C X; Hu, X H

    2017-07-20

    Objective: To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. Methods: From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients' general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. Results: The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. Conclusions: The flow-through descending branch of lateral

  11. Low Level Laser Therapy (Lllt) for Chronic Joint Pain of the Elbow, Wrist and Fingers

    Science.gov (United States)

    Okuni, Ikuko; Ushigome, Nobuyuki; Ohshiro, Toshio; Musya, Yoshiro; Sekiguchi, Masayuki

    2012-01-01

    Background and Aims: In previous studies, we successfully applied Low Level Laser Therapy (LLLT) in patients with non-specific chronic pain of the shoulder joint and lower back. The purpose of the present study was to assess the effectiveness of LLLT for chronic joint pain of the elbow, wrist, and fingers. Subjects and Methods: Nine male and 15 female patients with chronic joint pain of the elbow, wrist, or fingers, who were treated at the rehabilitation outpatient clinic at our hospital from April, 2007 to March, 2009 were enrolled in the study. We used a 1000 mW semiconductor laser device. Each tender point and three points around it were irradiated with laser energy. Each point was irradiated twice for 20 s per treatment, giving a total of three minutes for all 4 points. Patients visited the clinic twice a week, and were evaluated after four weeks of treatment. Pain was evaluated with a Visual Analogue Scale (VAS). Statistical analysis of the VAS scores after laser irradiation was performed with Wilcoxon's signed rank sum test, using SPSS Ver.17. Results: All VAS scores were totaled and statistically analyzed. The average VAS score before irradiation was 59.2±12.9, and 33.1±12.2 after the irradiation, showing a significant improvement in VAS score (p<0.001) after treatment. The treatment effect lasted for about one and a half days in the case of wrist pain, epicondylitis lateralis (tennis elbow), and carpal tunnel syndrome. In other pain entities, it lasted for about three to fifteen hours. No change in the range of motion (ROM) was seen in any of the 24 subjects. Conclusion: We concluded that LLLT at the wavelength and parameters used in the present study was effective for chronic pain of the elbow, wrist, and fingers. PMID:24610977

  12. The effect of a wrist-hand stretching device for spasticity in chronic hemiparetic stroke patients.

    Science.gov (United States)

    Jang, Woo H; Kwon, Hyuk C; Yoo, Kyong J; Jang, Sung H

    2016-02-01

    The majority of these stretching devices have focused on spasticity of the leg and only a few devices have been developed for spasticity of the wrist and hand. In addition, most of these devices were large and complicated, with less easy applicability for personal use. To investigate the effect of a stretching device for spasticity of the wrist and hand in chronic hemiparetic stroke patients. Prospective single blind randomized controlled clinical trial. Outpatients. Patients were randomly assigned to either the intervention group (11 patients) or the control group (10 patients). The stretching device consisted of a circular shaped plastic plate and five holders to immobilize the fingers. In position 1, finger tips were facing forward, position 2 was 90° external rotation from position 1, and position 3 was 90° external rotation from position 2. Each position was maintained for 4 minutes and a rest period of 1 minute was given, therefore, one session was performed for 14 minutes. The stretching program was conducted 3 sessions/day, 6 days/week for 4 weeks. Spasticity (modified Ashworth scale [MAS]) and motor function (Fugl-Meyer motor assessment [FMA], Active Range of Motion [AROM]) of affected wrist and hand were assessed three times (first assessment; Pre, second assessment; post-2 weeks, third assessment; post-4 weeks). In the intervention group, significant differences in the wrist and hand MAS and FMA were observed between three assessment times (P0.05). In the control group, no differences in MAS, FMA, and AROM were observed between three assessment times (P>0.05). Findings showed that this stretching device was effective in terms of relieving spasticity and functional recovery. This stretching device is effective in spasticity reducing and motor function improvement. Moreover, it is useful to patient because it is easy to use and portable.

  13. Differences in wrist mechanics during the golf swing based on golf handicap.

    Science.gov (United States)

    Fedorcik, Gregory G; Queen, Robin M; Abbey, Alicia N; Moorman, Claude T; Ruch, David S

    2012-05-01

    Variation in swing mechanics between golfers of different skill levels has been previously reported. To investigate if differences in three-dimensional wrist kinematics and the angle of golf club descent between low and high handicap golfers. A descriptive laboratory study was performed with twenty-eight male golfers divided into two groups, low handicap golfers (handicap = 0-5, n = 15) and high handicap golfers (handicap ≥ 10, n = 13). Bilateral peak three-dimensional wrist mechanics, bilateral wrist mechanics at ball contact (BC), peak angle of descent from the end of the backswing to ball contact, and the angle of descent when the forearm was parallel to the ground (DEC-PAR) were determined using an 8 camera motion capture system. Independent t-tests were completed for each study variable (α = 0.05). Pearson correlation coefficients were determined between golf handicap and each of the study variables. The peak lead arm radial deviation (5.7 degrees, p = 0.008), lead arm radial deviation at ball contact (7.1 degrees, p = 0.001), and DEC-PAR (15.8 degrees, p = 0.002) were significantly greater in the high handicap group. In comparison with golfers with a low handicap, golfers with a high handicap have increased radial deviation during the golf swing and at ball contact. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  14. A Rare Case of Tumoral Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Wrist Joint

    Directory of Open Access Journals (Sweden)

    Osamu Nakamura

    2015-01-01

    Full Text Available Introduction. Tumoral calcium pyrophosphate dihydrate (CPPD crystal deposition disease (CPPDCD, also known as tophaceous calcium pyrophosphate deposition disease (CPDD, is a tumorlike lesion, and it should be distinguished from usual CPDD that causes severe joint inflammation and arthralgia. A case of tumoral CPPDCD of the wrist joint that required differentiation from synovial osteochondromatosis is described. Case Presentation. The patient was a 78-year-old woman with a 5-year history of nodular lesions at the right wrist that had gradually increased in size. An excisional biopsy and a histological examination of the excised nodular lesions by hematoxylin and eosin (H&E staining were performed, demonstrating numerous polarizable, rhabdoid, and rectangular crystals, surrounded by fibroblasts, macrophages, and foreign body-type giant cells, consistent with tumoral CPPDCD. Conclusion. Tumoral CPPDCD, especially at the wrist joint, is rare, and, to the best of our knowledge, only 2 articles have been published. This case seems to need further follow-up for recurrence, because tumoral CPPDCD may recur after complete or incomplete surgical excision.

  15. Physical equilibrium of the normal wrist and its relation to clinically defined "instability".

    Science.gov (United States)

    Zdravkovic, V; Jacob, H A; Sennwald, G R

    1995-04-01

    The rotational stability of the proximal carpal row was tested on six unembalmed human cadaver hand specimens. The physiological load conditions were stimulated by loading the wrist flexor and extensor tendons. Pure torque was introduced to the lunate, scaphoid and triquetrum, one at a time, by means of a dynamometer wrench, forcing the bones loaded to perform a flexion-extension motion. A truly stable state of equilibrium could be found in the normal wrist only under axial load. A uni-directional coupling was observed through the scapho-lunate ligament as a counteraction to a tendency for the lunate to extend and the scaphoid to flex. The triquetrum and lunate moved together, showing close coupling in both directions. As conclusion: a stable wrist can be defined as one which, while being loaded within a physiological range of stress, does not deviate from a stable state of equilibrium (the ability to return to a single position when disturbed) at any point within the whole physiological range of motion.

  16. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program.

    Science.gov (United States)

    Krischak, Gert D; Krasteva, Anna; Schneider, Florian; Gulkin, Daniel; Gebhard, Florian; Kramer, Michael

    2009-04-01

    To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program. Randomized controlled cohort study. Hospital-based care, primary center of orthopedic surgery. Volunteers (N=48) with fractures of the distal radius after internal fixation with locking plates. There were 46 patients available for follow-up after exclusion of 2 participants due to physiotherapy sessions in excess of the study protocol. Not applicable. Evaluation of grip strength using a Jamar dynamometer, range of motion (ROM), and Patient Related Wrist Evaluation (PRWE). After a 6-week period of postoperative treatment, the patients (n=23) performing an independent home exercise program using a training diary showed a significantly greater improvement of the functionality of the wrist. Grip strength reached 54% (P=.003), and ROM in extension and flexion 79% (Pwrist function with a nearly 50% lower value (Pwrist fractures, instructions in a home exercise program are an effective alternative to prescribed physical therapy treatment.

  17. Measurements of wrist and forearm positions and movements: effect of, and compensation for, goniometer crosstalk.

    Science.gov (United States)

    Hansson, G-A; Balogh, I; Ohlsson, K; Skerfving, S

    2004-06-01

    Flexible biaxial goniometers are extensively used for measuring wrist positions and movements. However, they display an inherent crosstalk error. The aim was to evaluate the effect, of this error, on summary measures used for characterizing manual work. A goniometer and a torsiometer were combined into one device. An algorithm that effectively compensated for crosstalk was developed. Recordings from 25 women, performing five worktasks, were analyzed, both with and without compensation for crosstalk. The errors in the 10th, 50th and 90th percentiles of the flexion/extension distributions were small, on average <1 degrees. The ulnar/radial deviation distributions were weakly dependent on forearm position. The flexion/extension velocity measures were, for the 50th and 90th percentiles, as well as the mean velocity, consistently underestimated by, on average, 3.9%. For ulnar/radial deviation, the velocity errors were less consistent. Mean power frequency, which is a measure of repetitiveness, was insensitive (error <1%) to crosstalk. The forearm supination/pronation angular distributions were wider, and the velocities higher, than for the wrists. Considering wrist/hand exposure in epidemiologic studies, as well as for establishing and surveillance of exposure limits for prevention of work-related upper extremity musculoskeletal disorders, the crosstalk error can, when considering other errors and sources to variation, be disregarded.

  18. [Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: a randomized controlled trial].

    Science.gov (United States)

    Shu, Shi; Li, Tong-ming; Fang, Fan-fu; He, Hou-luo; Zhou, Qing-hui; Gu, Wei; Zhou, Shuang

    2011-06-01

    Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome. To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome. A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min. The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated. The therapeutic effect experienced by the treatment group was better than that of the control group (Pacupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

  19. A comparison of two diagnostic performance measures: signal-to-noise ratio versus partial area under receiver operating characteristic curve.

    Science.gov (United States)

    Taner, Mehmet Tolga; Sezen, Bulent; Atwat, Kamal

    2013-01-01

    This paper aims to compare two diagnostic performance measures, i.e. signal-to-noise ratio (S/N ratio) and partial area under receiver operating characteristic curves (pAUC). It proposes the use of S/N ratio rather than pAUC for establishing optimal cut-off point for diagnostic biomarkers. This paper discusses the properties, uses, advantages and shortcomings of the two performance measures, namely the partial area under receiver operating characteristic curve (pAUC) and Taguchi's signal-to-noise (S/N) ratio. The benefits of S/N ratio have been illustrated in a sample of four biomarkers, each having five cut-off points. The S/N ratio is compared to the pAUC index. The SAS software is employed to calculate pAUC and AUC. This paper shows that S/N ratio can be used as a measure of diagnostic accuracy. The cut-off point with the highest S/N ratio is the optimal cut-off point for the biomarker. The proposed method has the advantages of being easier, more practical and less costly than that of pAUC. This paper includes implications for the development of a more practical, equally powerful and less costly means of measuring clinical accuracy thereby reducing the costs and risks resulting from wrong selection of cut-off point can be decreased. This paper supports suggestions in the recent literature to replace pAUC with a new, more meaningful index.

  20. Success, Failure and Emotions: Examining the Relationship between Performance Feedback and Emotions in Diagnostic Reasoning

    Science.gov (United States)

    Jarrell, Amanda; Harley, Jason M.; Lajoie, Susanne; Naismith, Laura

    2017-01-01

    Students experience a variety of emotions following achievement outcomes which stand to influence how they learn and perform in academic settings. However, little is known about the link between student outcome emotions and dimensions of performance feedback in computer-based learning environments (CBLEs). Understanding the dynamics of this…

  1. Screening and diagnostic performance of enzyme immunoassay for antibody to lymphadenopathy-associated virus.

    Science.gov (United States)

    Handsfield, H H; Wandell, M; Goldstein, L; Shriver, K

    1987-05-01

    In a multicenter cooperative study, an enzyme immunoassay (EIA) using purified antigen of lymphadenopathy-associated virus was compared with radioimmune precipitation (RIP) for detection of antibody to human immunodeficiency virus (HIV) in 634 patients with acquired immunodeficiency syndrome or related conditions, 687 apparently healthy persons at risk for HIV infection, 93 controls with cancer or autoimmune diseases, and 10,038 blood or plasma donors. Excluding the donors, the EIA was reactive in 875 (61.9%) of 1,414 subjects; compared with RIP, the sensitivity and specificity of EIA both were 99.8%. There was one false-positive EIA among 148 intravenous drug abusers and two false-negative EIAs among 472 apparently healthy homosexual men; no other discordant results between EIA and RIP occurred in these subjects. The EIA was repeatably reactive in 20 donors (0.2%), among whom 13 (65%) were positive by RIP; none of 529 randomly selected EIA-negative donors was RIP positive. In addition to its utility as a screening test in low-risk populations, the EIA for antibody to lymphadenopathy-associated virus is useful as a diagnostic test in persons with clinical evidence of or at risk for HIV infection.

  2. Diagnostic performance of computed tomography angiography and contrast-enhanced magnetic resonance angiography in patients with critical limb ischaemia and intermittent claudication: systematic review and meta-analysis

    NARCIS (Netherlands)

    Jens, Sjoerd; Koelemay, Mark J. W.; Reekers, Jim A.; Bipat, Shandra

    2013-01-01

    To evaluate the diagnostic performance of computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA) in detecting haemodynamically significant arterial stenosis or occlusion in patients with critical limb ischaemia (CLI) or intermittent claudication (IC).

  3. Diagnostic performance of flat-panel CT arthrography for cartilage defect detection in the ankle joint: comparison with MDCT arthrography with gross anatomy as the reference standard

    National Research Council Canada - National Science Library

    Chemouni, David; Champsaur, Pierre; Guenoun, Daphné; Desrousseaux, Julie; Pauly, Vanessa; Le Corroller, Thomas

    2014-01-01

    The purpose of this study is to compare the diagnostic performance and radiation exposure of flat-panel CT arthrography for cartilage defect detection in the ankle joint to standard MDCT arthrography...

  4. A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

    NARCIS (Netherlands)

    Grinsven, S. van; Loon, C. van; Gorp, M. van; Kints, M. van; Konings, P.; Kampen, A. van

    2015-01-01

    PURPOSE: To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution. MATERIALS AND METHODS: Forty-five surgically

  5. ROC surface assessment of the ANB angle and Wits appraisal's diagnostic performance with a statistically derived 'gold standard': does normalizing measurements have any merit?

    NARCIS (Netherlands)

    Wellens, H.L.L.; BeGole, E.A.; Kuijpers-Jagtman, A.M.

    2017-01-01

    Objective: To assess the ANB angle's and Wits appraisal's diagnostic performance using an extended version of Receiver Operating Curve (ROC) analysis, which renders ROC surfaces. These were calculated for both the conventional and normalized cephalometric tests (calculated by exchanging the

  6. Performance of thyroid scintigraphy in the thyrotoxicosis etiological diagnosis: about 210 cases; Performance de la scintigraphie thyroidienne dans le diagnostic etiologique des thyrotoxicoses: a propos de 210 cas

    Energy Technology Data Exchange (ETDEWEB)

    Chatti, K.; Nouira, M.; Guezguez, M.; Sfar, R.; Essabbah, H. [CHU Sahloul, Service de medecine nucleaire, Sousse (Tunisia); Zantour, B. [CHU Mahdia, service d' endocrinologie (Tunisia)

    2010-07-01

    Purpose: The thyrotoxicosis is a syndrome linked to thyroid hormones excess grouping any causes leading to a overload in circulating hormones, including these ones linked to an inflammatory process (thyroiditis) or an exogenous contribution. The etiologic diagnosis is based on complementary examinations. The objective of our work is to elucidate the performance of scintigraphy in the etiologic diagnosis and the therapy approach of thyrotoxicosis through the experience of our service. Conclusions: Scintigraphy has a place in the etiologic diagnosis of thyrotoxicosis. it brings functional and morphological information and allows to guide the diagnostic and therapeutic approach. (N.C.)

  7. Metal artifact suppression at the hip: diagnostic performance at 3.0 T versus 1.5 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Nardo, Lorenzo; Han, Misung; Kretschmar, Martin; Krug, Roland; Link, Thomas M. [University of California San Francisco, Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Guindani, Michele [The University of Texas MD Anderson Cancer Center, Department of Biostatistics - Unit 1411, Houston, TX (United States); Koch, Kevin [Medical College of Wisconsin, Department of Biophysics, Milwaukee, WI (United States); Medical College of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Vail, Thomas [University of California San Francisco, Department of Orthopedic Surgery, San Francisco, CA (United States)

    2015-11-15

    This work aimed to compare the diagnostic performance of a metal artifact suppression sequence (MAVRIC-SL) for imaging of hip arthroplasties (HA) at 1.5 and 3 Tesla (T) field strength. Eighteen patients (10 females; aged 27-74) with HA were examined at 3.0 and 1.5 T within 3 weeks. The sequence protocol included 3D-MAVRIC-SL PD (coronal), 3D-MAVRIC-SL STIR (axial), FSE T1, FSE PD and STIR sequences. Anatomical structures and pathological findings were assessed independently by two radiologists. Artifact extent and technical quality (image quality, fat saturation and geometric distortion) were also evaluated. Findings at 1.5 and 3.0 T were compared using a Wilcoxon signed rank test. While image quality was better at 1.5 T, visualization of anatomic structures and clinical abnormalities was not significantly different using the two field strengths (p > 0.05). Fat suppression and amount of artifacts were significantly better at 1.5 T (p < 0.01). Inter- and intra-reader agreement for different anatomic details, image quality and visualization of abnormalities ranged from k = 0.62 to k = 1.00. MAVRIC-SL at 1.5 T had a comparable diagnostic performance when compared MAVRIC-SL at 3.0 T; however, the higher field strength was associated with larger artifacts, limited image quality and worse fat saturation. (orig.)

  8. Diagnostic performance of rectal swab versus bulk stool specimens for the detection of rotavirus and norovirus: Implications for outbreak investigations✩

    Science.gov (United States)

    Arvelo, Wences; Hall, Aron J.; Estevez, Alejandra; Lopez, Beatriz; Gregoricus, Nicole; Vinjé, Jan; Gentsch, Jon R.; Parashar, Umesh; Lindblade, Kim A.

    2015-01-01

    Background In January of 2008, during the peak of the rotavirus season in Guatemala, a gastroenteritis outbreak with high mortality among infants was reported in Guatemala. Despite extensive efforts, the investigation was limited by the lack of bulk stool specimens collected, particularly from the more severely dehydrated or deceased children. Objectives We evaluated the diagnostic performance of rectal swab specimens compared with bulk stool for the detection of rotavirus and norovirus. Study design Patients with diarrhea (≥3 loose stools in 24 h) were enrolled through an ongoing surveillance system in Guatemala. From January through March 2009, we attempted to enroll 100 patients <5years old captured by the diarrhea surveillance, and collected paired bulk stool and rectal swabs specimens from them. Specimens were tested for norovirus using real-time reverse transcription-polymerase chain reaction and for rotavirus via enzyme immunoassay. Results We enrolled 102 patients with paired specimens; 91% of 100 paired specimens tested for rotavirus yielded concordant results positive for rotavirus with a negativity rate of 83%. Among 100 paired specimens tested for norovirus, 86% were concordant norovirus detection and the negativity rate was 85%. The diagnostic performance for rotavirus and norovirus detection did not differ significantly between the two specimen types. Conclusions Testing of properly collected fecal specimens using rectal swabs may be a viable alternative to bulk stool for detection of rotavirus and norovirus, particularly during outbreaks where collection of bulk stool may be difficult. PMID:24139675

  9. Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance.

    Science.gov (United States)

    Gweon, Hye Mi; Youk, Ji Hyun; Son, Eun Ju; Kim, Jeong-Ah

    2013-03-01

    To determine whether colour overlay features can be quantified by the standard deviation (SD) of the elasticity measured in shear-wave elastography (SWE) and to evaluate the diagnostic performance for breast masses. One hundred thirty-three breast lesions in 119 consecutive women who underwent SWE before US-guided core needle biopsy or surgical excision were analysed. SWE colour overlay features were assessed using two different colour overlay pattern classifications. Quantitative SD of the elasticity value was measured with the region of interest including the whole breast lesion. For the four-colour overlay pattern, the area under the ROC curve (Az) was 0.947; with a cutoff point between pattern 2 and 3, sensitivity and specificity were 94.4 % and 81.4 %. According to the homogeneity of the elasticity, the Az was 0.887; with a cutoff point between reasonably homogeneous and heterogeneous, sensitivity and specificity were 86.1 % and 82.5 %. For the SD of the elasticity, the Az was 0.944; with a cutoff point of 12.1, sensitivity and specificity were 88.9 % and 89.7 %. The colour overlay features showed significant correlations with the quantitative SD of the elasticity (P colour overlay features and the SD of the elasticity in SWE showed excellent diagnostic performance and showed good correlations between them.

  10. In Vivo Estimation of Human Forearm and Wrist Dynamic Properties.

    Science.gov (United States)

    Park, Kyungbin; Chang, Pyung-Hun; Kang, Sang Hoon

    2017-05-01

    It is important to estimate the 3 degree-of-freedom (DOF) impedance of human forearm and wrist (i.e., forearm prono-supination, and wrist flexion-extension and radial-ulnar deviation) in motor control and in the diagnosis of altered mechanical resistance following stroke. There is, however, a lack of methods to characterize 3 DOF impedance. Thus, we developed a reliable and accurate impedance estimation method, the distal internal model based impedance control (dIMBIC)-based method, to characterize the 3 DOF impedance, including cross-coupled terms between DOFs, for the first time. Its accuracy and reliability were experimentally validated using a robot with substantial nonlinear joint friction. The 3 DOF human forearm and wrist impedance of eight healthy subjects was reliably characterized, and its linear behavior was verified. Thus, the dIMBIC-based method can provide us with 3 DOF forearm and wrist impedance regardless of nonlinear robot joint friction. It is expected that, with the proposed method, the 3 DOF impedance estimation can promote motor control studies and complement the diagnosis of altered wrist and forearm resistance post-stroke by providing objective impedance estimates, including cross-coupled terms.

  11. The effect of wrist orthoses on forearm muscle activity.

    Science.gov (United States)

    Johansson, Lena; Björing, Gunnar; Hägg, Göran M

    2004-03-01

    A general hypothesis is that a wrist orthosis reduces the wrist extensor muscle load. The aim of this study was to investigate the effects of a completely stiff wrist orthosis (SO) and a commercially available wrist orthosis (CO) on flexor and extensor electromyographic (EMG)-activity in a standardised intermittent gripping task and during standardised manual work tasks. Surface EMG from two forearm flexor and two extensor muscles was recorded. The target grip forces were 5%, 20% and 40% of maximal voluntary contraction (MVC). During the grip contraction phase CO had no effect on the EMG-readings. SO resulted in higher EMG activity than when gripping with CO and with no orthosis (NO), especially when gripping with 40% MVC. During the relaxation phase neither CO nor SO had any effect on the extensors. For the flexors the SO gave higher EMG-readings than when gripping with CO and NO, especially at 40% MVC. In conclusion the wrist orthoses tested did not reduce the EMG-activity from the flexors or the extensors during gripping or manual tasks.

  12. Effect of wrist position on young adults pinch grip control

    Directory of Open Access Journals (Sweden)

    Vanessa Luzia Barros de Andrade

    2015-12-01

    Full Text Available Pinch grip is used in a large number of handling activities that require precision and control of an object. The position of the upper arm joints affects the fingers force production in order to handle the object. This study aimed to verify the influence of the wrist position in the production of maximum strength and in the control fingers grip pinch submaximum strength control. Participants were 21 right handed adults (10 male, 18-26 years old. They made two attempts of maximum force production and eight attempts of submaximal force production (four at 20% and four at 40% of maximum strength for pinch grip in three wrist positions: neutral, flexion and extension. The results showed that the production of maximum strength is higher in neutral position compared to wrist flexion and extension and higher for men compared to women. In addition, there was a positive correlation between the length of the hand and the production of maximum strength. The results also indicated that the wrist position did not interfere in the submaximum force control during this task. However, participants showed more difficulty controlling 20% than 40% of maximum strength. The present study showed evidence that the motor units used to produce grip pinch maximum strength cross the wrist joint but those used for the 20% and 40% of maximum strength are present only in the fingers and hand.

  13. Diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses: determination of the most discriminatory parameter.

    Science.gov (United States)

    Au, Frederick Wing-Fai; Ghai, Sandeep; Moshonov, Hadas; Kahn, Harriette; Brennan, Cressida; Dua, Hemi; Crystal, Pavel

    2014-09-01

    The purpose of this article is to assess the diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses and to determine the most discriminatory parameter. B-mode ultrasound and shear wave elastography were performed before core biopsy of 123 masses in 112 women. The diagnostic performance of ultrasound and quantitative shear wave elastography parameters (mean elasticity, maximum elasticity, and elasticity ratio) were compared. The added effect of shear wave elastography on the performance of ultrasound was determined. The mean elasticity, maximum elasticity, and elasticity ratio were 24.8 kPa, 30.3 kPa, and 1.90, respectively, for 79 benign masses and 130.7 kPa, 154.9 kPa, and 11.52, respectively, for 44 malignant masses (p elasticity ratio (0.943) was the highest. By adding shear wave elastography parameters to the evaluation of BI-RADS category 4a masses, about 90% of masses could be downgraded to BI-RADS category 3. The numbers of downgraded masses were 40 of 44 (91%) for mean elasticity, 39 of 44 (89%) for maximum elasticity, and 42 of 44 (95%) for elasticity ratio. The numbers of correctly downgraded masses were 39 of 40 (98%) for mean elasticity, 38 of 39 (97%) for maximum elasticity, and 41 of 42 (98%) for elasticity ratio. There was improvement in the diagnostic performance of ultrasound of mass assessment with shear wave elastography parameters added to BI-RADS category 4a masses compared with ultrasound alone. Combined ultrasound and elasticity ratio had the highest improvement, from 35.44% to 87.34% for specificity, from 45.74% to 80.77% for positive predictive value, and from 57.72% to 90.24% for accuracy (p elasticity ratio (0.914) was the highest compared with the other combined parameters. There was a statistically significant difference in the values of the quantitative shear wave elastography parameters of benign and malignant solid breast masses. By adding shear wave elastography parameters to BI

  14. Diagnostic performance of unenhanced computed tomography and 18 F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours.

    Science.gov (United States)

    Delivanis, Danae A; Bancos, Irina; Atwell, Thomas D; Schmit, Grant D; Eiken, Patrick W; Natt, Neena; Erickson, Dana; Maraka, Spyridoula; Young, William F; Nathan, Mark A

    2018-01-01

    Evidence on the diagnostic performance of adrenal imaging is limited. We aimed to assess the diagnostic performance of unenhanced computed tomography (CT) and 18 F-fluorodeoxyglucose (18 FDG) positron emission tomography (PET)/CT imaging in a high-risk population for adrenal malignancy using an optimal reference standard. Retrospective cohort study. Imaging studies of patients with adrenal nodules who underwent adrenal biopsy and/or adrenalectomy between 1994 and 2014 were reviewed and compared to the reference standard of histology. Eighty % of patients presented with known or suspected extra-adrenal malignancy. Unenhanced abdominal CT was performed in 353 patients with adrenal lesions; median size was 3 (0.7-15) cm and median radiodensity was 33 (-21-78) Hounsfield units (HU). Radiodensity of >10 HU diagnosed malignancy with a sensitivity of 100%, specificity of 33%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 100%. 18 FDG-PET/CT was performed in 89 patients; median tumour size was 2.1 (0.7-9.2) cm. Maximum standardized uptake (SUV max) was higher in malignant lesions when compared to benign lesions (median=10 [2.3-29.4] vs 3.7 [1.4-24.5], respectively, P1.8 diagnosed malignancy with a sensitivity of 87%, specificity of 84%, PPV of 85% and NPV of 86%. Noncontract CT radiodensity of ≤10 HU excludes malignancy even in a high-risk population. For indeterminate adrenal lesions, given a superior specificity, 18 FDG-PET/CT could be considered as a second stage imaging study. © 2017 John Wiley & Sons Ltd.

  15. Does Applying Biomedical Knowledge Improve Diagnostic Performance When Solving Electrolyte Problems?

    Directory of Open Access Journals (Sweden)

    Kevin Mclaughlin

    2010-03-01

    Results. Students and nephrologists applied a similar number of biomedical concepts per case (1.8 (±1.1 vs. 1.8 (±1.2, respectively, p = 0.8, but nephrologists were more successful (86.8% vs. 63.5%, p = 0.003. We found a significant interaction between expertise and applying biomedical concepts (p < 0.05. For students the odds of success increased significantly with applying biomedical concepts (odds ratio 4.66 [2.07, 10.48], p < 0.001, whereas for nephrologists there was only a trend towards improved performance (odds ratio 1.72 [0.94, 3.11], p = 0.07. Conclusions. Our results suggest that improving biomedical knowledge of students should improve their performance on electrolyte problems. The performance of experienced physicians may also be improved, but this requires further study before teaching recommendations can be made.

  16. Development of a Low Cost, High Function 3D Printed Hand Prosthesis Using the Wrist Extension as Activator

    National Research Council Canada - National Science Library

    de Miranda luzo, Maria Candida; Pereira, Cesar Augusto Martins; Pessa, Mariana Miranda Nicolosi; Mattar, Rames; de Paula, Emygdio Jose Leomil

    2016-01-01

    Objective: The authors have developed a prosthesis for hand amputees or malformations that can be activeted mecanically through the moviment of the wrist using the wrist tenodesis pattern and not the the wrist...

  17. Reliability assessment of measuring active wrist pronation and supination range of motion with a smartphone.

    Science.gov (United States)

    Santos, C; Pauchard, N; Guilloteau, A

    2017-10-01

    This study aimed to improve clinical examination techniques by determining the reliability of different methods to evaluate forearm movements. Two methods using the iPhone™ 5 and its gyroscope application (alone [I5] or attached to a selfie stick [ISS]) were compared with two conventional measurement devices (a plastic goniometer with a hand-held pencil [HHP] and a bubble goniometer [BG]) to evaluate the active range of movement (AROM) of the wrist during pronation and supination. Two independent groups of subjects took part in this prospective single-center diagnostic study: 20 healthy subjects and 20 patients. The four evaluation methods had high intra-observer consistency after three measurements (intra-class correlation coefficient [ICC] [3, 1] of 0.916 for the HHP; 0.944 for ISS; 0.925 for BG; 0.933 for I5) and excellent inter-observer reliability (ICC [2, k] of 0.926 for HHP; 0.934 for ISS; 0.899 for BG; 0.894 for I5), with an agreement of plus or minus 2°. When these devices are used with rigorous methodology, they are reliable for the goniometric evaluation of AROM of wrist pronation and supination. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  18. Multi-temporal analysis of regression diagnostics for students' performance in property development and co-requisite courses

    Directory of Open Access Journals (Sweden)

    Ataguba Joseph Obaje

    2017-09-01

    Full Text Available Property development and other co-requisite courses have been embedded within academic programs in Estate Management. Among the objectives of this study include identifying the co-requisite courses that accounted for a variation in students' academic performance in property development, and to examine the characteristics of the diagnostics of ordinary least square (OLS regression model for this relationship over time. Data for this study comprised 2007/2008 to 2014/2015 (8-year scores for the 1st- and 2nd semester property development and its co-requisite courses in the Department of Estate Management of the Federal Polytechnic Idah, Nigeria. Tools of analysis comprised descriptive statistics (mean score, standard deviation, and coefficient of variation, fitted trend equations, multiple linear regression analysis, and a multi-temporal visualization of the regression diagnostics comprising *ZRESID vs. *ZPRED, normality tests for residuals, and the Durbin-Watson test. The variation in the scores for property development courses during the 8-year period was attributed to specific 1st- and 2nd semester co-requisite courses. EST311 (Valuation I was found to be the most consistent regressor for EST313 (Property Development I in the 1st semester, while EST325 (Estate Accounting, was the most consistent regressor for EST323 (Property Development II in the 2nd semester. Multi-temporal diagnostics analyses did not provide any sufficient evidence to invalidate the OLS regression models for the 1st- and 2nd semester Property Development courses and their co-requisites. Stakeholders' commitment to the teaching and learning of the co-requisite courses was recommended as triggers for a sustained pass rate in the property development courses.

  19. Diagnostic performance of the urinary canine calgranulins in dogs with lower urinary or urogenital tract carcinoma.

    Science.gov (United States)

    Heilmann, Romy M; McNiel, Elizabeth A; Grützner, Niels; Lanerie, David J; Suchodolski, Jan S; Steiner, Jörg M

    2017-04-21

    Onset of canine transitional cell carcinoma (TCC) and prostatic carcinoma (PCA) is usually insidious with dogs presenting at an advanced stage of the disease. A biomarker that can facilitate early detection of TCC/PCA and improve patient survival would be useful. S100A8/A9 (calgranulin A/B or calprotectin) and S100A12 (calgranulin C) are expressed by cells of the innate immune system and are associated with several inflammatory disorders. S100A8/A9 is also expressed by epithelial cells after malignant transformation and is involved in the regulation of cell proliferation and metastasis. S100A8/A9 is up-regulated in human PCA and TCC, whereas the results for S100A12 have been ambiguous. Also, the urine S100A8/A9-to-S100A12 ratio (uCalR) may have potential as a marker for canine TCC/PCA. Aim of the study was to evaluate the diagnostic accuracy of the urinary S100/calgranulins to detect TCC/PCA in dogs by using data and urine samples from 164 dogs with TCC/PCA, non-neoplastic urinary tract disease, other neoplasms, or urinary tract infections, and 75 healthy controls (nested case-control study). Urine S100A8/A9 and S100A12 (measured by species-specific radioimmunoassays and normalized against urine specific gravity [S100A8/A9 USG ; S100A12 USG ], urine creatinine concentration, and urine protein concentration and the uCalR were compared among the groups of dogs. S100A8/A9 USG had the highest sensitivity (96%) and specificity (66%) to detect TCC/PCA, with specificity reaching 75% after excluding dogs with a urinary tract infection. The uCalR best distinguished dogs with TCC/PCA from dogs with a urinary tract infection (sensitivity: 91%, specificity: 60%). Using a S100A8/A9 USG  ≥ 109.9 to screen dogs ≥6 years of age for TCC/PCA yielded a negative predictive value of 100%. S100A8/A9 USG and uCalR may have utility for diagnosing TCC/PCA in dogs, and S100A8/A9 USG may be a good screening test for canine TCC/PCA.

  20. A Wrist for Needle-Sized Surgical Robots

    Science.gov (United States)

    York, Peter A.; Swaney, Philip J.; Gilbert, Hunter B.; Webster, Robert J.

    2015-01-01

    The needle-sized surgical tools used in arthroscopy, otolaryngology, and other surgical fields could become even more valuable to surgeons if endowed with the ability to navigate around sharp corners to manipulate or visualize tissue. We present a needle-sized wrist design that grants this ability. It can be easily interfaced with manual tools or concentric tube robots and is straightforward and inexpensive to manufacture. The wrist consists of a nitinol tube with several asymmetric cutouts, actuated by a tendon. Perhaps counter-intuitively, within this seemingly simple design concept, design optimization is challenging due to the number of parameters available and nonlinearities in material properties. In this paper, we examine a subset of possible geometries and derive kinematic and static models. Experimental results with a 1.16 mm diameter prototype validate the models. Lastly, we provide a discussion summarizing the lessons learned in our early experience designing and fabricating wrists of this type. PMID:26405562

  1. The eWrist - A wearable wrist exoskeleton with sEMG-based force control for stroke rehabilitation.

    Science.gov (United States)

    Lambelet, Charles; Lyu, Mingxing; Woolley, Daniel; Gassert, Roger; Wenderoth, Nicole

    2017-07-01

    Chronic wrist impairment is frequent following stroke and negatively impacts everyday life. Rehabilitation of the dysfunctional limb is possible but requires extensive training and motivation. Wearable training devices might offer new opportunities for rehabilitation. However, few devices are available to train wrist extension even though this movement is highly relevant for many upper limb activities of daily living. As a proof of concept, we developed the eWrist, a wearable one degree-of-freedom powered exoskeleton which supports wrist extension training. Conceptually one might think of an electric bike which provides mechanical support only when the rider moves the pedals, i.e. it enhances motor activity but does not replace it. Stroke patients may not have the ability to produce overt movements, but they might still be able to produce weak muscle activation that can be measured via surface electromyography (sEMG). By combining force and sEMG-based control in an assist-as-needed support strategy, we aim at providing a training device which enhances activity of the wrist extensor muscles in the context of daily life activities, thereby, driving cortical reorganization and recovery. Preliminary results show that the integration of sEMG signals in the control strategy allow for adjustable assistance with respect to a proxy measurement of corticomotor drive.

  2. Novel approach for assessing performance of PCR cyclers used for diagnostic testing

    DEFF Research Database (Denmark)

    Schoder, D.; Schmalwieser, A.; Schauberger, G.

    2005-01-01

    -house PCR assay. The cyclers did not perform within the manufacturer's specification. Premature timing, under- and overshooting, and spatial variation of heat transfer were found to be the critical factors. The physical testing allowed us to distinguish accurate from less-accurate (2/6) cyclers. The lack...

  3. Head-To-Head Assessment of Diagnostic Performance of Testosterone Immunoassays in Patients With Polycystic Ovary Syndrome.

    Science.gov (United States)

    Schüring, Andreas N; Nolte, Stefan; Fobker, Manfred; Kannenberg, Frank; Nofer, Jerzy-Roch

    2016-09-01

    Determination of plasma testosterone is critical for the proper diagnosis of polycystic ovary syndrome (PCOS), but the interpretation of biochemical tests is hampered by inadequate specificity and precision of available immunoassays. We here compared the diagnostic performance of three testosterone immunoassays (Advia Centaur, Immulite 2000 XPi, Cobas e411) in PCOS patients using receiver operator characteristics curve analysis. Plasma levels of testosterone, androstendione, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, estradiol, progesterone, steroid hormone binding globulin, luteinizing hormone, and follicular stimulating hormone were determined in 188 patients with PCOS and 202 controls. Free testosterone (fT) levels and free androgen index (FAI) were calculated. Testosterone levels measured on Advia Centaur, Immulite 2000 XPi, and Cobas e411 showed clear linear relationship to each other. Testosterone measured with Advia Centaur showed discriminatory performance superior to Immulite 2000 XPi and Cobas e411. Calculation of fT or FAI improved the performance of Advia Centaur and Immulite 2000 XPi, which nevertheless performed better than Cobas e411. The performance of other parameters was inferior to that of testosterone, fT, and FAI. Present study documents striking differences between testosterone immunoassays with respect to their capacity to identify PCOS patients and favors the use of calculated parameters reflecting active testosterone in plasma. © 2015 Wiley Periodicals, Inc.

  4. Diagnostic performance of combined single photon emission computed tomographic scintimammography and ultrasonography based on computer-aided diagnosis for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Kyung Hoon; Choi, Duck Joo; Choe, Won Sick [Gachon Universtiy Gil Medical Center, Incheon (Korea, Republic of); Lee, Jun Gu; Kim, Jong Hyo [Seoul National University, College of Medicine, Seoul (Korea, Republic of); Lee, Hyung Ji; Om, Kyong Sik [CAD Impact, Inc., Seoul (Korea, Republic of); Lee, Byeong Il [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2007-06-15

    We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors.) The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve=0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve=0.860), but there was no statistical difference in sensitivity, specificity and accuracy between the combined method and a single modality. It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

  5. Contrast-enhanced ultrasound features of histologically proven focal nodular hyperplasia: diagnostic performance compared with contrast-enhanced CT.

    Science.gov (United States)

    Wang, Wei; Chen, Li-Da; Lu, Ming-De; Liu, Guang-Jian; Shen, Shun-Li; Xu, Zuo-Feng; Xie, Xiao-Yan; Wang, Yan; Zhou, Lu-Yao

    2013-09-01

    To investigate and compare contrast-enhanced ultrasound (CEUS) in the characterisation of histologically proven focal nodular hyperplasia (FNH) with contrast-enhanced computed tomography (CECT). CEUS was performed in 85 patients with 85 histologically proven FNHs. Enhancement, centrifugal filling, spoke-wheel arteries, feeding artery and central scarring were reviewed and correlated with lesion size or liver background. Independent factors for predicting FNH from other focal liver lesions (FLLs) were evaluated. Forty-seven FLLs with CECT were randomly selected for comparison of diagnostic performance with CEUS. Centrifugal filling was more common (P = 0.002) and the significant predictor (P = 0.003) in FNHs ≤3 cm. Lesion size or liver background has no significant influence on the detection rate of the spoke-wheel arteries and feeding artery (P > 0.05). Central scarring was found in 42.6 % of FNHs ≥3 cm (P = 0.000). The area under the ROC curve, sensitivity and specificity showed no significant differences between CEUS and CECT (P > 0.05), except that the sensitivity of CEUS was better for reader 1 (P = 0.041). CEUS is valuable in characterising centrifugal filling signs or spoke wheels in small FNHs and should be employed as the first-line imaging technique for diagnosis of FNH. • The confident diagnosis of focal nodular hyperplasia is important in liver imaging. • The centrifugal filling sign is useful for diagnosis of FNHs ≤3 cm. • Contrast-enhanced ultrasound and contrast-enhanced CT have similar diagnostic performance for FNH. • CEUS should be the first-line imaging technique for the diagnosis of FNH.

  6. Age-Related Decline of Wrist Position Sense and its Relationship to Specific Physical Training

    Directory of Open Access Journals (Sweden)

    Ann Van de Winckel

    2017-11-01

    Full Text Available Perception of limb and body positions is known as proprioception. Sensory feedback, especially from proprioceptive receptors, is essential for motor control. Aging is associated with a decline in position sense at proximal joints, but there is inconclusive evidence of distal joints being equally affected by aging. In addition, there is initial evidence that physical activity attenuates age-related decline in proprioception. Our objectives were, first, to establish wrist proprioceptive acuity in a large group of seniors and compare their perception to young adults, and second, to determine if specific types of training or regular physical activity are associated with preserved wrist proprioception. We recruited community-dwelling seniors (n = 107, mean age, 70 ± 5 years, range, 65–84 years without cognitive decline (Mini Mental State Examination-brief version ≥13/16 and young adult students (n = 51, mean age, 20 ± 1 years, range, 19–26 years. Participants performed contralateral and ipsilateral wrist position sense matching tasks with a bimanual wrist manipulandum to a 15° flexion reference position. Systematic error or proprioceptive bias was computed as the mean difference between matched and reference position. The respective standard deviation over five trials constituted a measure of random error or proprioceptive precision. Current levels of physical activity and previous sport, musical, or dance training were obtained through a questionnaire. We employed longitudinal mixed effects linear models to calculate the effects of trial number, sex, type of matching task and age on wrist proprioceptive bias and precision. The main results were that relative proprioceptive bias was greater in older when compared to young adults (mean difference: 36% ipsilateral, 88% contralateral, p < 0.01. Proprioceptive precision for contralateral but not for ipsilateral matching was smaller in older than in young adults (mean difference: 38

  7. Surface EMG pattern recognition for real-time control of a wrist exoskeleton

    Directory of Open Access Journals (Sweden)

    Khokhar Zeeshan O

    2010-08-01

    Full Text Available Abstract Background Surface electromyography (sEMG signals have been used in numerous studies for the classification of hand gestures and movements and successfully implemented in the position control of different prosthetic hands for amputees. sEMG could also potentially be used for controlling wearable devices which could assist persons with reduced muscle mass, such as those suffering from sarcopenia. While using sEMG for position control, estimation of the intended torque of the user could also provide sufficient information for an effective force control of the hand prosthesis or assistive device. This paper presents the use of pattern recognition to estimate the torque applied by a human wrist and its real-time implementation to control a novel two degree of freedom wrist exoskeleton prototype (WEP, which was specifically developed for this work. Methods Both sEMG data from four muscles of the forearm and wrist torque were collected from eight volunteers by using a custom-made testing rig. The features that were extracted from the sEMG signals included root mean square (rms EMG amplitude, autoregressive (AR model coefficients and waveform length. Support Vector Machines (SVM was employed to extract classes of different force intensity from the sEMG signals. After assessing the off-line performance of the used classification technique, the WEP was used to validate in real-time the proposed classification scheme. Results The data gathered from the volunteers were divided into two sets, one with nineteen classes and the second with thirteen classes. Each set of data was further divided into training and testing data. It was observed that the average testing accuracy in the case of nineteen classes was about 88% whereas the average accuracy in the case of thirteen classes reached about 96%. Classification and control algorithm implemented in the WEP was executed in less than 125 ms. Conclusions The results of this study showed that

  8. Non-invasive cytology brush PCR diagnostic testing in mucosal leishmaniasis: superior performance to conventional biopsy with histopathology.

    Science.gov (United States)

    Boggild, Andrea K; Valencia, Braulio Mark; Veland, Nicolas; Pilar Ramos, Ana; Calderon, Flor; Arevalo, Jorge; Low, Donald E; Llanos-Cuentas, Alejandro

    2011-01-01

    Traditional methods of diagnosing mucosal leishmaniasis (ML), such as biopsy with histopathology, are insensitive and require collection of an invasive diagnostic specimen. We compared standard invasive procedures including biopsy histopathology, biopsy PCR, and leishmanin skin test (LST) to a novel, non-invasive, cytology-brush based PCR for the diagnosis of ML in Lima, Peru. Consensus reference standard was 2/4 tests positive, and outcome measures were sensitivity and specificity. Leishmania species identification was performed by PCR-based assays of positive specimens. Twenty-eight patients were enrolled, 23 of whom fulfilled criteria for a diagnosis of ML. Sensitivity and specificity of biopsy with histopathology were 21.7% [95% CI 4.9-38.5%] and 100%; 69.6% [95% CI 50.8-88.4%] and 100% for LST; 95.7% [95% CI 87.4-100%] and 100% for biopsy PCR; and 95.7% [95% CI 87.4-100%] and 90% [95% CI 71.4-100%] for cytology brush PCR using both Cervisoft® and Histobrush® cervical cytology brushes. Represented species identified by PCR-RFLP included: L. (V). braziliensis (n = 4), and L. (V). peruviana (n = 3). Use of commercial grade cytology brush PCR for diagnosis of ML is sensitive, rapid, well tolerated, and carries none of the risks of invasive diagnostic procedures such as biopsy. Further optimization is required for adequate species identification. Further evaluation of this method in field and other settings is warranted.

  9. Performance of rapid diagnostic tests for imported malaria in clinical practice: results of a national multicenter study.

    Directory of Open Access Journals (Sweden)

    Sandrine Houzé

    Full Text Available We compared the performance of four rapid diagnostic tests (RDTs for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum (Plasmodium histidine-rich protein 2 (PfHRP2 or Plasmodium LDH (PfLDH and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH. 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%. For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%, positive predictive value (PPV (90% and negative predictive value (NPV (98%. The PfLDH test showed lower sensitivity (83% and NPV (80%, despite good PPV (98%. For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94-99% and 52-64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria.

  10. Performance of rapid diagnostic tests for imported malaria in clinical practice: results of a national multicenter study.

    Science.gov (United States)

    Houzé, Sandrine; Boutron, Isabelle; Marmorat, Anne; Dalichampt, Marie; Choquet, Christophe; Poilane, Isabelle; Godineau, Nadine; Le Guern, Anne-Sophie; Thellier, Marc; Broutier, Hélène; Fenneteau, Odile; Millet, Pascal; Dulucq, Stéphanie; Hubert, Véronique; Houzé, Pascal; Tubach, Florence; Le Bras, Jacques; Matheron, Sophie

    2013-01-01

    We compared the performance of four rapid diagnostic tests (RDTs) for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum (Plasmodium histidine-rich protein 2 (PfHRP2) or Plasmodium LDH (PfLDH)) and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH)). 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%). For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%), positive predictive value (PPV) (90%) and negative predictive value (NPV) (98%). The PfLDH test showed lower sensitivity (83%) and NPV (80%), despite good PPV (98%). For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94-99% and 52-64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria.

  11. High-performance double-filter soft x-ray diagnostic for measurement of electron temperature structure and dynamics

    Energy Technology Data Exchange (ETDEWEB)

    McGarry, M. B.; Den Hartog, D. J.; Goetz, J. A.; Thomas, M. A.; Reyfman, M.; Kumar, S. T. A. [Department of Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706 (United States); Franz, P. [Consorzio RFX, Associazione Euratom-ENEA per la Fusione, Padova (Italy)

    2012-10-15

    A new soft x-ray (SXR) T{sub e} and tomography diagnostic has been developed for MST that can be used for simultaneous SXR spectrum measurement, tomographically reconstructed emissivity, and reconstructed and line-of-sight electron temperature. The diagnostic utilizes high-performance differential transimpedance amplifiers (gain 10{sup 5}-10{sup 9}) to provide fast time response (up to 125 kHz), allowing for the study of plasma structure dynamics. SXR double-foil T{sub e} measurements are consistent with Thomson scattering. SXR brightness through a variety of filter thicknesses has been combined with charge exchange recombination spectroscopy (CHERS) impurity density measurements to determine the plasma energy spectrum. Magnetic pickup from the fluctuating magnetic fields in the plasma (B(tilde sign){approx}20 gauss at 10-20 kHz) has been dramatically reduced by improving the detector and housing design, so that nanoampere diode currents are now measured without interference from the substantial fluctuating magnetic field incident on the plasma facing surface of the probe.

  12. Diagnostic Performance of McMonnies Questionnaire as a Screening Survey for Dry Eye: A Multicenter Analysis

    Directory of Open Access Journals (Sweden)

    Yuxin Guo

    2016-01-01

    Full Text Available Purpose. To evaluate the diagnostic performance of the McMonnies questionnaire as a screening survey for dry eye in Chinese outpatients. Methods. The questionnaire was self-administered by 27,999 patients with dry eye symptoms. A thorough ophthalmic examination including tear break-up time (TBUT, fluorescein staining, and Schirmer I test was completed to make a clinical diagnosis of dry eye. Reliability, validity, and accuracy of the McMonnies questionnaire were assessed. Results. The McMonnies questionnaire showed poor internal consistency (Cronbach α=0.37, but excellent validity as the scores correlated with TBUT (Spearman test, r=-0.322, P<0.001 and Schirmer I test (Spearman’s test, r=-0.370, P<0.001, and significantly differed between the dry eye and control groups (2-sample t-test, t=69.51, P<0.001. The area under the receiver-operating characteristics (ROC curve (AUC was 0.729, suggesting moderate accuracy in identifying dry eye and non-dry eye patients. However, the AUCs varied significantly in different gender and age subgroups (z test, P<0.001, as the discriminating ability declined with age. Analysis of the ROC curves also revealed that different cut-off points should be employed for each subgroup to achieve the same level of accuracy. Conclusions. The McMonnies questionnaire demonstrates moderate diagnostic value, and different cut-off points should be selected for various study populations.

  13. Ultrasound-guided methotrexate injection for De Quervain disease of the wrist: what lies beyond the horizon?

    Directory of Open Access Journals (Sweden)

    Allam AE

    2017-09-01

    Full Text Available Abdallah El-Sayed Allam,1 Doaa Shawky Al-Ashkar,1 Ahmed A Negm,2 Basma Aly Eltawab,3 Wei-Ting Wu,4 Ke-Vin Chang4 1Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 3Department of Radiology, Tanta University Hospitals, Tanta, Egypt; 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan Abstract: De Quervain disease (DQVD is one of the most common causes of lateral wrist pain and can lead to significant disability. The current case involves a right-handed, middle-aged, female patient with severe lateral wrist pain due to DQVD. Her pain was not responsive to oral non-steroidal anti-inflammatory drugs, rehabilitation, and repeated corticosteroid injections. Because she refused surgical intervention, we performed ultrasound-guided methotrexate injections (four times. After the injections, dramatic pain relief, functional improvement, and reduction of the thickness of the retinaculum and tendons in the first dorsal extensor compartment of the wrist were noted. This case report highlights the potential usefulness of ultrasound-guided methotrexate injection for recalcitrant DQVD of the wrist. Keywords: hand, pain, sonography, rehabilitation