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A biomechanics-based method for the quantification of muscle selectivity in a musculoskeletal system.

In this paper, we have developed a novel and simple method to quantify the ability to selectively activate our muscles in an effective pattern to achieve a particular task. In the context of this study, we define an effective pattern as that in which muscles whose mechanical contribution to the task is greatest, are mostly active, while the antagonist muscles are mostly silent. This new method uses biomechanical parameters to project the multi-channel EMGs into a three-dimensional artificial torque space, where the EMGs are represented as muscle activation vectors. Using the muscle activation vectors we defined a simple scalar, the muscle selection index, to quantify muscle selectivity. We demonstrate that by using this index we are able to quantify the muscle selectivity during the generation of isometric shoulder or elbow torques in brain-injured and able-bodied subjects. This method can be used during both static and dynamic motor tasks in a multi-articular musculoskeletal system.

Animals↗

Effects of spaceflight on the musculoskeletal system: NIH and NASA future directions.

Prolonged bed rest, undertaken by volunteers or resulting from injury and disease, can impair bone and muscle function and structure; extended travel in space also induces these effects. Fluid shifts and disrupted fluid balance may also contribute to observed musculoskeletal aberrations in the weightless environment. Some molecular and cellular events involved in the loading and unloading of the musculoskeletal system are under neural and endocrine influence or control, whereas other events are influenced by local growth factors. Studies are in progress to develop interventions that preserve or improve musculoskeletal integrity in 1g. The NIAMS and NASA are interested in basic and clinical studies of the influence of microgravity on the musculoskeletal system. The interagency workshop results form the basis for new collaborative and cooperative research emphases for the biomedical community under a broad agreement between the National Institutes of Health and NASA.

Bone and Bones↗

Prevalence of musculoskeletal disorders is systematically higher in women than in men.

OBJECTIVES: Many studies report a higher prevalence of musculoskeletal pain in women than in men. This paper presents an overview of sex differences in musculoskeletal pain with specific attention for: different parameters for duration of musculoskeletal pain (ie, 1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain); and (2) different anatomic pain sites. METHODS: For the analyses, data from 2 general population-based prospective surveys (Dutch population-based Musculoskeletal Complaints and Consequences Cohort study and Monitoring Project on Risk Factors for Chronic Diseases-study) were used. The study population consisted of persons aged 25 to 64 years living in the Netherlands. Data on self-reported pain complaints were assessed by written questionnaires. RESULTS: The results of this study showed that prevalence rates of musculoskeletal pain were higher for women than for men in the Dutch general population aged 25 to 64 years on the basis of 2 population-based surveys. For musculoskeletal pain in any location, 39% of men and 45% of women reported chronic complaints. Highest female predominance was found for the hip and wrist/hand, whereas lowest and not statistically significant sex differences were found for the lower back and knee. All duration parameters of musculoskeletal pain showed a female predominance of musculoskeletal pain (1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain). In those with persistent chronic pain, women tended to report higher severity scores. DISCUSSION: The present study shows that women have higher prevalence rates of musculoskeletal pain in most anatomic pain sites, no matter the duration of musculoskeletal pain. Future research should focus on explaining these sex differences with the ultimate goal to develop better prevention and management strategies for musculoskeletal pain in both men and women.

Adult↗

Evaluation of the child with a bone or soft-tissue neoplasm.

The prebiopsy evaluation of a child with a musculoskeletal neoplasm is the cornerstone for all subsequent treatment. A better understanding of the natural history of pediatric musculoskeletal tumors and an explosion in the development of sensitive new imaging modalities have significantly advanced the care of the child with a musculoskeletal pathologic condition. This article details the prebiopsy clinical and radiographic evaluation of the child or adolescent with a musculoskeletal neoplasm.

Adolescent↗

Computer simulation of the upper extremities.

The development of real-time, interactive, three-dimensional, computer graphic simulation of the musculoskeletal system with emphasis on the upper extremities is described. Developments in image analysis, scientific visualization, and interactive computer methods and the continuous improvement in knowledge of musculoskeletal function have combined to provide an exciting new tool for musculoskeletal research. Interactive simulation also has promising applications in medical education and clinical rehabilitation. Only those developments that fit the specific criteria of realism, real-time response, intuitive interaction, three-dimensional structures, and modeling flexibility are discussed. It is hoped that an improved understanding of this emerging tool and an appreciation for its potential applications will be gained.

Arm↗

Granulomatous musculoskeletal disease: sarcoidosis versus tuberculosis.

A patient with systemic sarcoidosis insidiously developed tuberculous arthritis. The concurrence of these diagnoses in any individual patient is rare. Musculoskeletal features of sarcoidosis and tuberculosis are reviewed, and the importance of obtaining appropriate cultures to differentiate these granulomatous disorders is illustrated.

Adult↗

Musculoskeletal injection skills competency in physical medicine and rehabilitation residents: a method for development and assessment.

An educational module was developed in attempt to satisfy two main objectives: to develop and implement a methodology for instruction of generally encountered injection techniques in the practice of physical medicine and rehabilitation and to implement an objective assessment format to measure attainment of these skills. Guidelines for this module were developed in consideration of Accreditation Council for Graduate Medical Education (ACGME) physical medicine and rehabilitation residency program requirements and ACGME Outcome Project. Eleven physical medicine and rehabilitation residents participated in a 1-day didactic/laboratory workshop covering injection education and techniques, followed by a supervised 2-wk practice session. Knowledge acquisition and skill attainment were measured via before and after multiple-choice written examination and simulated patient encounters utilizing anatomic models. An increase in knowledge was observed on the multiple-choice examination from pretest to posttest (pretest, 59.3%; posttest, 90.6%). Before instruction, 0 of 11 residents were able to perform any of the injection techniques (14 injection techniques and one sterile technique). At completion of the module, 7 of 11 residents (64%) competently performed 15 of 15 techniques (100%), 3 of 11 (26%) competently performed 14 of 15 techniques (93%), and 1 of 11 (9%) competently performed 11 of 15 techniques (73%). Participation in this module resulted in substantial acquisition of knowledge and skills regarding musculoskeletal injections for physical medicine and rehabilitation residents. This workshop provided a framework for the definition of baseline competency in this clinical skill area.

Attitude of Health Personnel↗

Predictive model of muscle fatigue after spinal cord injury in humans.

The fatigability of paralyzed muscle limits its ability to deliver physiological loads to paralyzed extremities during repetitive electrical stimulation. The purposes of this study were to determine the reliability of measuring paralyzed muscle fatigue and to develop a model to predict the temporal changes in muscle fatigue that occur after spinal cord injury (SCI). Thirty-four subjects underwent soleus fatigue testing with a modified Burke electrical stimulation fatigue protocol. The between-day reliability of this protocol was high (intraclass correlation, 0.96). We fit the fatigue index (FI) data to a quadratic-linear segmental polynomial model. FI declined rapidly (0.3854 per year) for the first 1.7 years, and more slowly (0.01 per year) thereafter. The rapid decline of FI immediately after SCI implies that a "window of opportunity" exists for the clinician if the goal is to prevent these changes. Understanding the timing of change in muscle endurance properties (and, therefore, load-generating capacity) after SCI may assist clinicians when developing therapeutic interventions to maintain musculoskeletal integrity.

Adolescent↗

Historic and current strategies in bone tissue engineering: do we have a hope in Hench?

Professors Larry Hench and Julia Polak formed the Tissue Engineering and Regenerative Medicine Centre (TERM) at Imperial College London to foster collaborations between biologists and materials scientists. Early work at the center elucidated the biomolecular interactions between primary human osteoblasts and 45S5 Bioglass . As research efforts expanded, the team discovered that the dissolution products of both 45S5 Bioglass and 58S sol-gel bioactive glasses had osteoblastic stimulatory properties. To address the shortage of appropriate cells for bone tissue engineering applications, TERM scientists also demonstrated the differentiation of embryonic stem (ES) cells to osteoblasts when treated with the dissolution products of bioactive glasses. They also found that the soluble factors ascorbic acid, beta -glycerophosphate, and dexamethasone preferentially differentiated ES cells to osteoblasts, and their combination with the dissolution products of bioactive glasses stimulated differentiation even further. Taken together, these results demonstrate the suitability of bioactive glasses as scaffolds for bone tissue engineering as they not only provide an osteoconductive and osteoproductive substrate, but also actively stimulate cells to express appropriate osteoblastic phenotypes. Professor Hench's vision to pioneer regenerative medicine research continues with the aim of developing novel therapeutics to treat musculoskeletal disability.

Animals↗

Health status and utility measurement viewed from the right brain: experience from the rheumatic diseases.

Questionnaires for measuring function, health status, and quality of life have been developed for the rheumatic and musculoskeletal disorders. These new measures are as valid and as reliable as traditional measures of clinical status in clinical trials and health services research and add a valuable dimension to outcome assessment. However, they have limitations for use in patient care. Questionnaires cannot determine the etiologic basis of functional disability; nor cover any one function in enough depth; nor deal with the relative nature of function; nor account for the differences in functional priorities. Questionnaires are statistical approaches and based on normative model; patient care is humanistic emphasizing differences. Nevertheless, the interaction between psychometric approaches and concerns of patient care is a necessary and desirable goal for all we seek to accomplish with clinical investigation.

Arthritis, Rheumatoid↗

A modeling and computer simulation approach to determine optimal lower extremity joint angular velocities based on a criterion to maximize individual muscle power.

A computer program was developed in conjunction with a musculoskeletal modeling scheme to determine lower extremity joint angular velocity profiles which allow specific muscles, if activated tetanically, to generate their greatest power. As input the program requires subject anthropometric and joint configuration data. Muscle-tendon (MT) attachment location data and a straight line MT model are used to calculate MT lengths for each joint configuration. The shortening velocity which allows an active muscle to generate its greatest power is calculated based on muscle architecture and a relationship between power and shortening velocity. A finite difference technique is used to calculate the time between sequential joint configurations which will produce the optimal muscle shortening velocity. This time is then used to calculate optimal joint angular velocities for each muscle and and for each joint configuration. The utility of this program is demonstrated by calculating optimal joint angular velocities for fifteen muscles and comparing calculated knee extension velocities with experimental results cited in the literature.

Anthropometry↗

Molecular imaging promotes progress in orthopedic research.

Modern orthopedic research is directed towards the understanding of molecular mechanisms that determine development, maintenance and health of musculoskeletal tissues. In recent years, many genetic and proteomic discoveries have been made which necessitate investigation under physiological conditions in intact, living tissues. Molecular imaging can meet this demand and is, in fact, the only strategy currently available for noninvasive, quantitative, real-time biology studies in living subjects. In this review, techniques of molecular imaging are summarized, and applications to bone and joint biology are presented. The imaging modality most frequently used in the past was optical imaging, particularly bioluminescence and near-infrared fluorescence imaging. Alternate technologies including nuclear and magnetic resonance imaging were also employed. Orthopedic researchers have applied molecular imaging to murine models including transgenic mice to monitor gene expression, protein degradation, cell migration and cell death. Within the bone compartment, osteoblasts and their stem cells have been investigated, and the organic and mineral bone phases have been assessed. These studies addressed malignancy and injury as well as repair, including fracture healing and cell/gene therapy for skeletal defects. In the joints, molecular imaging has focused on the inflammatory and tissue destructive processes that cause arthritis. As described in this review, the feasibility of applying molecular imaging to numerous areas of orthopedic research has been demonstrated and will likely result in an increase in research dedicated to this powerful strategy. Molecular imaging holds great promise in the future for preclinical orthopedic research as well as next-generation clinical musculoskeletal diagnostics.

Animals↗

Interfering effects of multitasking on muscle activity in the upper extremity.

Multitasking, where workers are required to perform multiple physical tasks with various levels of cognitive load is common in today's workplace. Simultaneous physical and mental demands are thought to cause task interference and likely increase muscle activity. To test the interfering effects of multitasking, 16 healthy participants performed hand and shoulder exertions with combinations of four grip conditions (no grip, 30% grip with low precision, 30% grip with high precision, and maximal grip) and three shoulder conditions at 90 degrees abduction (maintaining posture, 40% force-controlled moment, 40% posture-controlled moment), with and without the Stroop test while surface EMG was recorded from eight upper extremity muscles. Both 40% MVC shoulder moments increased extrinsic forearm muscle activity by 2-4% MVE (p<0.01). Grip exertion at 30% MVC reduced anterior and middle deltoid activity by 2% MVE (p<0.01). Exerting a constant force against the transducer (force-controlled) required 3-4% MVE greater middle and posterior deltoid activity (p<0.001) compared to supporting an equivalent inertial load at the same shoulder angle (posture-controlled). Performing the mental task (Stroop test) concurrently with either 40% MVC shoulder moments significantly increased trapezius activity by nearly 2% MVE (p<0.05). Interestingly, the Stroop test also reduced all deltoid activity by 1% MVE (p<0.05). The addition of both the Stroop test and force-control shoulder exertion independently reduced maximal grip force by 7% and 10% MVC, respectively. These results suggest that more complex workplace tasks may act to increase muscle load or interfere with task performance. These small but significant findings may play a role in the development of long-term musculoskeletal disorders in the workplace.

Adult↗

Shoulder muscle activity in young and older people during a computer mouse task.

OBJECTIVE: Assessment of the age effect in relation to computer work. BACKGROUND: Increasingly, more older people are using computers, while hardware and software are not designed with special consideration of their needs. METHODS: Eight young and nine older females performed different computer mouse tasks. Shoulder muscle activity was recorded from the right deltoid muscle, right and left upper trapezius muscle, and the neck extensor muscles. RESULTS: Mean trapezius muscle activity was significantly higher in the older people (2.8%/3.7% EMG(max) for R/L) compared to the young (1.1%/1.2% EMG(max)). There was a tendency to a higher activity in the older people for the deltoid muscle and the neck extensor muscles. There were small differences in shoulder muscle activation levels between mouse actions, target directions, and between precision demands. CONCLUSIONS: Shoulder muscle activity during computer work is affected by age, but only to a minor extent by the type of computer mouse task. The deltoid and the trapezius muscle activities are low during computer mouse use when there is efficient forearm support by the table. RelevanceAn increasing number of people use computers for hours every day. Intensive use of computers increases the risk of development of work-related musculoskeletal symptoms in the shoulder region.

Adult↗

In vitro effect of S-adenosyl methionine on ethanol embryopathy in the rat.

S-adenosyl methionine (SAM) is a universal methyl donor for biological systems. Chronic consumption of ethanol results in depletion of available SAM and reduces its biosynthesis in the transmethylation pathway. Administration of excess SAM may reduce the embryopathic effects of ethanol. The in-vitro effects of SAM on ethanol embryopathy was investigated by culturing 9.5 day old whole rat embryos for 48 hours in ethanol alone (Group II), 0.05 mM SAM (Group III), ethanol + 0.05 mM SAM (Group IV), ethanol + 0.1 mM SAM (Group V), ethanol + 1 mM SAM (Group VI), and in ethanol + 3 mM SAM (Group VII). In Group VII embryos, cardiovascular, nervous, auditory, visual, craniofacial and musculoskeletal systems were retarded in development; crown-rump length, yolk-sac diameter, as well as morphological scores, were reduced compared to those in embryos treated with ethanol alone (Group II). There were, however, significant differences between Group II and Group IV embryos with respect to crown-rump length, yolk sac diameter and somite number. The mean crown-rump length, yolk sac diameter and somite number in Group II were 2.3 +/- 0.2, 2.8 +/- 0.3 and 22.4 +/- 3.5 respectively, compared to 2.6 +/- 0.2, 3.1 +/- 0.2 and 25.3 +/- 3.1 in Group IV. These results suggest that simultaneous administration of S-adenosyl methionine and ethanol may protect against the embryopathic effects of ethanol.

Animals↗

[Design and evaluation of the Extra Short Musculoskeletal Function Assessment Questionnaire XSMFA-D].

AIM: The XSMFA-D (German Extra Short Musculoskeletal Function Assessment Questionnaire) was developed on the basis of the SMFA-D to provide a short questionnaire for assessment of the functional status from patient's perspective in routine use. METHODS: Based on psychometric and medical aspects 16 items were extracted from the SMFA-D during an iterative process. 633 SMFA-D questionnaires of 199 patients were used as basic data. The XSMFA-D was evaluated on 67/51 patients with primary osteoarthritis of the knee/hip undergoing total joint replacement. RESULTS: The tests for reliability and internal consistency produced favorable results. The Knee Score, Harris Hip Score, WOMAC and SMFA-D showed significant correlations to the XSMFA-D indicating construct validity. The criterion validity could be demonstrated successfully by relations with external parameters like walking distance, patients reported pain, mobility judgements by physicians and degree of osteoarthritis. The discriminant validity could also be demonstrated by significant differences between several different patient groups. Almost all effect sizes were generally large. CONCLUSIONS: The XSMFA-D could be demonstrated to be an appropriate short questionnaire for the evaluation of therapy results from patient's perspective. The use of the XSMFA-D can be recommended for routine use. Further investigations of the instrument will be undertaken.

Activities of Daily Living↗

Impact during equine locomotion: techniques for measurement and analysis.

Impact is implicated in the development of several types of musculoskeletal injury in the horse. Characterisation of impact experienced during strenuous exercise is an important first step towards understanding the mechanism for injury. Measurement and analysis of large, short duration impacts is difficult. The measurement system must be able to record transient peaks and high frequencies accurately. The analysis technique must be able to characterise the impact signal in time and frequency. This paper presents a measurement system and analysis technique for the characterisation of large impacts. A piezo-electric accelerometer was securely mounted on the dorsal surface of the horses hoof. Saddle mounted charge amplifiers and a 20 m coaxial cable transferred these data to a PC based logging system. Data were down-loaded onto a UNIX workstation and analysed using a proprietary statistics package. The values of parameters calculated from the time series data were comparable to those of other authors. A wavelet decomposition showed that the frequency profile of the signal changed with time. While most spectral energy was seen at impact, a significant amount of energy was contained in the signal immediately following impact. Over 99% of this energy was contained in frequencies less than 1250 Hz. The sampling rate and the frequency response of a measurement system for recording impact should be chosen carefully to prevent loss or corruption of data. Time scale analysis using a wavelet decomposition is a powerful technique which can be used to characterise impact data. The use of contour plots provides a highly visual representation of the time and frequency localisation of power during impact.

Acceleration↗

Randomized phase III trial of marimastat versus placebo in patients with metastatic breast cancer who have responding or stable disease after first-line chemotherapy: Eastern Cooperative Oncology Group trial E2196.

PURPOSE: To determine whether a matrix metalloproteinase inhibitor improves progression-free survival (PFS) in patients with metastatic breast cancer who have responding or stable disease after first-line chemotherapy. PATIENTS AND METHODS: One hundred seventy-nine eligible patients were randomly assigned to receive oral marimastat (10 mg bid; n = 114) or a placebo (n = 65) within 3 to 6 weeks of completing six to eight cycles of first-line doxorubicin- and/or taxane-containing chemotherapy for metastatic disease. Patients were evaluated every 3 months until disease progression. RESULTS: When comparing placebo with marimastat, there was no significant difference in PFS (median, 3.1 months v 4.7 months, respectively; hazard ratio, 1.26; 95% CI, 0.91 to 1.74; P = .16) or overall survival (median, 26.6 months v 24.7 months, respectively; hazard ratio, 1.03; 95% CI, 0.73 to 1.46; P = .86). Patients treated with marimastat were more likely to develop grade 2 or 3 musculoskeletal toxicity (MST), a known complication of the drug indicative of achieving a biologic effect, compared with patients administered placebo (63% v 22%, respectively; P < .0001). Patients with grade 2 or 3 MST had significantly inferior survival compared with patients who had grade 0 or 1 MST (median, 22.5 months v 28.2 months; P = .04). In addition, patients who had a marimastat plasma concentration of at least 10 ng/mL at month 1 and/or 3 were significantly more likely to have grade 2 to 3 MST (P < .0001). CONCLUSION: Marimastat does not prolong PFS when used after first-line chemotherapy for metastatic breast cancer. Patients with higher marimastat levels exhibited MST, and MST was associated with inferior survival.

Administration, Oral↗