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PubMed2003

Validation of a functional evaluation system in patients with musculoskeletal tumors.

The validity and reliability of the Musculoskeletal Tumor Society functional evaluation system were evaluated using the Nottingham Health Profile, the Short Form-36, and the EuroQol protocol to measure the quality of life of patients with malignant musculoskeletal tumors. Forty-nine patients were assessed and osteosarcoma around the knee was the most common type of tumor. Prosthetic reconstructions had been done in 55.1% of patients. In a content validity analysis, neither social nor psychologic domain was identified in the Musculoskeletal Tumor Society system. All items of the lower extremity were related to the same function-walking ability. The Musculoskeletal Tumor Society system had a strong correlation with other quality of life measures in the construct validity and the reliability, but each domain of the system was so comprehensive that it could not represent the quality of life properly. Furthermore, the preoperative and postoperative status of patients could not be compared using this system. The overall validity and reliability of the Musculoskeletal Tumor Society system seemed to be acceptable. However, this system may require additional development of the appropriate domains for evaluating the quality of life in patients with musculoskeletal tumors.

Adolescent↗
PubMed2004

Informed consent is not routinely documented for procedures using allografts.

Patients who receive musculoskeletal allografts may have severe postoperative infections develop. Media reports have heightened public awareness of the risk of allograft use. Explaining these risks to patients preoperatively has become more important as attention to informed consent issues has increased. This study retrospectively investigated the patterns of informed consent for allograft bone used during elective orthopaedic procedures at a major teaching hospital. Forty-seven (32%) of 148 patients had preoperative discussions of allograft risks and benefits documented with a signed preoperative consent. In nearly 70% of the cases in which structural allograft was used, preoperative consent was documented. Only 8% of cases in which nonstructural, highly processed allograft was used had documented preoperative consent. Forty-eight (32%) of 148 patients were treated with allograft and autograft. Consent was obtained for the harvesting and use of autograft from 90% of these patients. In none of these patients was consent obtained for the allograft used. Although risks of disease transmission vary widely with the degree of allograft processing and the source of its procurement, informed consent for any allograft use should be a routine part of preoperative discussions of risks and benefits in elective orthopaedic surgeries.

Bone Transplantation↗
PubMed2005

Arthrodesis of the shoulder after tumor resection.

UNLABELLED: Functional outcomes of patients with arthrodesis after resection of a shoulder girdle neoplasm are only sparsely reported. Fusion of the shoulder can be done as a primary reconstruction or secondarily for salvage of a failed limb-sparing procedure. We retrospectively reviewed 21 patients at a mean followup of 11 years. In eight patients, arthrodesis was done as the primary reconstruction and in 13 patients as the secondary procedure. There were no local recurrences, and no patient had metastatic disease develop. The overall Toronto extremity salvage and Musculoskeletal Tumor Society scores were 81% (range, 46-97) and 23 points (range, 17-26), respectively. There was no difference with respect to function between patients who had their arthrodesis as a primary or secondary procedure. Eight of 21 patients (43%) had a complication that required major surgical intervention. Shoulder arthrodesis as a limb salvage procedure after tumor resection provides good function independent of whether the procedure is done primarily or secondarily. Because of the high complication rate, future efforts must be directed at surgical methods to decrease such complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

A plyometric training model used to augment rehabilitation from tibial fasciitis.

Shin splints, an exercise-induced form of lower leg pain, is a common complaint among athletes. Considered an overuse injury that compromises the dense and tough fascial attachments of the tibialis posterior and/or tibialis anterior muscles from the tibia, it responds well to a multiphase treatment plan that incorporates plyometric strengthening and conditioning exercises. Plyometrics may be safely introduced as early as the third or functional phase of recovery. A progressive plyometric program that emphasizes a gradual development of eccentric stress loading to the musculoskeletal components of the deep posterior and anterior muscle compartments of the lower leg is described.

Athletic Injuries↗
PubMed1983

Orthopedics in adolescence.

Many orthopedic problems occur during adolescence. This paper describes the various types of musculoskeletal deformities associated with this stage of development, and discusses methods of diagnosis and correction. It is argued that since such problems are managed most effectively if diagnosed early, the role of the primary-care physician is critical.

Acetabulum↗
PubMed2004

A swimming robot actuated by living muscle tissue.

Biomechatronics is the integration of biological components with artificial devices, in which the biological component confers a significant functional capability to the system, and the artificial component provides specific cellular and tissue interfaces that promote the maintenance and functional adaptation of the biological component. Based upon functional performance, muscle is potentially an excellent mechanical actuator, but the larger challenge of developing muscle-actuated, biomechatronic devices poses many scientific and engineering challenges. As a demonstratory proof of concept, we designed, built, and characterized a swimming robot actuated by two explanted frog semitendinosus muscles and controlled by an embedded microcontroller. Using open loop stimulation protocols, the robot performed basic swimming maneuvers such as starting, stopping, turning (turning radius ~400 mm) and straight-line swimming (max speed >1/3 body lengths/second). A broad spectrum antibiotic/antimycotic ringer solution surrounded the muscle actuators for long term maintenance, ex vivo. The robot swam for a total of 4 hours over a 42 hour lifespan (10% duty cycle) before its velocity degraded below 75% of its maximum. The development of functional biomechatronic prototypes with integrated musculoskeletal tissues is the first critical step toward the long term objective of controllable, adaptive and robust biomechatronic robots and prostheses.

Journal Article↗
PubMed2003

The association between psychological distress and musculoskeletal symptoms experienced by Chinese high school students.

STUDY DESIGN: A cross-sectional nonexperimental study. OBJECTIVES: To determine the prevalence of musculoskeletal symptoms during a 6-month period and explore the contributing factors associated with these symptoms in Chinese senior class high school students. We also explored the relationship between psychological distress and musculoskeletal symptoms in this population. BACKGROUND: Musculoskeletal symptoms with no underlying identifiable pathology are a management puzzle to medical professionals. Finding the prevalence of musculoskeletal symptoms is the first step in the prevention of further chronic pain syndromes in young adults. No study, however, has directly measured the prevalence of musculoskeletal symptoms in this population. Investigations of the contributing factors to these symptoms, though rare, can provide information to assist in the prevention of further injuries. METHODS: The Musculoskeletal Symptom Questionnaire (MSQ) and the 12-question version of the Chinese Health Questionnaire (CHQ-12) were randomly distributed to students (n = 550) in 4 different high schools in the Tainan area of Taiwan. Of these, 471 students returned the questionnaires for analysis. Descriptive statistics were computed for means, standard deviations, and frequencies. Chi-square statistics were used for analysis of the association between psychological distress and musculoskeletal symptoms. RESULTS: The most frequent complaints of musculoskeletal symptoms among the adolescent Chinese student population were reported as being located in the following anatomical areas: neck (56%), shoulder (45%), and back (37%). Based on the results from the CHQ-12, all of the participants were divided into 2 groups: a high psychological (CHQ-12 score > or = 5) and a low psychological (CHQ-12 score < 5) distress group. There were significant differences of prevalence of musculoskeletal symptoms between these 2 groups (P < .05), especially for the neck region (P = .003). CONCLUSION: The results showed that the prevalence of musculoskeletal symptoms was high in this adolescent population and demonstrated a certain association with psychological distress. We suggest that surveys of this type may serve as preclinical detectors of future musculoskeletal disorders and may permit early interventions. Developing an intervention that addresses both physical and psychological problems may be beneficial for this population.

Adolescent↗
PubMed1995

Three-dimensional MRI reconstructions of musculoskeletal tumors. A preliminary evaluation of 2 cases.

We have developed a new method for three-dimensional (3D) reconstruction of malignant bone and soft-tissue tumors from MRI. Data from transverse images of T2-weighted images were transferred into a personal computer. The contours of tumors, major vessels, major nerves and bones were outlined, whereupon the 3D data were processed into a 3D display, using a solid model. The determination of tumor volume both before and after preoperative adjuvant therapy was quantified. The 3D images allowed a better understanding of the relationship between the tumor and the major vessels and nerves, thereby aiding in preoperative planning. The images also provided a quantitative, reproducible measurement of the effect of adjuvant therapy.

Adolescent↗
PubMed2006

Treatment of acute infection.

Military injuries are classically thought of as being limited to penetrating trauma caused by gunshot and blast injuries. However, blunt trauma caused by motor vehicle crashes and crush injuries can produce severe open injuries in the extremities. Most military injuries involve a higher level of energy than is commonly seen in civilian injuries, and the environment can be austere. These factors contribute to the development of infections that appear shortly after musculoskeletal trauma. Thus, the orthopaedic surgeon must know how to treat anaerobic soft-tissue infection, including clostridial fasciitis, clostridial myonecrosis, and tetanus; bacterial necrotizing fasciitis; and both superficial and deep bacterial wound infections.

Acute Disease↗
PubMed2002

Short-term effects of workstation exercises on musculoskeletal discomfort and postural changes in seated video display unit workers.

BACKGROUND AND PURPOSE: In recent years, a number of exercise programs have been developed for computer operators in order to promote movement and to reduce musculoskeletal discomfort. Tests of the effectiveness of these exercise programs, especially in field trials, are rare. The authors tested the hypothesis that doing regular, short-term (<10 days) exercises while at a workstation would decrease musculoskeletal discomfort and increase in-chair movement (ICM). SUBJECTS: Eleven directory assistance operators (8 female, 3 male) with no recent history of musculoskeletal problems volunteered. METHODS: In-chair movement was measured by tracking the center of pressure at the buttock-chair interface as subjects sat on a pressure-sensitive mat. Musculoskeletal discomfort was rated through the use of the Body Part Discomfort Scale (BPDS) and a body map. We used a revised Dataspan exercise program. Operators were tested for 2 hours, on 2 occasions: before and after doing exercises for 3- to 5-day shifts. During each test, ICM was measured during three 15-minute periods at the start of the test and at the end of hours 1 and 2. Subjects rated musculoskeletal discomfort per body part using the BPDS at 30, 60, and 120 minutes of each test. The effects of exercises on ICM and BPDS ratings were examined with a two-way repeated-measures analysis of variance with day (2) x time (3) designs. RESULTS: When subjects were doing their exercises, ICM was higher at the start and hour 1, and perceived discomfort was lower during each test period (start, hour 1, and hour 2). When not exercising, subjects' musculoskeletal discomfort increased over time and was higher during all test periods. DISCUSSION AND CONCLUSION: Exercises done by video display unit operators while at a workstation resulted in short-term decreases in both musculoskeletal discomfort and postural immobility. These results suggest that workstation exercises may be beneficial.

Adult↗
PubMed2002

[Basic results of the investigation of the effects of antiorthostatic hypokinesia on the functioning of various systems in monkey's organism].

Presented are results of comprehensive studies of functioning various body systems of Macaca mulatta after 4 weeks in antiorthostatic hypokinesia (head-down tilting, HDT). HDT deteriorated monkeys' tolerance of +Gz, altered the higher nervous functioning, and brought about serious disorders in coordination and locomotion. It also impacted energy metabolism, reduced hydration of organism, caused various shifts in the neuroendocrine system, circulation and its controls, and protein, carbohydrate and mineral metabolism. HDT resulted in inhibition of the lymphoid activity of structural components of the lymph nodes, changes in the musculoskeletal apparatus of the lower limbs, atrophic developments in the iliac crest spongiosis, and reduction of the oxidative potential of fibers in the crus extensors, and the number of capillaries in a fiber. These observations are ascribed to redistribution of the body fluids, hypokinesia per se and absence of the effects of support. This HDT model can be applied to monkeys for studying processes of the hypokinetic syndrome and developing countermeasures.

Animals↗
PubMed2003

Phase I study of docosahexaenoic acid-paclitaxel: a taxane-fatty acid conjugate with a unique pharmacology and toxicity profile.

PURPOSE: Docosahexaenoic acid (DHA)-paclitaxel, a novel conjugate formed by covalently linking the natural fatty acid DHA to paclitaxel, was designed as a prodrug targeting intratumoral activation. This Phase I trial examined its toxicity and pharmacokinetics (PKs). EXPERIMENTAL DESIGN: Patients with advanced refractory solid tumors received a 2-h i.v. infusion of DHA-paclitaxel every 3 weeks. Plasma and urine samples were obtained to characterize the pharmacological profile of DHA-paclitaxel and paclitaxel. RESULTS: Twenty-four patients received 78 cycles of DHA-paclitaxel over five dose levels (200-1100 mg/m(2)). Median number of cycles was 2 (range, 1-8). Myelosuppression was the principal toxicity observed (grade 3/4 neutropenia in 21%/53% of courses at 1100 mg/m(2)); during cycle 1, febrile neutropenia occurred in 1 of 9 patients treated at 1100 mg/m(2). Other grade 3 toxicities were infrequent. No patients developed alopecia, peripheral neuropathy > grade 1, or musculoskeletal toxicity > grade 1. At 1100 mg/m(2), DHA-paclitaxel had a mean (CV%) volume of distribution of 7.5 (64) liters, beta half-life of 112 (56) h, and clearance of 0.11 (30) liters/h. Paclitaxel PK parameters at 1100 mg/m(2) were: C(max), 282 (46) ng/ml; AUC, 10,705 (60) ng/ml x h; and terminal half-life, 85 (101) h. Paclitaxel plasma exposure represented < or =0.06% of DHA-paclitaxel exposure. Paclitaxel AUC was correlated with neutropenia. One partial response was observed. CONCLUSIONS: The starting dose recommended for subsequent studies is 1100 mg/m(2). DHA-paclitaxel dramatically alters the PK profile of derived paclitaxel compared with values observed after a 3-h infusion of paclitaxel (175 mg/m(2)). In addition, its favorable toxicity profile offers potential advantages over existing taxanes.

Adult↗
PubMed2003

Acquisition of operant-trained bipedal locomotion in juvenile Japanese monkeys (Macaca fuscata): a longitudinal study.

This study investigated developmental aspects of the acquisition of operant-trained bipedal (Bp) standing and Bp walking in the normally quadrupedal (Qp) juvenile Japanese monkey (M. fuscata). Four male monkeys (age: 1.6 to 2.4 years, body weight: 3.3 to 4.6 kg) were initially operantly trained to stand upright on a smooth floor and a stationary treadmill belt (width = 60 cm, walking length = 150 cm). They were then trained to walk bipedally on the moving treadmill belt (speed: 0.4-0.7 m/s). A regular training program (5 days/week; 30-60 min/day) was given to each monkey for the first 40 to 60 days, followed by less intensive training. After the beginning of locomotor training, upright postural stability and Bp walking capability were assessed kinematically for 592, 534, 526, and 537 days on monkeys A, B, C, and D, respectively. Left side- and back-views of the walking monkey were photographed (10 frames/s) and videotaped (250 frames/s). Stick figures of the head, body, and hindlimbs were drawn with reference to ink-marks positioned in front of the ear and over the pivot points of hindlimb joints. All kinematic data were digitized and analyzed using image-analyzing software. After sufficient physical growth and locomotor training, all the monkeys gradually acquired: (a) a more upright and a more stable posture with a constant body axis orientation during Bp locomotion; (b) a more stable and a stronger functional coupling between the body and hindlimb movements with a less anterior (A)-posterior (P) fluctuation of a body axis; (c) a smaller leftward (Lt)-rightward (Rt) displacement of the midline pelvic position, allowing the monkey to walk along a straight course; (d) a more coordinated relationship among hip-knee, knee-ankle, and ankle-metatarsophalangeal (MTP) joints; and finally (e) the acquisition of well-coordinated Bp walking even at high treadmill belt speeds up to 1.5 m/s. All of these results demonstrated the capability of the physically developing monkey to integrate the neural and musculoskeletal mechanisms required for sufficient coordination of upper (head, neck, trunk) and lower (hindlimbs) motor segments so that Bp standing and Bp walking could be elaborated.

Age Factors↗
PubMed2006

[Avascular necrosis in a man with HIV infection].

Recently, a high incidence of avascular necrosis (AVN) has been reported in HIV-infected individuals. We present a further case of AVN of both femoral heads, the left distal femur and the proximal tibia in a 19-year-old HIV-positive man. The patient complained of severe pain in both hips, which had lasted 10 months. The diagnosis was aided by radiological assessment and radioisotope bone scan and confirmed by magnetic resonance imaging. The patient had been receiving antiretroviral therapy for 30 months and had no other known risk factors for developing AVN. We recommend early evaluation of musculoskeletal pain in HIV-infected patients to rule out AVN.

Adult↗
PubMed2004

Applying evidence-based health care to musculoskeletal patients as an educational strategy for chiropractic interns (a one-group pretest-posttest study).

OBJECTIVE: To describe and measure the effectiveness of a problem-based educational strategy for teaching evidence-based health care (EBHC) to chiropractic interns, which focused on the development and appraisal of answerable clinical questions using actual musculoskeletal patients. METHODS: A 1-group pretest-posttest design (simple panel design) with investigator-blinded survey administration was used to measure effectiveness of educational activities using adult learning theory with a study population of interns (n=31) at a chiropractic college (Los Angeles College of Chiropractic, Southern California University of Health Sciences [LACC/SCUHS]) teaching clinic. Activities included 2 workshops on constructing clinical questions and critical appraisal of published research and independent patient-based EBHC assignments. A qualitative self-assessment survey was administered before and after a 6-week period of EBHC activities to measure their effectiveness. Sign tests and paired t tests were utilized to determine P values for significant difference of score results. RESULTS: Eighty-one percent of subjects completed the pretest-posttest surveys. All survey item responses showed an average increase in subjects' self-rating of skills and attitudes from pretest to posttest. There were statistically significant differences in interns' self-assessed ability to construct an answerable clinical question and appraise research articles and apply them to patient management, as well as their rating of importance of EBHC in patient decision making. CONCLUSIONS: The results of this study suggest that having chiropractic interns apply EBHC to actual musculoskeletal patients along with attending EBHC workshops had a positive impact on interns' perceived ability to practice EBHC.

Adult↗
PubMed1995

Health counseling and health promotion of musculoskeletal disorders.

The steady increase in the number of musculoskeletal disorders has heightened the importance of health promotion accordingly. In Germany, health promotion efforts have become the responsibility of health insurers. Commissioned by the health insurance organization, Hamburg-Münchener Ersatzkasse, we developed and evaluated a new health counseling service for persons with musculoskeletal (rheumatic) complaints. In order to draft the scope and principles of the counseling program, we questioned more than 1000 enrollees per questionnaire. The aim of the survey was to estimate the actual demand for participation in the health counseling. The results show that the subjective need for health counseling is strongly linked to the kind of physical limitation involved, so that it can be assumed that particularly persons with relevant complaints and musculoskeletal disorders will participate in the program. To evaluate the counseling sessions, a range of measurements was developed. The aim was to obtain a comprehensive and precise record of the problems and complaints of those taking part in the program. The evaluation shows that the new service is used mainly by persons who have suffered limitations to their health for years due to musculoskeletal disorders. Especially middle-aged persons use the counseling service, with women showing the most interest. When participants were asked after counseling which health support measures they had taken or were planning, their answers indicated that in most cases the recommendations of the counselor were being put into practice. We conclude that health counseling can be considered a meaningful option for health promotion.

Adult↗
PubMed2004

Genetic basis for individual variations in pain perception and the development of a chronic pain condition.

Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. We identified three genetic variants (haplotypes) of the gene encoding catecholamine-O-methyltransferase (COMT) that we designated as low pain sensitivity (LPS), average pain sensitivity (APS) and high pain sensitivity (HPS). We show that these haplotypes encompass 96% of the human population, and five combinations of these haplotypes are strongly associated (P=0.0004) with variation in the sensitivity to experimental pain. The presence of even a single LPS haplotype diminishes, by as much as 2.3 times, the risk of developing myogenous temporomandibular joint disorder (TMD), a common musculoskeletal pain condition. The LPS haplotype produces much higher levels of COMT enzymatic activity when compared with the APS or HPS haplotypes. Inhibition of COMT in the rat results in a profound increase in pain sensitivity. Thus, COMT activity substantially influences pain sensitivity, and the three major haplotypes determine COMT activity in humans that inversely correlates with pain sensitivity and the risk of developing TMD.

Adolescent↗