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PubMed2004

Molecular cloning and characterization of Mustang, a novel nuclear protein expressed during skeletal development and regeneration.

Bone regeneration occurs as a series of events that requires temporal and spatial orchestration of numerous cell types guided by the transcriptional activity of thousands of genes, as recently demonstrated by our laboratory. Using the rat femoral fracture model, bioinformatics, cloning, expression assays, fusion proteins, and transfection, we report on the identification and characterization of one such differentially expressed gene, termed Mustang (musculoskeletal temporally activated novel gene). Mustang encodes for an 82 amino acid nuclear protein with no homology to any known protein family. However, other species homologues (mouse, human, cow) were identified within EST (expressed sequence tag) databases. Nuclear localization was confirmed using a GFP-Mustang fusion protein. Using in situ hybridization, Mustang expression was localized to differentiating periosteal osteogenic cells, proliferating chondrocytes, and osteoblasts of the fracture callus. Unlike adult tissues, developing embryos abundantly express Mustang, especially in mesenchymal condensations of limbs, vertebral perichondrium, and mesenchymal cells of the intervertebral discs. Although the precise function of Mustang is unknown, its unique pattern of expression during bone development and regeneration, absence in adult tissues (except skeletal muscle and tendon), and nuclear localization suggest that Mustang is involved in the development and regeneration of the mammalian musculoskeletal system.

Amino Acid Sequence↗
PubMed1997

The effect of Lodronat(R) on development of osteoporosis in tail-suspended rats.

It has been recently revealed that deficient loading of the musculoskeletal apparatus gives rise to osteoporosis. It is also a common knowledge, that diphosphonate preparations are used to advantage in clinical practice to prevent and treat osteoporosis of varying etiology. In connection with the above an attempt was made to evaluate potentials of dichlormethylene diphosphonic acid (Lodronat(R), Boehringer Mannheim) as a countermeasure against osteoporosis in tail-suspended rats (micro-g simulation).

Animals↗
PubMed2000

PET imaging of musculoskeletal tumours with fluorine-18 alpha-methyltyrosine: comparison with fluorine-18 fluorodeoxyglucose PET.

Fluorine-18 labelled alpha-methyltyrosine (FMT) was developed for positron emission tomography (PET) imaging, and its potential for clinical application in patients with brain tumours has been demonstrated. This is the first trial to compare FMT with 18F-fluoro-2-deoxy-D-glucose (FDG) for the evaluation of musculoskeletal tumours. Seventy-five patients were examined with both FMT- and FDG-PET within a 2-week period. Imaging findings were visually inspected in conjunction with computed tomography and/or magnetic resonance imaging, and standardized uptake values (SUVs) for both FMT and FDG in lesions were also generated and compared with histological findings. A significant correlation between FMT and FDG SUVs was found for all lesions (r=0.769, P<0.0001), and mean values for malignant tumours were significantly higher than those for benign lesions in both FMT- and FDG-PET. The diagnostic sensitivities and specificities for malignancy were 72.7% and 84.9%, respectively, using FMT with a cut-off SUV of 1.2, and 72.7% and 66.0%, respectively, using FDG with a cut-off SUV of 1.9. The resultant accuracy with FMT was 81.3%, higher than that for FDG (68.0%), and the difference with respect to specificity was significant (chi2cal=5.0625, P<0.05). On the other hand, while a significant correlation was found between malignant tumour grade and SUV with both FMT- (rho=0.656) and FDG-PET (rho=0.815), only the latter demonstrated significant differences among grades I, II and III. FMT and FDG for PET appear equally effective at detecting musculoskeletal tumours. In evaluating musculoskeletal tumours, FMT may be superior to FDG in the differentiation between benign and malignant tumours, while FDG may be the better choice for non-invasive malignancy grading.

Adolescent↗
PubMed2001

The role of radionuclides in primary musculoskeletal tumors beyond the 'bone scan'.

Radionuclides represent a means of functional imaging, which is able to reflect the metabolic state of tissues. Recently developed radiotracers and older radiotracers with newer applications, imaged through single photon emission computed tomography (SPECT) and positron emission tomography (PET), can provide significant information in the diagnosis, grading, therapy response or recurrence of primary musculoskeletal tumors. The unique ability of these radiotracers to demonstrate non-invasively the efflux pump rate, which is a common reason of therapy failure, as well as the metabolic and proliferative rates of the tumors should be a powerful tool in the orthopaedic oncology in the evaluation of musculoskeletal tumors.

Bone Neoplasms↗
PubMed2005

The reported incidence of work-related ill-health in Scotland (2002-2003).

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.

Adolescent↗
PubMed2006

Development and initial assessment of objective fatigue measures for apple harvest work.

Previous research has shown that neck, back and shoulder musculoskeletal strain is a major occupational health problem affecting migrant orchard harvest workers. Researchers seek to measure the effect of an ergonomic modification to the apple picking bucket on muscle fatigue, however objective measures for use in the orchard are not yet available. The purpose of this study is to develop simple back, shoulder or arm strength measures, which detect statistically significant drops in strength over one workday. Candidate muscle strength measures were piloted in the laboratory, adapted for the orchard and evaluated (n=102). Data were analyzed for morning to afternoon fatigue, and for correlation between fatigue score and hours worked. In the laboratory, the timed arm hold (35.7% time reduction, 95% CI: 21.81-49.61), and the timed spinal extension (31.8% time reduction, 95% CI: 23.54-39.96) showed significant fatigue. In the orchard (n=102), only the timed arm hold showed significant (11.4%, p<.0001) fatigue. The potential effect of field conditions and subject motivation on these results needs further exploration.

Agricultural Workers' Diseases↗
PubMed2005

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks.

PROBLEM STATEMENT: Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful. SPECIFIC AIMS: The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment. INTERVENTION: The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy. METHODS: A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs. RESULTS: The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of 'unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation. CONCLUSIONS: This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Absenteeism↗
PubMed1999

Tissue engineering of bone. Cell based strategies.

Skeletal tissue regeneration requires the interaction of three basic biologic elements: cells, growth and differentiation factors, and extracellular matrix scaffolds. Therapeutic approaches for tissue engineered repair of bone defects have attempted to mimic the natural process of bone repair by delivering a source of cells capable of differentiating into osteoblasts, inductive growth and differentiation factors, or bioresorbable scaffolding matrices to support cellular attachment, migration, and proliferation. Sophisticated designs even have tried to combine two or more of these elements. The development of cell based approaches has advanced dramatically in recent years as an understanding of musculoskeletal cell biology improves. Cell based approaches do not depend on the presence of local osteoprogenitors for the synthesis of new bone and, as a result, they particularly are attractive for patients who have a diminished pool of these progenitors, or in whom the host tissue bed has been compromised. This review highlights the development of cell based approaches for the tissue engineering of bone, and offers perspectives on the optimal elements for success. Although logistical and regulatory issues remain to be solved, cell based therapies for the repair of clinically significant bone defects rapidly are approaching clinical feasibility.

Animals↗
PubMed1982

The effect of vibration on the skeleton, joints and muscles. A review of the literature.

Owing to the elasticity and plasticity of the skeleton, joints and muscles, the musculoskeletal system is capable of absorbing and damping mechanical vibration without damage as long as the vibration level is within tolerable limits. However, technical developments have led to the exposure of many people to intolerable variation levels with destructive changes as a result. These injuries to the musculoskeletal system continue to be the subject of research interest. Initially, the joints and joint complaints attracted the greatest attention. Vibration damping takes place mainly in the joints. The incidence of destructive joint changes has been examined in comprehensive clinical, epidemiological and radiographic studies, mainly concentrating on the joints of the hand and arm. The response of muscles to vibration is often expressed in the form of a tonic vibration reflex (TVR) which arises as a result of stimulation of the muscle spindles and therefore resembles the classic tonic stretch reflex. There is increased muscular activation for stabilisation of the joint positions, especially during whole-body vibration. Studies have also disclosed how vibration affects body equilibrium and equilibrium control and how vibration can elicit muscle pain, cramps and reduced muscular strength.

Journal Article↗
PubMed2006

Bone graft substitutes in the upper extremity.

The development of effective bone graft substitutes is one of the most important innovations in musculoskeletal surgery. Bone graft substitutes provide an osteoconductive scaffolding similar to those of autogenous bone. They eliminate donor site morbidity,decrease operative time and complexity and treatment costs, and improve patient satisfaction. Osteoinductive and osteogenic elements may be added to further stimulate and enhance healing and incorporation of the scaffolding substance into the adjacent bone. Bone graft substitutes have proven effective in the spine and larger long bones of the extremities. The continuing development of bone graft substitutes, evaluation of their efficacy relative to autogenous bone grafts and to each other, and their use in the hand and wrist are emerging fields.

Arm Bones↗
PubMed2003

Reducing musculoskeletal discomfort: effects of an office ergonomics workplace and training intervention.

Effects of an office ergonomics workplace and training intervention on workers' knowledge and self-reported musculoskeletal pain and discomfort were investigated. An instructional systems design process was used to develop an office ergonomics training program and the evaluation tools used to measure the effectiveness of the training program on workers' office ergonomics knowledge and skills. It was hypothesized that the training and workplace intervention would allow the worker to more effectively use their workplace through increased office ergonomics knowledge and skills. Following the intervention, there was a significant increase in workers' office ergonomics knowledge and awareness. Self-reported work-related musculoskeletal disorders significantly decreased for the group who had a workplace change and received ergonomic training relative to a workplace change-only group and a no intervention control group.

Computer Terminals↗
PubMed1994

Contrast enhancement in musculoskeletal imaging. Current status.

This article discusses intravenous and intra-articular uses of contrast in cross-sectional imaging for the evaluation of musculoskeletal abnormalities. Emphasis will be placed upon the important traditional uses of contrast-enhanced computed tomography and the recent developments in contrast-enhanced magnetic resonance imaging.

Contrast Media↗
PubMed2003

The changing organization of work and the safety and health of working people: a commentary.

Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development.

Cardiovascular Diseases↗
PubMed2006

Exploring the perceived role and impact of the nurse consultant.

BACKGROUND: Nurse consultant roles were introduced in 1999 with defined role criteria including expert practice, research, education and leadership. The primary objective of the role is to develop nurses and nursing to provide effective patient outcomes. In 2000 the first nurse consultant in rheumatology was appointed to establish a co-ordinated service for the management of patients with chronic musculoskeletal pain. There are now ten nurse consultants within rheumatology yet little is known of their role or impact. AIM: The aim of the study was to identify the perceived role and impact of one nurse consultant (NC) in rheumatology within the context of being a practitioner-researcher. METHOD: Seven peers of the NC and five patients cared for by the NC participated in a semi-structured interview to identify their perceptions regarding the role of the NC within the rheumatology service. RESULTS: The following themes were identified from the interviews: (1) development of a new model of care for patients with chronic musculoskeletal pain; (2) holistic person-centred care experienced and valued by the patient; (3) leadership and education; and (4) feeling cared for. CONCLUSION: The NC role had impacted on service development and culture in the instigation of a chronic musculoskeletal pain service and leadership and education activities. Patients experienced the holistic nature of the role.

Humans↗
PubMed1997

Neuropathic symptoms and musculoskeletal pain in carpal tunnel syndrome: prognostic and therapeutic implications.

BACKGROUND: Repetitive activities in the workplace can not only jeopardize the median nerve across the carpal tunnel but also the musculoskeletal structures, such as the ligaments, synovia, tendons and muscles producing pain, and local tenderness at the wrist, elbow, and shoulder. The occurrence of this latter condition can dominate the overall clinical picture and affect the outcome of treatments for this very common condition. METHODS: A clinical evaluation of 30 patients who previously underwent a successful and uncomplicated carpal tunnel release surgery was conducted. These patients were referred back for another electrodiagnostic study to consider the possibility of persistent or recurrent nerve entrapment. These patients all had musculoskeletal pain and local tenderness at the wrist, elbow, and shoulder as their primary and disabling symptoms; and neuropathic symptoms as their less disabling complaints. RESULTS: All patients reported significant resolution of their neuropathic symptoms following surgery but their musculoskeletal symptoms persisted preventing them from returning to their original occupation. Fifty percent showed mild to moderate improvement in their electrophysiologic abnormalities but none had complete normalization of nerve conduction. Few patients developed symptoms of sympathetic nerve overactivity. CONCLUSIONS: Some patients suffering from carpal tunnel syndrome may present with a disabling musculoskeletal pain and local tenderness in the upper extremities that can persist following surgery despite resolution of neuropathic symptoms. These two symptom complexes, although both sequelae of repetitive activities, have fundamental clinicopathologic differences that must be recognized because of their therapeutic, prognostic, and medico-legal implications.

Adult↗
PubMed2002

Central nervous system mechanisms of pain in fibromyalgia and other musculoskeletal disorders: behavioral and psychologic treatment approaches.

Pain is one of the most important and challenging consequences of musculoskeletal disorders. This article examines the role of central nervous system structures in the physiology of pain. It also describes the neuromatrix, a construct that provides a framework for understanding the interaction between physiologic mechanisms and psychosocial factors in the development and maintenance of chronic pain. This construct suggests that behavioral and psychologic interventions may alter the pain experience primarily through their effects on emotional states and cognitive processes. The literature on cognitive-behavioral interventions for patients with rheumatoid arthritis and osteoarthritis indicates that they are well-established treatments for these disorders. However, the efficacy of these interventions for patients with fibromyalgia has not been established. It is anticipated that the development of valid measures of readiness for behavioral change may allow investigators to identify the patients with musculoskeletal disorders who are most likely to benefit from cognitive-behavioral intervention.

Behavior Therapy↗
PubMed1991

Development of anencephaly and its variants.

Extreme variants of anencephaly in two human embryos of the same stage, namely 22 (54 days), shed new light on problems such as craniocerebral interrelationships and the timing of developmental events. Embryo X had a chondrocranium that possessed features typical of a holoacranial anencephalic skull and an extremely well-preserved brain, in which some of the neural tracts were comparable to those in a normal control. On the other hand, embryo Y of the same stage had a completely degenerated brain, although the chondrocranium was more nearly normal and represented the precursor of a meroacranial skull. A comparison of the two cases seems to indicate a certain independence between skull and brain. Moreover, it appears possible that the disturbances are related primarily to the skeletal, and only secondarily to the nervous, component. Comparisons with experimental data allow the conclusion that the maldevelopment involves mostly paraxial mesenchyme and little or no disturbance of neural crest. The timing of the mesenchymal defect is probably as early as stages 8 and 9 (18-20 days). This is also the time at which mesenchymal defects can result in failure of the neural tube to close.

Abnormalities, Multiple↗
PubMed2003

[Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder,Hand (DASH) questionnaire].

The Disability of Arm, Shoulder, Hand (DASH) Version 2.0 questionnaire captures the subjective experience of patients regarding their own health. This 78-item instrument was developed by the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies and the Institute for Work and Health,Toronto and measures components of health-status relevant to upper-extremity conditions. We translated and validated DASH with the aim of producing a tool which could also be used in German-speaking countries. The paper reports the method of translation and cross-cultural adaptation which was carried out according to the AAOS guidelines. The result was a standardised German version of DASH. Psychometric testing of the translated questionnaire was carried out with 6 samples (n=342) who had undergone hand surgery for a variety of conditions. The study yielded good results across all groups with regard to the construct, criterion and content validity. We confirm that the German version is suitable for use in future studies.

Adult↗