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Comparison of motor strategies in sit-to-stand and back-to-sit motions between healthy and Alzheimer's disease elderly subjects.

We studied the kinematics of shoulder displacement during sit-to-stand and back-to-sit in 6 healthy elderly subjects and six elderly subjects with mild to moderate Alzheimer's disease in order to elucidate the impact of Alzheimer's disease on motor planning and control processes. During sit-to-stand, Alzheimer's disease subjects reduced their forward displacement and started their upward displacement earlier than healthy elderly subjects. Furthermore, shoulder path curvatures were more pronounced for upward compared with downward displacement in healthy elderly group, in contrast with Alzheimer's disease group. Temporal analysis found that: 1) for both groups, profiles of velocity of sit-to-stand and back-to-sit showed two peaks corresponding respectively to forward/upward and to downward/backward displacements, 2) peaks of velocity were almost comparable between the two groups, 3) duration of sit-to-stand was shorter than duration of back-to-sit in the two groups and 4) duration of sit-to-stand and back-to-sit was shorter in Alzheimer's disease group than in healthy elderly group. However, dissimilarities were observed for transition and deceleration phases during sit-to-stand, and for acceleration and transition phases during back-to-sit, between the two groups. Interestingly, while sit-to-stand and back-to-sit differed in healthy elderly subjects during transition and deceleration phases, such a difference was not observed for Alzheimer's disease subjects. So, our study showed that invariant spatio-temporal movement parameters in the two groups differed, while non-invariant parameters did not, and suggests that higher level motor process of whole body motions are affected by Alzheimer's disease, while lower level motor features remain intact.

Acceleration↗

Trunk muscle co-ordination during gait: relationship between muscle function and acute low back pain.

Low back pain costs billions of Euros annually in all industrialized countries. Often radiological diagnosis fails to give evidence of the pathogenesis of low back pain. Although psychophysiological characteristics have an influence, it seems that insufficient muscular spinal stabilization may play the major role in the development of low back pain. Assessment of trunk muscle stabilization activity during everyday activities is rare. Therefore, in this study healthy persons were investigated during walking on a treadmill at a speed of 4 km/h. Women (n = 16) with no history of back pain were investigated before and after a static loading situation of the spine, i.e. while wearing a waistcoat. After this loading situation four women developed pain (pain subjects). Surface EMG (SEMG) was taken from five trunk muscles of both sides. Grand averaged amplitude curves over stride, amplitude normalized curves and variation between all included strides were calculated for all muscles and subjects, respectively. The normal range of all calculated parameters was defined within the span between the 5th and the 95th percentiles of all pain free subjects. Data were evaluated according to deviations from the normal range. Already before the load situation, pain subjects showed considerable deviations from the normal range, mainly of their abdominal muscles. There was no relationship between magnitude of deviation and pain intensity, but perceived exertion was highest in those subjects who showed the most symptoms in terms of number of muscles being identified as considerably deviating from the normal range. No specific "dysfunction pattern" could be identified, which argues for highly individual mechanisms instead of a single target muscle. The results suggest cumulative effects of different disturbance levels resulting in acute back pain. Since deviations could be identified already before the pain occurred, disturbed muscle function seems to be a risk factor for developing back pain. Further investigations aimed at clear identification of and, as a second step, correction of muscle function are necessary.

Journal Article↗

Evolutionary aspects and muscular properties of the trunk--implications for human low back pain.

Considerations about back pain, its aetiology, pathogenesis and therapy often argue that low back pain is the "price" that humanity has to pay for the upright body posture and the bipedal mode of locomotion. In fact, there are only few species that have evolved an obligate bipedal locomotion (e.g. kangaroos). Surprisingly, there are only minor morphological adaptations in humans clearly connected to the upright body posture (e.g. the habitual lumbar lordosis). The overall organization of the body axis has been evolved in quadrupedal animals and was more or less unchanged suitable for the human bipedal mode of locomotion. Up to now, the assumed uniqueness of human's trunk does not explain the frequency of back problems. Because of minor macroscopic differences between humans and other mammals, and even primates, we started to take a closer look at the paravertebral musculature. A three-dimensional investigation of muscle's fibre type distribution was undertaken on laboratory rats. Serial sections from the caudal thoracic and lumbar regions of the back were analysed, and the fibre type distribution pattern in all paravertebral muscles was described. Comparisons to other species imply more general characters of the fibre type distribution in mammals. Established concepts of human back muscle function were exposed to be valid for quadruped mammals as well. Muscle properties predicted by a biomechanical model based on human's anatomy (Wagner et al., this issue) were confirmed by results of the current study on a small mammal. Therefore, we propose only minor differences from the observed pattern in human back muscles.

Journal Article↗

Comparison of procedural errors resulting during root canal preparations completed by senior dental students in patients using an '8-step method' versus 'serial step-back technique'.

OBJECTIVE: To compare procedural errors that occur in patients during root canal preparation by senior dental students using a new '8-step method' versus the traditional 'serial step-back technique.' STUDY DESIGN: Senior dental students treated 221 root canals of maxillary and mandibular teeth. Instrumentation included coronal flaring with Gates-Glidden reamers and standardized stainless steel K-files in all teeth. A new 8-step method was used to prepare 67 canals using standardized stainless steel hand instruments (8-step SS) and 69 canals using the rotary Nickel Titanium instruments (8-step NiTi). The traditional serial step-back technique (step-back) was used for 85 root canals. In the apical third, reaming or filing motions were used up to sizes 25 and only reaming motion in sizes larger than 25 with the new 8-step method. A filing motion was used in the step-back for all sizes. Root canals of all groups were obturated with gutta-percha points and AH26 using a lateral condensation technique. Pre- and postoperative radiographs were taken of each tooth. Procedural errors were recorded and statistically analyzed using a binomic test for comparison of proportion. RESULTS: Procedural errors detected consisted of 2 canals with transportation (3%) with the 8-step SS, and 3 canals (4%) with transportation with 8-step NiTi. There were no canal obstructions or instrument separations. With the step-back, 20 canals were transported (24%), 7 canals had obstructions (8%), and in 1 canal instrument was separated (1%). CONCLUSIONS: The new 8-step method resulted in fewer procedural errors than the traditional serial step-back technique when senior students prepared root canals in patients either by hand with standardized K-files or by rotary NiTi instrumentation.

Bismuth↗

An investigation of respiration while wearing back belts.

The research was conducted to evaluate the frequency of respiration during a repetitive lifting task when abdominal compression occurs from wearing a back belt. Three back belts were evaluated in this study: a nylon back belt, an inflatable back belt and an elastic vest. Analysis of the data revealed that the frequency of respiration increased while wearing the back belts at rest and while performing a repetitive lifting task. A statistically significant increase in the frequency of respiration was found while wearing the nylon back belt during the lifting task.

Abdomen↗

Steroidal and nonsteroidal "add-back" therapy: extending safety and efficacy of gonadotropin-releasing hormone agonists in the gynecologic patient.

OBJECTIVE: To assess the efficacy of various steroidal and nonsteroidal add-back regimes in ameliorating hypoestrogenic side effects of long-term GnRH agonist (GnRH-a) therapy in gynecologic patients. DESIGN: English language literature review. PATIENTS: Gynecologic patients administered GnRH-a as therapy for ovarian hyperandrogenism, premenstrual syndrome, dysfunctional uterine bleeding, uterine leiomyomata, and symptomatic endometriosis. INTERVENTIONS: Steroidal and nonsteroidal add-back regimes including estrogens with progestins, progestins alone, and progestins with organic bisphosphonates in combination with various GnRH-a for > or = 6 months of therapy. MAIN OUTCOME MEASURES: Vasomotor symptoms, bone density changes, lipid profiles, alterations in presenting symptoms, and disease state. RESULTS: Estrogens in combination with progestins were efficacious as add-back in the management of ovarian hyperandrogenic states, dysfunctional uterine bleeding, premenstrual syndrome, and leiomyomata. Medroxyprogesterone acetate alone is ineffective as add-back for treatment of endometriosis or leiomyomata. Norethindrone is effective as add-back in the management of endometriosis but not leiomyomata, although high doses alter lipid profiles in an undesirable fashion. Organic bisphosphonates show great promise in preserving bone density without other untoward effects. CONCLUSIONS: No single add-back regime is appropriate for all gynecologic indications for GnRH-a. Ideal protocols preserve the efficacy of agonists while suppressing associated vasomotor symptoms and bone density loss.

Diphosphonates↗

Do upper ureteral stones need to be manipulated (push back) into the kidneys before extracorporeal shock wave lithotripsy?

The current practice for the management of upper ureteral stones is to push the stone back into the renal pelvis before extracorporeal shock wave lithotripsy (ESWL*). The results in 903 patients with an upper third ureteral stone pushed back before ESWL were compared to those of 815 with an upper third ureteral stone treated by ESWL in situ with a ureteral stent bypassing the stone. The stone size in the in situ group was larger than in the push back group. More shocks at a higher kilovoltage were required to treat the in situ group. The retreatment rate and post-ESWL secondary procedure rate for the push back group with single stones were 4% and 1.5%, respectively, compared to 5% and 7.5%, respectively, for the in situ group. The stone-free rate with single stones at 3 months was 73% in the push back group and 79% in the in situ group. There appears to be little advantage in manipulating a ureteral stone into the kidney (push back) before treatment by ESWL.

Humans↗

An in vivo evaluation of the efficacy of ultrasound after step-back preparation in mandibular molars.

This study histologically compared the in vivo debridement efficacy of the step-back preparation versus a step-back/ultrasound preparation in the mesial root canals of vital mandibular molars. Group 1 consisted of 17 teeth prepared with a step-back technique using intermittent irrigation with 5.25% sodium hypochlorite. Group 2 consisted of 17 teeth prepared with a step-back technique as in group 1 followed by 3 min of ultrasonic instrumentation per canal utilizing a #15 Endosonic file in an Enac unit set at 3.5. An additional 6 ml/canal of 5.25% sodium hypochlorite was used during the ultrasonic preparation. Eight uninstrumented mandibular molars served as histological controls. Following extraction and histological preparation, 0.2-microns cross-sections from the 1- to 3-mm apical levels of the canal and isthmus were evaluated for percentage of tissue removal using an Olympus CUE-2 Image Analysis System. Factorial analysis of variance indicated canal and isthmus cleanliness values were significantly higher, at all 11 apical levels, with the ultrasonic technique. Sample values at the 1-, 2-, and 3-mm levels for the step-back and step-back/ultrasonic techniques, respectively, were: canal, 64% versus 92%, 81% versus 97%, and 90% versus 99.9%; isthmus, 2% versus 46%, 15% versus 60%, and 16% versus 83%.

Adult↗

Blood back flow into angiographic catheters.

PURPOSE: Because of a potential impact on thrombus formation, this study determines the degree of blood back flow into catheters filled with different fluids. MATERIALS AND METHODS: Catheters filled with saline or non-ionic or ionic contrast medium were placed in pulsatile circulating human blood in vitro. Catheter orientation was varied, and blood back flow was recorded. RESULTS: When the leading end of the catheter was angled downward, blood back flow into a contrast material-filled catheter was far greater than that into a saline-filled catheter (7.0 vs 0.5 cm). Conversely, when the leading end of the catheter was horizontal, blood back flow was much greater when the catheter contained saline versus contrast media (3.6 vs 0.4 cm). Ionicity of contrast material did not affect back flow. CONCLUSION: Back flow of blood into a catheter can be considerable and is dependent on the type of fluid within the catheter and orientation of the leading end of the catheter. Angiographic techniques adjusted to these findings are important to maintain patient safety.

Blood Physiological Phenomena↗

Spatial distribution of back scattering in the nuclear area of the non-cataractous human lens.

The spatial distribution of back scattering from a vertical cross-section of the nuclear area in non-cataractous human lens was investigated. The cross-section was centred on the pupil. There is no significant difference in average nuclear back scattering between sides. The distribution of back scattering along an axis perpendicular to the anatomical axis can be modelled as a second-order polynomial. It is believed that the increase of back scattering in the central region corresponds to the peak protein concentration in the centre of the nucleus. This information was obtained by imaging back scattering with Scheimpflug photography. The back scattering was measured photometrically in a 3 x 10 matrix of measuring areas within the lens nucleus. Each measuring area was 0.20 x 0.20 mm in size. It is anticipated that the established model will allow detection of nuclear cataract with high sensitivity, especially in early stages.

Aged↗

Preparation of the apical part of the root canal by the Lightspeed and step-back techniques.

This study measured in vitro the displacement of natural canal centres in 18 human teeth before and after shaping by the step-back or Lightspeed techniques. Experimental roots (n = 9 per group), embedded in clear plastic, were cross-sectioned using a 0.1-mm-thick band saw at distances 1.25 mm, 3.25 mm and 5.25 mm from the apices. A stereo microscope was used to take 35 mm slides of the cut surfaces of the sectioned roots and canals. The slides of the uninstrumented canals were scanned into a computer and saved. Each sectioned root was then reassembled and the canals shaped by the step-back or Lightspeed technique. File size 40 and instrument size 50 were selected as the master apical file and master apical rotary for the step-back and Lightspeed groups, respectively. The 18 prepared canals were photographed, and the 35 mm slides scanned and computer stored as previously. This allowed the positions of the pre- and postinstrumented roots to be electronically superimposed for subsequent analyses. Displacements of the root canal centres before and after preparation were assessed in relation to the cross-sectional diameter of the files or instruments used. In addition, increases in cross-sectional area of the root canals after preparation were evaluated in relation to the cross-sectional area of the files or instruments used. Engine-driven nickel-titanium Lightspeed instruments caused significantly less (P < 0.001) displacement of the canal centres, so roots in the Lightspeed group remained better centred than those in the step-back group. The mean cross-sectional area after preparation in the Lightspeed group was significantly less (P < 0.001) than that recorded in the step-back group. Clinically, this implies less apical transportation and less dentine destruction with the Lightspeed technique than with the step-back technique.

Dental Instruments↗

Knee flexion to extension peak torque ratios and low-back injuries in highly active individuals.

The purpose of this study was to investigate for possible relationships between knee flexion to extension peak torque ratios (F1/Ext(rat)) and low-back injuries in highly active males and females. Forty-eight male (age 25.9 +/- 4.5 years) and 41 female (age 27.3 +/- 2.6 years) competitive rowers, and 20 male (age 26.6 +/- 6.0 years) professional ballet dancers volunteered for the study. Each subject performed a test of lumbar and knee flexor flexibility, isokinetic dynamometry and completed a self-administered questionnaire. Flexibility was assessed by using the sit-and-reach test. Knee flexion to extension peak torques were bilaterally monitored at the angular velocities of 1.04 and 4.19 rad x s(-1). The questionnaire was designed to obtain information regarding the number of days off action (e.g., training, competition, and rehearsals), due to low-back injuries, for the 12-month period prior to testing. Results revealed significant negative correlation coefficients between knee F1/Ext(rat), obtained at 1.04 rad x s(-1), and days off physical activity for oarsmen (r = - 0.69; p < 0.01), oarswomen (r = -0.62; p < 0.01) and male dancers (r = -0.57; p < 0.05). No such correlations were found for either knee F1/ Ext(rat) obtained at the angular velocity of 4.19 rad x s(-1) or between the sit-and-reach test results and low-back injuries. A sub-group of 22 female rowers was re-tested after a 6-8 month period, during which a special hamstring strength training programme was introduced. The main conclusions were: a) the lower the F1/Ext(rat) the greater the degree of low-back injury, b) at least in female rowers, 6-8 months of hamstring strength training can contribute to a reduction of the incidence of low-back injury, and c) isokinetic assessment of quadriceps and hamstrings obtained at lower compared to higher angular velocities is more prognostic of low back injury.

Adult↗

Mechanical loading of the low back and shoulders during pushing and pulling activities.

The objective of this study was to quantify the mechanical load on the low back and shoulders during pushing and pulling in combination with three task constraints: the use of one or two hands, three cart weights, and two handle heights. The second objective was to explore the relation between the initial and sustained exerted forces and the mechanical load on the low back and shoulders. Detailed biomechanical models of the low back and shoulder joint were used to estimate mechanical loading. Using generalized estimating equations (GEE) the effects were quantified for exerted push/pull forces, net moments at the low back and shoulders, compressive and shear forces at the low back, and compressive forces at the glenohumeral joint. The results of this study appeared to be useful to estimate ergonomics consequences of interventions in the working constraints during pushing and pulling. Cart weight as well as handle height had a considerable effect on the mechanical load and it is recommended to maintain low cart weights and to push or pull at shoulder height. Initial and sustained exerted forces were not highly correlated with the mechanical load at the low back and shoulders within the studied range of the exerted forces.

Adult↗

Long-term medical therapy for leiomyomata uteri: a prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin 'add-back' for 2 years.

Treatment of women with leiomyomata with gonadotrophin-releasing hormone agonists (GnRHa) for > 6 months is not recommended because of concerns regarding adverse sequelae of prolonged hypoestrogenism. It has been postulated that addition of low-dose sex steroids to GnRHa treatment, i.e. 'add-back' therapy, may avert some of these adverse effects (accelerated bone resorption, vasomotor flushes) without altering the efficacy of GnRHa therapy. To evaluate the effects of long-term GnRHa therapy on uterine size, bleeding patterns, bone mass and lipids, 51 pre-menopausal women with leiomyomata were treated with the GnRHa leuprolide acetate depot, 3.75 mg every 4 weeks for 2 years. After 3 months of leuprolide therapy, the women were randomized to receive either low-dose continuous oestropipate, 0.75 mg daily, plus cyclic norethindrone, 0.7 mg on days 1-14 each month (the oestrogen-progestin add-back group) or higher-dose norethindrone, 10 mg daily (the progestin add-back group), for the remaining 21 months. Mean uterine volume decreased by 40% in both treatment groups during the first 3 months on leuprolide treatment. There was no significant change in uterine size following oestrogen-progestin add-back. However, mean uterine volume in the progestin add-back group increased to 87% of pre-treatment size by treatment month 12 and 95% of pre-treatment size by treatment month 24. Mean bone density of the lumbar spine as measured by dual X-ray absorptiometry decreased significantly by 2.6% during the first 3 months in all patients, but did not change significantly following steroid add-back in both treatment groups during the final 21 treatment months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Metal-backed and all-polyethylene tibial components in total knee replacement.

One hundred seventy-five patients with 243 consecutive primary Press Fit Condylar cruciate-substituting total knee replacements were evaluated at a mean of 5.5 years. One hundred thirteen knees had modular metal-backed tibial components and 130 had all-polyethylene tibial components. The mean knee score and functional score for the patients with unrevised components was not significantly different. The incidence of osteolysis and synovitis was higher in patients in the modular metal-backed tibia group (5%; five patients, six knees). No patients in the all-polyethylene tibia group had osteolysis or synovitis. Five revision operations were necessary: four for osteolytic defects and one for synovitis, all in patients in the modular metal-backed tibia group. All of the retrieved polyethylene inserts had evident backside wear. The best case rate of survival of the all-polyethylene tibial components was 96%+/-0.8% at 7 years and for the modular metal-backed components it was 75%+/-10% at 7 years. Metal backing and modularity were added to the Press Fit Condylar total knee replacement design to improve fixation durability. However, the superiority of the modular metal-backed implants remains in question.

Adolescent↗

Population limitation of the northern red-backed vole in the boreal forests of northern Canada.

1. Across the vast boreal forests of North America, no population cycles in Clethrionomys species occur. In Eurasia, by contrast, some Clethrionomys populations of the same species undergo regular 3-5-year cycles. We examined the effects of nutrients, food, competitors, predators and climate on population limitation in the northern red-backed vole (Clethrionomys rutilus Pallas) in the south-western Yukon to determine why this difference occurs. 2. From 1986 to 1996 we added food, reduced large mammal predators and excluded snowshoe hares (Lepus americanus Erxleben) from large plots and found that none of these manipulations affected red-backed vole abundance. Adding nutrients as nitrogen, phosphorus and potassium (NPK) fertilizer had a slight negative effect, probably acting through a reduction in dwarf shrub productivity caused by competition from grasses. 3. We monitored weasel populations directly through trapping and indirectly through snow tracking. Predation by these vole specialists was irrelevant as a limiting factor most of the time because voles in this area do not reach the densities needed to sustain weasel populations. Other boreal forest mammal and bird predators did not focus on red-backed voles. However, when red-backed vole populations increased in the forest and Microtus voles also increased in the meadows, weasel populations increased and may have temporarily depressed red-backed voles in winter. 4. We monitored one major potential food, white spruce seeds, but seed fall was not related to population changes in red-backed voles, even after mast years. 5. We assessed the impact of weather variables, and the average depth of the snow pack during winter (October-March) was correlated directly with vole demography, having both direct effects in that year and delayed effects in the following year. 6. Our long-term trapping data (1973-96) indicate that Clethrionomys populations fluctuated, with peaks following hare peaks by 2-3 years. 7. We propose that the key variable limiting these vole populations is overwinter survival, and this is a function of overwinter food from berries produced during the previous summer by dwarf shrubs. These shrubs may be stimulated by abundant moisture from winter snows or by periodic fertilization from large quantities of pellets produced at snowshoe hare peaks.

Animals↗

The use of retention sutures and tensed Silastic-Dacron strips for the prevention of stretch-back after alopecia-reducing procedures.

BACKGROUND: A comparison between using retention sutures (N = 25), a tensed Silastic-Dacron strip (N = 25), or nothing (N = 25) for the prevention of stretch-back (after alopecia-reducing procedures) was performed between 1990 and 1992. OBJECTIVE: The purpose was to determine if retention sutures or a tensed Silastic-Dacron strip placed subgaleally from one donor fringe to the other would reduce the amount of stretch-back after alopecia-reducing procedures. METHOD: A prospective study of a total of 75 patients was performed. The width of the bald area was measured immediately after the surgery and at 3 months with each of the three modalities. RESULTS: Retention sutures resulted in some prevention of stretch-back. Tensed Silastic-Dacron strips totally prevented stretch-back and in some cases made the bald area compressed. CONCLUSIONS: Retention sutures placed through subgaleal tunnels reduces stretch-back after alopecia-reducing procedures. Tensed Silastic-Dacron strips totally prevent stretch-back and in approximately half the cases compress the area of baldness.

Adult↗

Impact of ultrafiltration on back-diffusion in hemodialyzer.

Ultrafiltration of water from blood to dialysate decreases the rate of back-diffusion of solutes from dialysate to blood. Therefore, back-clearance (bK) of hemodialyzers may be expressed as bK = bK0--bTrQu, where bK0 is the diffusive back-clearance, bTr is the "back-"transmittance coefficient, and Qu is the net ultrafiltration rate. A formula for bK was derived from the one-dimensional theory of hemodialyzer, and bTr was described as a function of bK0 and the Staverman reflection coefficient. The transport parameters, bK0 and bTr, for creatinine and vitamin B12 were measured in two types of hemodialyzers with negligible back-filtration, using water solutions, and compared with the transport parameters, K0 and Tr, for the case of both diffusion and ultrafiltration from blood to dialysate. bK0 was in general equal to K0. bTr was not different from Tr for creatinine whereas bTr was lower than Tr for vitamin B12. Experimental values of bTr for vitamin B12 were in general agreement with theoretical predictions. However, experimental values of bTr for creatinine were lower than predicted values. We conclude that the impact of ultrafiltration on back-clearance for slowly diffusing solutes is weaker than on their clearance.

Algorithms↗