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The semaphorins.

Semaphorins are secreted, transmembrane, and GPI-linked proteins, defined by cysteine-rich semaphorin protein domains, that have important roles in a variety of tissues. Humans have 20 semaphorins, Drosophila has five, and two are known from DNA viruses; semaphorins are also found in nematodes and crustaceans but not in non-animals. They are grouped into eight classes on the basis of phylogenetic tree analyses and the presence of additional protein motifs. The expression of semaphorins has been described most fully in the nervous system, but they are also present in most, or perhaps all, other tissues. Functionally, semaphorins were initially characterized for their importance in the development of the nervous system and in axonal guidance. More recently, they have been found to be important for the formation and functioning of the cardiovascular, endocrine, gastrointestinal, hepatic, immune, musculoskeletal, renal, reproductive, and respiratory systems. A common theme in the mechanisms of semaphorin function is that they alter the cytoskeleton and the organization of actin filaments and the microtubule network. These effects occur primarily through binding of semaphorins to their receptors, although transmembrane semaphorins also serve as receptors themselves. The best characterized receptors for mediating semaphorin signaling are members of the neuropilin and plexin families of transmembrane proteins. Plexins, in particular, are thought to control many of the functional effects of semaphorins; the molecular mechanisms of semaphorin signaling are still poorly understood, however. Given the importance of semaphorins in a wide range of functions, including neural connectivity, angiogenesis, immunoregulation, and cancer, much remains to be learned about these proteins and their roles in pathology and human disease.

Animals↗

Osteomyelitis and septic arthritis in children: appropriate use of imaging to guide treatment.

Modern imaging techniques have become essential components of the management of acute osteomyelitis and septic arthritis in children. This article addresses the role of these techniques, based on clinical practice guidelines recently developed at a children's hospital by an interdisciplinary group. The recommendations reflect a review of the literature and an analysis of our own experience with 84 children treated for musculoskeletal sepsis during the past 3 years. We attempt to optimize imaging resources by analyzing the unique aspects of these infections in the pediatric skeleton, the clinical needs at different stages of the disease, and the relative strengths and weaknesses of the various imaging procedures. Our goal was to define the use of imaging in cases of osteomyelitis and septic arthritis in children in specific clinical scenarios in which additional information is likely to lead to management modification.

Acute Disease↗

Education of garment workers: prevention of work related musculoskeletal disorders.

This educational intervention was designed as part of a garment worker occupational health and safety initiative, with the goal to reduce musculoskeletal symptoms in this monolingual Cantonese speaking population. Using risk communication and the Chinese concepts of yin and yang, the class curriculum was designed to be participatory. It focused on linking symptoms to high risk work activities; explaining the nature of musculoskeletal injury; and encouraging compliance with self care measures of ice, stretching, and early symptom reporting. A total of 21 women completed the Healthy Work Classes, with an increase in perceived levels of energy measured after each class. Additionally, contingency contracting for both individual and workplace change was piloted. This curriculum was revised to become a "train the trainer" program, with training of garment worker leaders and the goal to disseminate this prevention based curriculum to garment workers in the Oakland, California community.

Attitude to Health↗

Uncomplicated malaria.

All symptoms and signs of uncomplicated malaria are non-specific, as shared with other febrile conditions, and can occur early or later in the course of the disease. In endemic areas, the presence of hepatosplenomegaly, thrombocytopenia and anaemia is clearly associated with malaria, particularly in children. Fever, cephalgias, fatigue, malaise, and musculoskeletal pain constitute the most frequent clinical features in malaria. Following single exposure to Plasmodium falciparum infection, the patient will either die in the acute attack or survive with the development of some immunity. Elderly individuals are prone to a more severe course of disease. The non-fatal P. vivax and P. ovale cause similar initial illnesses, with bouts of fever relapsing periodically, but irregularly over a period of up to 5 years. Renal involvement of a moderate degree is more common in mild falciparum malaria than initially suspected. The liver is also afflicted in mild disease, but organ damage is limited and fully reversible after parasitological cure. Whereas the cardiotoxic adverse effects of antimalarial chemotherapeutics are well known, clinically relevant cardiac involvement in humans is rare in severe disease and even rarer in uncomplicated falciparum malaria. Co-infection can aggravate malaria. There is a growing body of evidence that there is significant interaction in terms of mutual aggravation of the course of disease between HIV and malaria, particularly in pregnant women. Children with a high level of exposure to P. falciparum have a lower risk of developing atopic disorders.

Anemia↗

Rheumatological lesions in individuals with human immunodeficiency virus infection.

One hundred and twenty-three patients with human immunodeficiency virus infection have been referred to rheumatologists at our hospitals between October 1985 and April 1989 because of musculoskeletal symptoms. Thirty-four homosexual men presented with acute, peripheral, non-erosive arthritis (mean number of four joints affected) with the knees being involved in 23. Other features developing concurrently with arthritis included psoriasis, keratoderma blenorrhagica, plantar fasciitis, urethritis, conjunctivitis and anterior uveitis. Four of five patients investigated were HLA-B27-positive; none of 15 patients tested had raised titres of rheumatoid or antinuclear factors. Various infections were associated with the onset of arthritis and two patients with a recent history of diarrhoea had serological evidence of yersinia infection. No micro-organisms were identified within the joint except for HIV itself. At the time of onset of arthritis four of these individuals had the acquired immunodeficiency syndrome (AIDS); 11 were not known to be HIV-positive before testing which was performed following referral for arthritis. Six patients have since developed AIDS and four have died. In 15 individuals, including those who progressed to AIDS, joint symptoms have been severe, persistent and poorly responsive to non-steroidal anti-inflammatory drugs. In only five patients has the arthritis been known to resolve. Synovitis has also been seen in two women: in one of these HIV infection was thought to have been acquired through intravenous drug abuse. Other rheumatic lesions included myalgia/myositis, non-inflammatory peripheral arthritis, spinal pain, soft tissue lesions, arthralgia or myalgia of unknown cause and infective lesions including septic arthritis and bony infection due to histoplasmosis and atypical mycobacterial infection. It appears likely that HIV infection is a risk factor for the development of seronegative arthritis and other rheumatic lesions.

Acquired Immunodeficiency Syndrome↗

[Malignant hyperthermia during the 13th general anaesthesia (author's transl)].

We report a case of malignant hyperthermia in a man of 41 years during his 13th general anaesthesia. All previous anaesthetics were quite normal. Musculoskeletal abnormalities and increased CPK-levels are to be found in some members of the patient's family. The combined use of suxamethonium and halothane might have caused the development of malignant hyperthermia. As a concept of the aetiology of the syndrome the case history indicates that it may be stress-related.

Adult↗

A computer algorithm for defining the group electromyographic profile from individual gait profiles.

A computer algorithm was developed to determine the group electromyographic (EMG) profile for the soleus muscle during free speed level walking. Subjects consisted of 50 adults (21 male, 29 female) with no history of musculoskeletal disease. EMG was recorded from the soleus muscle with wire electrodes, and was normalized by maximum muscle test. Two algorithms (time-adjusted mean profile (TAMP) and mean intensity profile (MIP)) were implemented to construct a group profile from identical individual EMG profiles. In addition, a grand ensemble average (GEAV) of the same individual data was performed. A high positive correlation (omega 2 > .995) was found between MIP and GEAV of EMG data. A control group was established based on mean timing and relative intensity of the individual EMG profiles. The MIP and GEAV were shown to have earlier onsets, later cessations, and extended EMG duration in comparison to control values. No significant differences were observed comparing TAMP and mean values for any measure.

Adult↗

Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone.

Until recently, vitamin D was only considered as one of the calciotrophic hormones without major significance in other metabolic processes in the body. Several recent findings have demonstrated that vitamin D plays also a role as a factor for cell differentiation, function and survival. Two organs, muscle and bone, are significantly affected by the presence, or absence, of vitamin D. In bone, vitamin D stimulates bone turnover while protecting osteoblasts of dying by apoptosis whereas in muscle vitamin D maintains the function of type II fibers preserving muscle strength and preventing falls. Furthermore, two major changes associated to aging: osteoporosis and sarcopenia, have been also linked to the development of frailty in elderly patients. In both cases vitamin D plays an important role since the low levels of this vitamin seen in senior people may be associated to a deficit in bone formation and muscle function. In this review, the interaction between vitamin D and the musculoskeletal components of frailty are considered from the basic mechanisms to the potential therapeutic approach. We expect that these new considerations about the importance of vitamin D in the elderly will stimulate an innovative approach to the problem of falls and fractures which constitutes a significant burden to public health budgets worldwide.

Aging↗

Treatment of leg edema and wounds in a patient with severe musculoskeletal injuries.

This case report describes the application of a technique for the treatment of leg edema and wounds resulting from a severe distal tibiofibular fracture. Following injury and numerous fracture- and wound-related surgeries in the first year postinjury, this patient developed leg edema, required daily treatment of 2 leg wounds, and was unable to wear a shoe due to foot swelling. He was referred to the physical therapy clinic 1 year postinjury for ankle rehabilitation and to diminish the leg edema. Therapy consisting of manual lymph drainage, compressive bandaging, exercise, and skin care was provided for 7 weeks. A compression stocking was issued near the end of treatment, which the patient continued to wear daily thereafter. At the time of discharge from therapy, the leg edema had decreased 74% and the wound area of both wounds had decreased 89%. Improvements continued following discharge. By 10 weeks after the start of treatment, edema had decreased 80.9%, one wound had healed, and the second wound was 93% improved. The patient was able to wear a shoe and resume recreational activities. This case report provides insight into a treatment that may shorten rehabilitation and control the cost of caring for injuries complicated by prolonged edema.

Bandages↗

Development of activity monitoring for determining load carriage patterns in school students.

The loads that school students are carrying to, around and from school is an issue of increasing concern particularly as the long term effects of excessive load carriage on school students' musculoskeletal health is unknown. A greater understanding of the temporal patterns of students' load carriage, which usually involves backpacking, would assist in determining the magnitude of the problem that is faced by school students. The aim of this study was to determine the duration of school students' walking, running and stair climbing while backpacking and identify when students take off and put on their backpacks using activity monitoring and video, and therefore validate activity monitoring as a tool for measuring the temporal patterns of backpacking in school students. An activity monitor was secured in the backpacks of six school students while they completed a predefined physical activity course. Participants firstly completed the course following a set time pattern ('set course') and then repeated the course while performing activities as they pleased ('free course'). Video footage and activity monitor data were captured simultaneously. The activity monitor provided consistent visual differentiation between walking, running and taking off and putting on a backpack. The greatest variation between measures was for walking during the 'free course' (mean 8, SD 7 seconds), while the least variation between measures was for stair climbing during the 'set course' (mean 3, SD 2 seconds). There were no statistical differences between the activity monitor and video camera determined durations for any of the activities. These preliminary results suggest that activity monitoring may enable valid analysis of the temporal patterns of backpacking with little disruption to the user, although more work is required to verify this.

Adolescent↗

Advances in the management of musculoskeletal trauma.

During the past year, several important advances have occurred in the diagnosis and treatment of orthopedic trauma. The increased use of magnetic resonance imaging in the diagnosis of acute cervical spine injuries has enhanced the ability to treat these patients. The development of better fixation systems for the lumbar spine, particularly pedicle screw systems, has increased our ability to stabilize and decompress fractures and fracture-dislocations in this region. New techniques for pelvic stabilization have proved useful in the treatment of these complex injuries. In extremity trauma, the association of compartment syndrome with intramedullary nailing has gained more attention and more aggressive treatment is advocated for fractures secondary to penetrating trauma.

Compartment Syndromes↗

Prenatal diagnosis of musculoskeletal anomalies.

Musculoskeletal anomalies are not uncommon in prenatal life. They can be either sporadic or part of chromosomal syndromes causing prenatal morbidity and mortality. The prenatal diagnosis of musculoskeletal anomalies is based on information assembled from various imaging modalities and from biochemical and genetic workups. The prenatal diagnosis can serve as a prognostic tool and in counseling the parents. Among the imaging methods, ultrasonography is the most popular and cost effective in observing and following fetal development from the very early stages of gestation. Transvaginal sonography can detect and identify most of the normal and the specific pathologic changes very close to the stage of their embryogenic development. From a practical point of view, early detailed transvaginal sonography screening at 14 to 15 weeks of gestation is very useful while late detection at 20 to 23 weeks of gestation may provide some additional information in low-risk pregnancies. Very early screening, even during the ninth week, may be indicated in high-risk pregnancies. Additional genetic counseling is recommended when abnormal findings are suspected. We summarize the diagnostic approach and the information available for the most common musculoskeletal anomalies.

Female↗

Corporate ergonomics programme at automobiles Peugeot-Sochaux.

An ergonomic assessment tool for design procedures, exclusive to Peugeot-Citroën, called ECM, was developed and applied at the design stage by method technicians in the 1990s. It generates data, which are followed up by the project leader of a new model and ergonomists until two years before each launch. During this time, vehicle design is subject to modification, to adapt to ergonomic demands. Simplified methods (DACORS and METEO) were also developed to assess workstations on the shop floor in trim and final plants. Assessments were used to grade the workstations into four profiles linked to physical and static requirements. Production technicians are responsible for the application of these local methods on the shop floor. The management of these centres aimed to reduce the risks of musculoskeletal disorders by reduced heavy profiles of these stations. New cases of musculoskeletal disorders, surveyed by the company doctor among workers on the assembly lines had decreased since 1996. In 1999, the incidence increased again, despite the pursuit of ergonomic methods. This increase in musculoskeletal disorders was above all linked to a major reorganisation of work conditions, including a reduction in the cycle time on the assembly line, and to a move into a new workshop.

Automobiles↗

Musculoskeletal aging.

PURPOSE OF REVIEW: Chronic conditions associated with musculoskeletal aging contribute to a heavy functional and economic burden for our rapidly aging population. The purpose of this article is to review recent investigations in musculoskeletal epidemiology related to aging. RECENT FINDINGS: Well over half the older adults in the United States report chronic joint symptoms. With the projected growth of the older population in the next 25 years, the number of elders with arthritis is expected to double to 41 million. Accumulating evidence points to large ethnic and racial differences in the prevalence of arthritis. Primary care interventions to improve self-management of arthritis have been developed and tested, although further work in this area is warranted. Progress is being made in other major chronic conditions associated with aging. Research shows that optimal screening for osteoporotic fracture risk will require risk factor information in addition to bone densitometry. Recent findings shed new light on treatments for osteoporosis and musculoskeletal pain. A new field of study is investigating sarcopenia, or skeletal muscle loss, in very old populations. Research to date has uncovered evidence that this disabling condition may be the result of immunologic and hormonal changes related to aging. SUMMARY: Investigations in many areas are contributing to a better understanding of the major chronic conditions that affect the lives of many older adults. However, the surge in the elderly population will require far greater research and intervention efforts to postpone or prevent a huge population burden of disability related to common musculoskeletal problems of old age.

Aged↗

Musculoskeletal manifestations and autoimmune diseases related to new biologic agents.

PURPOSE OF REVIEW: The anti-tumor necrosis factor agents are now widely used in the management of patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile inflammatory arthritis. One of the most common observations made during their use is the development of autoantibodies. The purpose of this paper is to review this phenomenon and its clinical implications. RECENT FINDINGS: While the development of different autoantibodies is a common encounter, rare cases of lupus-like syndromes have been reported. On the other hand, a variety of immune-mediated clinical manifestations have been described, including vasculitis and demyelinating syndromes. Rare cases of cytopenia and non-specific lung injuries have also been reported. SUMMARY: While these clinical complications are rare and isolated events, clinicians must be aware of their occurrence. The experience with the anti-tumor necrosis factor agents is rather short and new, unusual immune-mediated complications may still appear. Clinicians should be prepared to recognize them.

Adalimumab↗