Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement

BACKGROUND

Differentiation between subacromial impingement versus subcoracoid impingement are important for the treatment target. We evaluated the correlations between coracohumeral ligament (CHL) thickness and distance (CHD) and characterized the CHL and subscapularis (SSC) in subcoracoid impingement subjects.

METHODS

An observational, cross-sectional study was carried out. Twenty subcoracoid impingement subjects and age/gender matched controls were assessed in 4 different shoulder positions by ultrasonography.

RESULTS

Moderate correlations between CHL thickness with CHD (r = 0.455 in neutral rotation, p = 0.044; r = 0.483 in interior rotation, p = 0.031) were found in subacromial subjects. Subcoracoid impingement subjects had greater CHL thickness (difference = 0.3 mm, effect size = 0.85, p = 0.006), SSC tendon thickness (difference = 0.7 mm, effect size = 0.92, p = 0.01) and SSC/CHD occupation ratio (difference = 8%, effect size = 0.95, p = 0.005) compared with the control.

CONCLUSIONS

Coracohumeral distance is related to ligament thickness, especially in subacromial impingement subjects. Increased coracohumeral ligament and subscapularis thickness as well as decreased subscapularis/coracohumeral distance occupation ratio are characterized in subcoracoid impingement subjects. These quantitative measurements can be useful in identifying patients at risk of subcoracoid impingement from subacromial impingement.

Effects of Extracorporeal Shock Wave-Mediated Transdermal Local Anesthetic Drug Delivery on Rat Caudal Nerves

Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.

Rapidly increasing liver progenitor cell numbers in human regenerating liver after portal vein ligation and liver partition

BACKGROUND

Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy so that major hepatectomy can be performed safely. This staged procedure allows for liver biopsy specimens to be taken before and after the liver begins to regenerate.

CASE PRESENTATION

The liver progenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatic tumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number of liver progenitor cell under high magnification examination by stain of immunomarkers. This is the first in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.

Measurement of body joint angles for physical therapy based on mean shift tracking using two low cost Kinect images

Range of motion (ROM) is commonly used to assess a patient's joint function in physical therapy. Because motion capture systems are generally very expensive, physical therapists mostly use simple rulers to measure patients' joint angles in clinical diagnosis, which will suffer from low accuracy, low reliability, and subjective. In this study we used color and depth image feature from two sets of low-cost Microsoft Kinect to reconstruct 3D joint positions, and then calculate moveable joint angles to assess the ROM. A Gaussian background model is first used to segment the human body from the depth images. The 3D coordinates of the joints are reconstructed from both color and depth images. To track the location of joints throughout the sequence more precisely, we adopt the mean shift algorithm to find out the center of voxels upon the joints. The two sets of Kinect are placed three meters away from each other and facing to the subject. The joint moveable angles and the motion data are calculated from the position of joints frame by frame. To verify the results of our system, we take the results from a motion capture system called VICON as golden standard. Our 150 test results showed that the deviation of joint moveable angles between those obtained by VICON and our system is about 4 to 8 degree in six different upper limb exercises, which are acceptable in clinical environment.

Comparative proteomic analysis of cauliflower under high temperature and flooding stresses

High-temperature and waterlogging are major abiotic stresses that affect the yield and quality of cauliflower. Cauliflower cultivars 'H41' and 'H69' are tolerant to high temperature and flooding, respectively; however, 'H71' is sensitive to both stresses. The objectives of this study were to identify the proteins that were differentially regulated and the physiological changes that occurred during different time periods in 'H41', 'H69', and 'H71' when responding to treatments of flooding, 40 °C, and both stresses combined. Changes in the leaf proteome were analyzed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS) and identified by Mascot peptide mass fingerprint (PMF) and database searching. Stress treatments caused significant reductions in electrolyte leakage, chlorophyll fluorescence Fv/Fm, chlorophyll content, and water potential as stress times were prolonged. By the comparative proteomic analysis, 85 protein peaks that were differentially expressed in response to combination treatments at 0, 6, and 24 h, 69 (33 in 'H41', 29 in 'H69', and 9 in 'H71') were identified, of which were cultivar specific. Differentially regulated proteins predominantly functioned in photosynthesis and to a lesser extent in energy metabolism, cellular homeostasis, transcription and translation, signal transduction, and protein biosynthesis. This is the first report that utilizes proteomics to discover changes in the protein expression profile of cauliflower in response to heat and flooding.

Bidirectional and multi-user telerehabilitation system: clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities

Background

The application of internet technology for telerehabilitation in patients with stroke has developed rapidly.

Objective

The current study aimed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities (LTCFs).

Method

This pilot study used a multi-site, blocked randomization design. Twenty-four participants from three LTCFs were recruited, and the participants were randomly assigned into the telerehabilitation (Tele) and conventional therapy (Conv) groups within each LTCF. Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks. The outcome measures included Berg Balance Scale (BBS), Barthel Index (BI), and the telerehabilitation satisfaction of the participants.

Setting

A telerehabilitation system included “therapist end” in a laboratory, and the “client end” in LTCFs. The conventional therapy was conducted in LTCFs.

Results

Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI. No significant difference between groups could be demonstrated. The satisfaction of participants between the Tele and the Conv groups also did not show significant difference.

Conclusions

This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs.

Altered Co-contraction of Cervical Muscles in Young Adults with Chronic Neck Pain during Voluntary Neck Motions

[Purpose] Muscle co-contraction is important in stabilizing the spine. The aim of this study was to compare cervical muscle co-contraction in adults with and without chronic neck pain during voluntary movements. [Subjects and Methods] Surface electromyography of three paired cervical muscles was measured in fifteen young healthy subjects and fifteen patients with chronic neck pain. The subjects performed voluntary neck movements in the sagittal and coronal plane at slow speed. The co-contraction ratio was defined as the normalized integration of the antagonistic electromyography activities divided by that of the total muscle activities. [Results] The results showed that the co-contraction ratio of patients was greater during flexion movement, lesser during extension movement, slightly greater during right lateral bending, and slightly lesser during left lateral bending compared with in the controls. [Conclusion] The results suggested that neck pain patients exhibit greater antagonistic muscle activity during flexion and dominate-side bending movements to augment spinal stability, while neuromuscular control provides relatively less protection in the opposite movements. This study helps to specify the changes of the stiffness of the cervical spine in neck pain patients and provides a useful tool and references for clinical assessment of neck disorders.

Effect of a combination of whole-body vibration and low resistance jump training on neural adaptation

This study investigated and compared the effects of an eight-week program of whole body vibration combined with counter-movement jumping (WBV + CMJ) or counter-movement jumping (CMJ) alone on players. Twenty-four men's volleyball players of league A or B were randomized to the WBV + CMJ or CMJ groups (n = 12 and 12; mean [SD] age of 21.4 [2.2] and 21.7 [2.2] y; height of 175.6 [4.6] and 177.6 [3.9] cm; and weight, 69.9 [12.8] and 70.5 [10.7] kg, respectively). The pre- and post-training values of the following measurements were compared: H-reflex, first volitional (V)-wave, rate of electromyography rise (RER) in the triceps surae and absolute rate of force development (RFD) in plantarflexion and vertical jump height. After training, the WBV + CMJ group exhibited increases in H reflexes (p = 0.029 and <0.001); V-wave (p < 0.001); RER (p = 0.003 and <0.001); jump height (p < 0.001); and RFD (p = 0.006 and <0.001). The post-training values of V wave (p = 0.006) and RFD at 0-50 (p = 0.009) and 0-200 ms (p = 0.008) in the WBV + CMJ group were greater than those in the CMJ group. This study shows that a combination of WBV and power exercise could impact neural adaptation and leads to greater fast force capacity than power exercise alone in male players.

CERVICAL ELECTROMYOGRAPHIC ACTIVITIES DURING NECK MOVEMENTS AT DIFFERENT SPEEDS IN HEALTHY SUBJECTS: VOLUNTARY RESPONSE INDEX ANALYSIS

The assessment of cervical muscle control patterns is important for the diagnosis of cervical dysfunction. Voluntary response index (VRI), including the similarity index (SI) and the magnitude (MAG), provides quantitative analysis of the surface electromyography (sEMG) pattern and total muscle voluntary activities respectively. This study was to investigate the effect of movement directions and speeds of the VRI response of cervical muscles in healthy subjects. The sEMG of bilateral sternocleidomastoid, semispinalis capitis, and splenius capitis were measured in thirteen asymptomatic young subjects. The subjects performed voluntary neck movements in flexion, extension, left and right side bending at fast, medium, and slow speeds. The results showed that SI ranged from 1–0.8 and MAG was generally less than 40 μV. The SI was significantly smallest and the MAG was largest at fast speed. The MAG was also significantly different among directions but the effect of direction on SI was only significant at fast speed. In conclusion, the movement speed and direction could affect the magnitude and control pattern of cervical muscles, such that both the speed and direction of the examined tasks should be carefully monitored during the assessment of cervical muscle activation.

H-reflex, muscle voluntary activation level, and fatigue index of flexor carpi radialis in individuals with incomplete cervical cord injury

BACKGROUND

Individuals with incomplete spinal cord injury (SCI) are predisposed to muscle fatigue during voluntary exercise. However, the origin of fatigue is unclear.

OBJECTIVE

The authors examined the motoneuron excitability, muscle activation level, and fatigue properties of the flexor carpi radialis muscle, just below the level of injury.

METHODS

Nine individuals with chronic, incomplete cervical cord injury and 9 age-matched healthy individuals were recruited. The authors tested maximum voluntary contraction (MVC), motoneuron excitability by the maximum amplitude of the H-reflex (Hmax at C-7), and muscle voluntary activation level measured by the interpolated twitch technique. Subjects were fatigued by repetitive maximal voluntary isometric wrist flexion. General fatigue index (GFI), central fatigue index (CFI), and peripheral fatigue index (PFI) of flexor carpi radialis were examined before, during, and immediately after exercise.

RESULTS

The Hmax in the SCI group was significantly higher (P = .0028) than in controls. The MVC (P < .001) and voluntary activation level (P = .016) in the SCI group were significantly lower. The GFI and CFI decreased in both the SCI and the non-SCI groups. The PFI in the SCI group was significantly higher (ie, less fatigue) than that in controls at 30 repetitive contractions.

CONCLUSIONS

In individuals with incomplete SCI, the deficit in central drive is an important source of muscle weakness and fatigue in the muscle below the level of injury.

Brain reorganization after bilateral arm training and distributed constraint-induced therapy in stroke patients: a preliminary functional magnetic resonance imaging study

BACKGROUND

Bilateral arm training (BAT) and constraint-induced therapy (CIT) have shown beneficial effects in improving motor control and function of the upper extremities (UE) for patients with stroke. Thus far, no study has directly investigated the relative effects of BAT versus CIT on brain reorganization. This study compared the effects of BAT with distributed CIT (dCIT) on brain reorganization and motor function in 6 stroke patients.

METHODS

In a pre-post randomized controlled trial, 6 stroke patients received BAT (intensive bilateral simultaneous and symmetrical training) or dCIT (restraint of the unaffected UE combined with intensive training of the affected UE) for a period of 3 weeks, 5 days per week. Functional magnetic resonance imaging (fMRI) examination and 3 clinical measures (Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) were administered before and after the intervention.

RESULTS

After intervention, patients showed varied patterns of fMRI changes and improved motor function. Two well-recovered patients, one from each group, showed large increases in bilateral hemisphere activation, especially in the ipsilesional hemisphere during affected hand movement and in the contralesional hemisphere during unaffected hand movement. During bilateral elbow movement, 3 of the 4 BAT patients showed increased bilateral cerebellum activation, especially in the left cerebellum, whereas 2 dCIT patients showed decreased cerebellar activation.

CONCLUSIONS

The findings of this preliminary research revealed that neuroplastic changes after stroke motor rehabilitation may be specific to the intervention. Further research using a larger sample and more complex fMRI tasks is warranted to validate the findings.

Role of the premotor cortex in leg selection and anticipatory postural adjustments associated with a rapid stepping task in patients with stroke

The premotor cortex (PMC) plays an important role in selecting and preparing for movement. This study investigates how stroke-induced PMC lesions affect stepping leg selection and anticipatory postural adjustments (APAs) preparation. Fifteen hemi-paretic patients (eight with PMC lesions (PMC(Lesion)) and seven PMC spared (PMC(Spared))) and eight age- and sex-matched healthy adults participated in the study. The subjects performed rapid forward stepping with the right or left leg under simple and choice reaction time conditions. The percentage of trials in which the subject showed the correct initial vertical ground reaction force pattern before lift-off of the stepping leg indicated the accuracy in selecting the designated stepping leg. The latency of bilateral contractions in the tibialis anterior (TA) and the reaction time (RT) of the stepping leg represented the time needed to prepare for stepping-related APAs and stepping movement, respectively. All three groups demonstrated a similar rate of accuracy of the stepping leg selection under both conditions. However, in both conditions, the PMC(Lesion) group exhibited a longer RT and TA contraction latency of the affected leg than the healthy and PMC(Spared) groups. The PMC(Lesion) group also presented a longer TA contraction latency of the unaffected leg than the healthy group in both conditions. These results suggest that the PMC is involved in APAs associated with leg stepping movement and that a PMC lesion in one hemisphere impairs APAs of both the contralateral and ipsilateral legs during stepping.

Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury

OBJECTIVE

To determine factors influencing disease-management self-efficacy in individuals with spinal cord injury.

DESIGN

A cross-sectional study.

SUBJECTS/PATIENTS

Forty-nine community-dwelling individuals with chronic spinal cord injury (mean age 44 years) participated in the study.

METHODS

Each subject was evaluated for disease-management self-efficacy (Self-efficacy for Managing Chronic Disease), depression (10-item Center for Epidemiologic Studies Depression Scale), pain interference (Pain Interference Scale), and availability of support (Interpersonal Support Evaluation List short form). Multiple regression analysis was performed to determine the relative contributions of these factors to disease-management self-efficacy.

RESULTS

The mean disease-management self-efficacy score was 6.5 out of 10 (standard deviation 1.6). Bivariate correlation analysis showed that higher self-efficacy was significantly correlated with longer time since injury (r = 0.367, p = 0.010), better social support (r = 0.434, p = 0.002), lower pain interference (r = -0.589, p <0.001), and less severe depressive symptoms (r=-0.463, p=0.001). In multiple regression analysis, only lower pain interference and less severe depressive symptoms were significantly associated with higher disease-management self-efficacy (F 4,44=10.249, R2=0.482, p<0.001).

CONCLUSION

Disease-management self-efficacy is suboptimal in many community-living people with spinal cord injury. This research suggests that rehabilitation of patients with spinal cord injury should include self-efficacy-enhancing strategies. Alleviation of depressive symptoms and pain self-management may be important for improving disease-management self-efficacy in this population, but this requires further study.

Haematopoietic stem cell transplantation in Taiwan: past, present, and future

In Taiwan, haematopoietic stem cell transplantation (HSCT) has been used to treat patients with haematological diseases since 1983. Thereafter till 2007, there were 2537 patients who had undergone HSCT in more than 15 hospitals. Their diseases included acute myeloid leukaemia in 27.8% of cases, non-Hodgkin's lymphoma 23.3%, acute lymphoblastic leukaemia 12.8%, chronic myeloid leukaemia 11.9%, severe aplastic anaemia 8.7%, and multiple myeloma 4.1%. Most of the cases received myeloablative conditioning regimens. More than 15% of cases received non-myeloablative regimens, and the mean age of these cases was at least 10 years older than those who received myeloablative regimens. The types of graft included peripheral blood (60.4%) and bone marrow (32.0%). A total of 35% of patients received autologous grafts. Of 1557 allogeneic HSCT patients, 338 (21.7%) received grafts from unrelated donors. Cord blood transplantation has been successfully performed in paediatric patients with thalassaemia major and with a large body size, and adult patients. The incidence of acute graft-versus-host disease was relatively low in Taiwan. On the contrary, a relatively higher proportion of hepatitis B carrier in the recipients had led to a higher incidence of reactivation hepatitis, which was markedly decreased following lamivudine prophylaxis. In conclusion, HSCT has become a routine therapy for major medical centres in Taiwan. Our unique experiences in the past decades also contributed to the progress of HSCT. With the establishment of professional association and patient supportive groups, we hope we can fully improve our daily practice and clinical as well as basic research in HSCT.

Long-term outcome of allogeneic human leukocyte antigen-matched sibling-donor peripheral blood stem cell transplantation in leukaemia patients

Between 1993 and July 2008, a total of 354 leukaemic patients received either allogeneic bone marrow transplantation (BMT) [n = 180] or peripheral blood stem cell transplantation (PBSCT) [n = 174] from human leukocyte antigen-matched sibling donors. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A and methotrexate. When comparing with BMT group, patients in the PBSCT group received much higher nucleated cells and CD34+ cells, and had much faster recovery of the neutrophil and platelet counts. The probability of developing acute GVHD was slightly higher in PBSCT patients (P = 0.02). The probability of chronic GVHD (cGVHD) in PBSCT was much higher in PBSCT (70 +/- 5.4%, extensive 48 +/- 6.5%) than in BMT (25 +/- 4.7%, extensive 10 +/- 3.4%; P < 0.001). Chronic GVHD was associated with long-term impairment of life quality and decreased quality-adjusted survival. In standard-risk leukaemia, use of PBSCT was associated with higher cGVHD, transplant-related mortality and a trend for decreased overall survival. The results suggest that allogeneic PBSCT is associated with high incidence of cGVHD in Chinese patients and its long-term risk and benefit remains to be defined in early stage of leukaemia.

Persistent knee instability following revision total knee arthroplasty

Instability is an important cause of failure following total knee arthroplasty (TKA). Knee stability needs to be optimal in both the coronal and sagittal planes. We describe failed revision TKA with persistent deformity and instability secondary to a deficient medial collateral ligament in a 71-year-old Chinese woman. Revision knee arthroplasty using constrained implants was performed on her with good result. During both primary and revision TKA, assessment of knee stability is critical. Constrained prosthesis would need to be considered when there is significant ligamentous deficiency.

Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study

STUDY DESIGN

This was a prospective cross-sectional study for people with chronic spinal cord injury (SCI).

OBJECTIVES

To (1) evaluate the intensity level and nature of physical activity in community-dwelling individuals living with SCI, and (2) explore the relation between descriptive individual variables (for example, lesion level), secondary complications and participation in physical activity.

SETTING

Urban community setting.

METHODS

A total of 49 subjects with SCI who used a manual wheelchair for primary mode of mobility (mean years since injury, 11.8; mean age, 43.7 years; 67% paraplegia) completed the physical activity recall assessment for people with SCI (PARA-SCI).

RESULTS

Approximately 50% of reported physical activity among individuals with SCI is due to activities of daily living. The amount of physical activity was not related to lesion level, age, body mass index or waistline size. Greater heavy-intensity activity was related to lower levels of pain and fatigue and higher levels of self-efficacy, whereas higher amounts of mild-intensity activity and total activity were related to less depressive symptoms.

CONCLUSIONS

Activities of daily living are a large component for physical activity among individuals with SCI. It appears that greater physical activity is associated with less secondary complications (pain, fatigue and depression) in individuals with SCI.

Real-time morphologic changes of the iliotibial band during therapeutic stretching; an ultrasonographic study

The purpose of this study was to evaluate the utility of ultrasonography (US) in determining the morphological changes of the iliotibial band (ITB) with the modified Ober maneuver. Forty-four subjects (23 men and 21 women, mean age (+/- SD), 24.7+/-4.7 years) who had no previous history of lower back, gluteus, hip or knee pain and satisfied additional inclusion criteria were recruited. Twenty out of the 44 subjects were initially examined by both MRI and US for measurement confirmation. Band width of the left ITB (the measures of which were highly correlated between techniques) was then assessed for these 44 subjects by US with the modified Ober maneuver in three gradually increased hip adduction positions; neutral, adducted and adducted with weight in these 44 subjects. In addition, examiner reliability was assessed by conducting duplicate measurements in 20 randomly chosen subjects. Results demonstrated that measures of band width, but not thickness, were highly correlated between MRI and US (p<0.001, r=0.850). Significant reductions in band width were observed between the three positions with the modified Ober maneuver (p<0.001). Intratester reliability was high (intraclass correlation coefficient (ICC)=0.86-0.94). Band width changes indicated that the ITB was subjected to a significant stretching force during hip adduction. We conclude that US is a reliable means to directly assess the real-time effects of stretching exercises.

Protein markers in the microcyst of the posteroventral cochlear nucleus of the gerbil

Microcysts are most evident in the posteroventral and anteroventral cochlear nuclei (PVCN and AVCN) of the Mongolian gerbil. The origin and contents of the microcyst are not elucidated at present. The present study investigated the possible inclusions in the microcyst by employing immunocytochemical labeling to localize the existence of various protein markers. Thirty and 100 microm thick sections were used to substitute and reconstruct between 6 and 20 paraffin serial sections, respectively. In 30-microm-thick slice sections, immunoreactivity of glial fibrillary acidic protein (GFAP-IR), mitochondria inner membrane (MCA-In-IR), S-100 (S-100-IR), serotonin (5-HT-IR), myelin proteolipid protein (PLP-IR) and substance P (SP-IR) abutted on the perimeter of the microcyst. The immunolabeled SP-positive cells were adjacent to the evagination of the microcyst. In 100-microm-thick slice sections, immunoreactivity of nitric oxide synthase (NOS-IR) and somatostatin (SOM-IR) mainly precipitated as flocculent structures in the small to medium-sized microcysts. 5-HT-IR also precipitated as an elongated flocculent stalk adjacent to the large microcyst or randomly distributed in the neuropil. The findings suggest that GFAP, MCA-In, S-100, 5-HT, PLP, SP, NOS and SOM may be involved in modulating the physiological functions and maintaining micro-environmental homeostasis of the microcyst in the cochlear nucleus of the gerbil.

Assessment of Stretching of the Iliotibial Tract With Ober and Modified Ober Tests: An Ultrasonographic Study

OBJECTIVE

To assess stretching of the iliotibial tract with Ober and modified Ober tests, by assessing morphologic changes of the tract using ultrasonography during stretching.

DESIGN

Cross-sectional study.

SETTING

Orthopedic laboratory.

PARTICIPANTS

Thirty-six healthy subjects (age, 24.3+/-4.0 y) were recruited. They had no history of previous low back, gluteus, hip, or knee pain and satisfied the inclusion criteria for this study.

INTERVENTION

Each subject was randomly assigned to first undergo either the Ober test or the modified Ober test, and 30 minutes after the first to undergo the other test. Measurements were obtained with the subjects lying on the right side. The left knee was flexed 90 degrees for the Ober test and positioned at 0 degrees for the modified test.

MAIN OUTCOME MEASURES

The iliotibial tract widths in subjects were measured in 3 gradually increased hip adduction positions (neutral, adducted, adducted with weight) when performing Ober and modified Ober tests. Ten of these 36 subjects were randomly chosen to undergo a repeat of the same protocol to test the reliability of ultrasonographic measurements in the iliotibial tract.

RESULTS

Ultrasonography was reliable in measuring the width of iliotibial tract (intraclass correlation coefficient range, .81-.82). The width of the iliotibial tract was significantly reduced from the neutral to adducted position of the hip with both Ober (P=.001) and modified Ober (P<.001) tests. However, with further stretching using a greater hip adduction angle, the width of the iliotibial tract was only reduced with the modified Ober test.

CONCLUSIONS

Both the Ober and modified Ober tests are effective in the initial stage of stretching of the iliotibial tract. However, the modified Ober test might be more effective in stretching the iliotibial tract if a further stretching effect is desired.

Risk-Factor Analysis of High School Basketball–Player Ankle Injuries: A Prospective Controlled Cohort Study Evaluating Postural Sway, Ankle Strength, and Flexibility

OBJECTIVE

To analyze risk factors, including postural sway, ankle strength, and flexibility, for the prediction of ankle injuries in men's high school basketball players.

DESIGN

A cohort study with follow-up duration of 1 basketball season.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Forty-two (age, 16.5+/-1.1y) players competing in first league of the High School Basketball Association without history of injury in the lower extremities within 6 months before recruitment and without significant malalignment in the lower extremities were included. None of these players met exclusion criteria such as using ankle braces or taping or failed in wearing low-top sports shoes during the follow-up season.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Biomechanic measurements including isokinetic ankle strength, 1-leg standing postural sway, and ankle joint dorsiflexion flexibility were performed before the basketball season by 1 physical therapist. The subsequent monthly follow-up questionnaires were sent and returned by mail to prospectively record the incidence of ankle injury occurring in the season. Results of these preseason measurements were analyzed to correlate if any of these measured variables could predict future ankle injuries.

RESULTS

Eighteen ankle sport injuries were recorded for 42 players during the follow-up season. High variation of postural sway in both anteroposterior and mediolateral directions corresponded to occurrences of ankle injuries (P=.01, odds ratio [OR]=1.220; P< .001, OR=1.216, respectively). All other variables were not associated with injury.

CONCLUSIONS

High variations of postural sway in 1-leg standing test could explain partly the increased prevalence of ankle injury in basketball players. It may be used as a screening tool to recommend balance training before basketball season.

Improved treatment results for childhood acute myeloid leukemia in Taiwan

To improve treatment results for children with de novo acute myeloid leukemia (AML), we introduced a novel protocol, Taiwan Pediatric Oncology Group-AML-97A, for AML other than acute promyelocytic leukemia (APL), for which modified conventional protocols were used. From January 1, 1997, to December 31, 2002, 141 children younger than 17 years old with de novo AML were enrolled. In total, 117 patients with non-APL AML were treated with induction therapy of idarubicin and cytarabine (Ara-C), postremission therapy with high-dose Ara-C - containing regimens for four monthly courses, and moderate-dose therapy with idarubicin and Ara-C for four monthly courses. The first 19 patients with APL were treated with all-trans retinoic acid, idarubicin and Ara-C, with the remaining five patients receiving all-trans retinoic acid and idarubicin, followed by maintenance therapy for 2 years. Stem cell transplantation was performed in 29 patients in first remission with a similar outcome as chemotherapy alone. The remission rate in the AML-97A study was 90%, the 5-year survival 51 +/- 5.3% (s.e.) and the 5-year event-free survival 50 +/- 4.8%; for APL, these were 100%, 86 +/- 7.0, and 75 +/- 9.8%. For the whole group, the 5-year survival was 57 +/- 4.7% and the 5-year event-free survival 54 +/- 4.4%. The AML-97A regimen was well tolerated.

Effects of task constraints on reaching kinematics by healthy adults

Understanding the control of movement requires an awareness of how tasks constrain movements. The present study investigated the effects of two types of task constraints--spatial accuracy (effector size) and target location--on reaching kinematics. 15 right-handed healthy young adults (7 men, 8 women) whose mean age was 23.6 yr. (SD=3.9 yr.) performed the ringing task under six conditions, formed by the crossing of effector size (larger vs smaller size) and target location (left, right, or a central position). Significant main effects of effector size and target location were found for peak velocity and movement time. There was a significant interaction for the percentage of time to peak velocity. The findings suggested that task constraints may modulate movement performance in specific ways. Effects of effector size might be a consequence of feedforward and feedback control, and location effects might be influenced by both biomechanical and neurological factors.

Post-poliomyelitis syndrome: case report and review of the literature

INTRODUCTION

Postpoliomyelitis syndrome (PPS) refers to the new neuromuscular symptoms that occur in patients years after their acute poliomyelitis has stabilised. PPS cases seen now are probably related to the poliomyelitis epidemics of the 1940s and 1950s.

CLINICAL PICTURE AND INVESTIGATION

A 57-year-old Chinese man with a history of poliomyelitis affecting both lower limbs presented with left upper limb weakness. Physical examination revealed atrophy of his left upper limb muscles. There were fasciculations in the biceps and brachioradialis muscles. Electromyography revealed ongoing denervation neurogenic units in the C5 to TI myotomes comparable with PPS.

CONCLUSION

The aim of this paper is to review the present situation and to give a short summary of PPS, which can be difficult to diagnose because the symptoms of presentation are usually non-specific. We describe a case of PPS and review the current literature.

Mortality after proximal hip fracture in the Singapore population

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55-98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses. (Hip International 2005; 15: 166-70).

Measurement of cervical range of motion pattern during cyclic neck movement by an ultrasound-based motion system

Goniometers and radiographic imaging have been used to measure active or passive cervical range of motion (ROM) in asymptomatic adults. However, the ultrasound-based coordinate measuring system (CMS) can measure continuous neck motion in three dimensions. The aims of this investigation are to evaluate the reliability and validity of ultrasound-based CMS (Zebris, CMS 70P), and to compare the cervical ROM patterns of asymptomatic young and middle-aged adults during continuous neck motions in the three cardinal planes. The ROM reciprocal ratio was defined as the ratio of the ROM from neutral position in one direction versus that in the opposite direction at the same cardinal plane. This study demonstrated the high test-retest reliability and validity of CMS during cervical motion in Chinese participants. Middle-aged adults exhibit reduced ROM ratios in the sagittal and frontal planes. The advantages and limitations of the CMS measurement tool and the potential future applications are documented. The measurement of neck motion pattern by ultrasound-based CMS may provide information on the management of neck dysfunction during functional movements.

Electromyographical assessment on muscular fatigue—an elaboration upon repetitive typing activity

The objectives of this study were to quantify the electromyographic activities (EMG) of finger muscles during prolonged, low-forces, and repetitive typing with an ergonomically designed VDT workstation, as well as to analyze the occurrence and the possible mechanisms of muscular fatigue in touched typists. Thirty healthy female typists were recruited to type consecutively for 2 h. The surface EMG of extensor digitorum communis (EDC) and flexor digitorum superficialis (FDS) of both hands was recorded throughout the entire test. Electrical activity (EA) and median frequency (MDF) were calculated, and then regressed against the time courses to obtain the slopes of progress. Further analysis of the EMG parameters was done by the joint analysis of spectra and amplitudes (JASA). The results indicated that maximum voluntary electrical activation (MVE) decreased after 2-h typing, and did not recover to the initial values even after a 10-min break. Besides, there was a trend of decrement in frequency throughout the entire trail, and the MDF reduced by 25% in comparison with the initial values. With the JASA plot, 74% of the muscles manifested fatigue after 2-h typing activity. Furthermore, we observed that the EDC muscles were more susceptible to muscular fatigue than the FDS muscles. In conclusion, prolonged consecutive typing may induce muscular fatigue in the healthy typists even in an ergonomic typing environment.

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program

OBJECTIVE

To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment.

METHODS

One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (>/=20), subthreshold binge eaters (10-19), and nonbinge eaters (0-9).

RESULTS

This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program.

CONCLUSION

Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.

Functional independence of residents in urban and rural long-term care facilities in Taiwan

PURPOSE

To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan.

METHODS

A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score.

RESULTS

(1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76).

CONCLUSIONS

Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Field-induced structures in miscible ferrofluid suspensions with and without latex spheres

We explore magnetic-field-induced ordering and microphase separation of aqueous ferrofluid and of aqueous mixtures of ferrofluid with nonmagnetic latex spheres. The ferrofluid is a surfactant stabilized aqueous suspension of magnetite (Fe3O4) particles with average diameter 20 nm (including the approximately 2.5-nm thick surfactant layer); the nonmagnetic latex spheres are charge stabilized polymethylmethacrylate (PMMA) particles with diameters of 42 nm, 108 nm, and 220 nm. In the presence of a uniform magnetic field, needlelike ferrofluid droplets formed that eventually grew to sample-traversing columns at fields of approximately 600 G; the two-dimensional structure of these columns was, however, glassy rather than hexagonal. In higher fields, approximately 1000 G, the columns stretched and coalesced into sheetlike striped liquids, but a true lamellar phase was not observed. The addition of nonmagnetic latex spheres to the ferrofluid suspension lowered substantially the critical field for the formation of columns, and induced lamellar (stripe) phases at relatively low applied fields. Image analysis was used to determine the spatial correlation functions, the average needle or column spacing, and the average lamellae spacing of these samples as a function of latex sphere size and concentration.

Aberrant caspase-activated DNase (CAD) transcripts in human hepatoma cells

The gene of caspase-activated DNase (CAD), the key enzyme for nucleosome cleavage during apoptosis, is mapped at chromosome 1p36, a region usually associated with hemizygous deletions in human cancers, particularly in hepatoma (HCC). It is tempting to speculate that CAD plays a tumour-suppressive role in hepatocarcinogenesis. To address this, we examined the CAD transcripts in six human HCC cell lines, one liver tissue from a non-HCC subject, and peripheral blood leukocytes (PBL) from three healthy individuals. Alternatively spliced CAD transcripts with fusion of exon 1 to exon 7 were isolated in most of the examined samples including HCC cells and normal controls. However, relatively abundant alternatively spliced CAD transcripts with fusion of exon 2 to exon 6 or 7, in which the corresponding domain directing CAD interaction with ICAD was preserved, were found only in poorly differentiated Mahlavu and SK-Hep1 cells. Interestingly, an abnormal CAD transcript with its exon 3 replaced by a truncated transposable Alu repeat was isolated in Hep3B cells, indicative of the implication of an Alu-mediated genomic mutation. Moreover, mis-sense mutations in the CAD genes were identified in all six HCC cell lines. Upon UV-induced apoptosis, DNA fragmentation efficiency was found to be intact, partially reduced and remarkably reduced in Huh7 and J328, Hep3B and HepG2, and Mahlavu cells, respectively. That mutations and aberrantly spliced transcripts for the CAD gene are frequently present in human HCC cells, especially in poorly differentiated HCC cells, suggests a significant role of CAD in human hepatocarcinogenesis.

Decommissioning of a 60Co unit and estimation of personal doses

Chang-hua Christian Hospital needs to uninstall the 60Co unit. The mode of this 60Co teletherapy unit is SHIMADZU RTGS-10. The original lead head was taken as the source container of this 60Co unit. The source head was dismantled and put into the prepared wooden box, after the source was sealed. This study describes the planning and dismantling of the retirement and transport of the 60Co unit, and personal doses measured during the procedure. This work estimates the doses of radiation received by exposed workers during the dismantling of the machine. The workers received doses of approximately 53 microSv. This study shows that the original lead head can be used as the source container of this 60Co unit. The 60Co machine was smoothly dismantled and transported by conscientious and careful workers, using planned and controlled radiation protection, following the ALARA (as low as reasonably achievable) rule.

Psychobehavioral response and weight loss prediction in a hospital-based weight reduction program

BACKGROUND AND PURPOSE

Depression and binge eating are common adverse psychologic responses associated with weight loss in overweight and obese adults. This study aimed to assess the effects of different degrees of weight loss on psychologic functioning and the relationship between mood change and weight reduction, and to identify predictors of short-term weight loss among subjects in a hospital-based weight reduction program.

METHODS

A total of 189 obese subjects who participated in a hospital-based weight-reduction program during a 12-week interval were enrolled in this study. They ranged in age from 18 to 67 years (mean, 40.5 +/- 12.3 yr) with female predominance (87.8%). Mean body weight was 79.3 +/- 13.9 kg and mean body mass index was 31.1 +/- 3.8 kg/m2 on entry into the program. Body weight was periodically measured and subjects were asked to complete two self-administered questionnaires including the Brief Symptom Rating Scale (BSRS) and the Bulimic Investigatory Test, Edinburgh (BITE), pre- and post-treatment.

RESULTS

Using the last observation carried forward method of analysis, the average weight loss for all participants was 5.6 +/- 3.7 kg. For subjects who completed the 12-week program, weight loss was 6.6 +/- 3.6 kg. Subjects who completed the program (n = 115, 60.8%) had significantly reduced BITE as well as all BSRS subscale scores at the end of the program. There was no linear relationship between mood change and weight loss by correlation analysis, but subjects with higher degrees of weight loss had improvement in more dimensions of psychologic functioning. Initial mood and binge-eating status predicted neither compliance nor weight reduction. Two biologic factors (initial weight loss, initial body weight) and one behavioral factor (attendance rate) were identified as significant predictors of short-term weight loss for all subjects.

CONCLUSIONS

There was no evidence that weight loss made mood or eating pathology worse among those who completed the weight loss program. Beneficial effects on general psychologic functioning and eating pathology were demonstrated for subjects with a minimal weight loss of 5% of initial weight and who completed the program. Psychologic assessments at the start of the program did not predict weight loss at the end of participation in this hospital-based weight loss program.

Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia

OBJECTIVE

To assess the effect of resistive inspiratory muscle training (RIMT) on the static pulmonary function and sleep-induced breathing disorder of individuals with chronic cervical cord injury.

DESIGN

Before-after training.

SETTING

Home-setting training program.

PATIENTS

Fourteen complete traumatic tetraplegic patients (12 men, 2 women; mean age, 41.1 +/- 14y; range, 19-56y) injured for more than 6 months.

INTERVENTION

Subjects participated in a 6-week RIMT program for 15 minutes twice daily at a training intensity of 60% of maximum inspiratory pressure (MIP). The participants were reevaluated at the end of 6-week training.

MAIN OUTCOME MEASURES

Lung volume, peak expiratory flow (PEF), MIP, and maximum expiratory pressure (MEP) were measured by using a spirometry and inspiratory force meter, respectively. Capnography was used to monitor nocturnal pulse oxyhemoglobin saturation (SpO(2)) and end-tidal carbon dioxide tension level (ETCO(2)) of the patients.

RESULTS

The maximum voluntary ventilation (MVV) and MIP of individuals with chronic cervical cord injury substantially improved after RIMT. MIP increased from -68.7 +/- 27.4cmH(2)O to -77.3 +/- 24.0cmH(2)O and MVV rose from 62.7 +/- 33.2L to 73.4 +/- 31.3L (P <.05). Despite increasing from 3.5 +/- 1.8L/s to 4.0 +/- 1.7L/s, PEF was statistically insignificant. For the individuals with improved MIP, the duration of ETCO(2) greater than 48mmHg reduced from 2.2% +/- 3.3% to 1.0% +/- 2.0% of total sleep time (P =.05) and that of SpO(2) less than 90% significantly declined from 1.8% +/- 2.8% to 1.3% +/- 2.4% of total sleep time (P <.05).

CONCLUSION

These findings suggest that RIMT can enhance the respiratory muscle strength and endurance of chronic tetraplegia and further ameliorate the sleep-induced breathing disorder. Therefore, RIMT is suggested as a home program for patients with sleep-disordered breathing.

Compression forces and amount of outer coating layer affecting the time-controlled disintegration of the compression-coated tablets prepared by direct compression with micronized ethylcellulose

The influence of compression force to inner core tablet or to outer coating layer of the compression-coated tablet on the function of time-controlled disintegration was investigated. The inner core tablet was directly compacted by sodium diclofenac (model drug) and ethylcellulose (EC) with 4.6-microm particle size was used as an outer coating layer. The immersion time of the compression-coated tablet previously soaked in pH 1.2 solution to simulate the residence time of the tablet in the GI tract affecting the dissolution behavior of the compression-coated tablet was also investigated. The effect of the amount of the outer coating layer used on the drug release was examined. The results indicate that sodium diclofenac released from these compression-coated tablets exhibited a longer lag of a period about 16.3 h in both distilled water and pH 6.8 buffer solution, followed by a different drug release behavior. The lag time was independent of the pH of dissolution medium, and the immersion time in pH 1.2 solution. After that lag time, the outer shell of the compression-coated tablets broke into two halves to make a rapid drug release. However, the drug release behavior of the soaked tablet in pH 6.8 buffer solution was dependent on the immersion time. The compression force < 200 kg/cm(2) to the inner core tablet influenced the release behavior of drug less, but > 200 kg/cm(2) might delay the lag time. The lag time of the compression-coated tablets was linearly correlated with the compression force to the outer coating layer (r = 0.9896). We also found that the more the amount of outer coating layer added, the longer the lag time obtained. The study demonstrates that the time-controlled disintegration of the compression-coated tablet was effectively controlled by the compression force applied and the amount of outer coating layer added.

Ruptured cystic teratoma of the testis in a neonate

Neonatal testicular tumors are extremely rare. We report the case of a full-term male newborn with right hemiscrotal swelling found immediately after birth. The right hemiscrotal skin gradually turned dusky dark and then adhered to the hard scrotal contents. Missed right testicular torsion was suspected and emergency exploration was not attempted. Right hemiscrotal swelling became aggravated, so right orchiectomy and left orchidopexy were performed. During surgery, severe inflammation of the right testis and the right hemiscrotum were observed and diffuse hemorrhage with focal hematomas was noted within the removed right testis. Histopathology of the specimen revealed a ruptured mature cystic teratoma of the testis. The alpha-fetoprotein concentration was 729 x 10(4) micrograms/L 10 days after the operation, and dropped to 185 x 10(4), 25 x 10(4), and less than 20 x 10(4) micrograms/L 2, 5, and 8 months later, respectively. Postoperative abdominal and pelvic computerized tomography scans revealed neither lymphadenopathy nor distant metastasis. During a follow-up of 8 months, no evidence of tumor recurrence was found. Although extremely rare, testicular tumors should be included in the differential diagnosis of an enlarged hard or firm scrotal mass in the male neonate.

Philadelphia chromosome-positive acute lymphoblastic leukemia in Taiwan

From January 1986 to December 1998, 26 (23%) of 114 acute lymphoblastic leukemia (ALL) patients older than 15 years were found to have Philadelphia (Ph) chromosome. They accounted for 28% (26 of 94) of the patients with B-lineage ALL. Compared with the other 88 ALL patients, the leukemic cells from all but one Ph-positive ALL patients were early pre-B cells with a higher rate of CD34 expression (92% vs 50%, P<0.05). At presentation, the Ph-positive adult ALL patients had higher circulating blasts (mean 21.4 vs 3.66x10(4)/microl, P<0.05) and lower initial platelet counts (mean 4.47 vs 7.34x10(4)/microl, P<0.01) and showed a trend toward higher frequency of initial central nerve system (CNS) involvement (25% vs 11%, P=0.098) than the others. Among patients with adequate chemotherapy, 16 (64%) of the 25 Ph-positive ALL patients achieved complete remission (CR), an incidence marginally lower than that of Ph-negative ALL (62 of 76, 82%, P=0.06) and significantly lower than that of Ph-negative B-lineage ALL (50 of 58, 86%, P=0.0037). However, all patients relapsed except for those who received allogeneic hemopoietic stem cell transplantation (allo-HSCT). The probabilities of 5-year continuous CR and 5-year survival for Ph-positive adult ALL patients were significantly inferior to those for Ph-negative adult ALL patients (0% vs 12%, P=0.0001, and 7% vs 19%, P=0.047, respectively), and those for Ph-negative B-lineage ALL (0% vs 14%, P<0.0001, and 7% vs 23%, P=0.002, respectively). Prognostic factors were analyzed among the Ph-positive ALL patients including the 26 adults mentioned above and an additional 11 children. No clinical or biological characteristics such as age, sex, initial circulating blast count, extramedullary involvement, or CD34 expression had an impact on the disease outcome. Allo-HSCT in first CR may improve the probability of 5-year continuous CR (100% vs. 0% for those without allo-HSCT, P=0.0091) although only three patients received it in this study. In conclusion, Ph-positive ALL patients tended to have a poor prognosis, regardless of whether other possible risk factors were present or not. Aggressive treatment, such as high-dose chemotherapy with allo-HSCT, should be considered for these patients to improve survival.