The Fundamentals and Applications of Wearable Sensor Devices in Sports Medicine: A Scoping Review

PURPOSE

To (1) characterize the various forms of wearable sensor devices (WSDs) and (2) review the peer-reviewed literature of applied wearable technology within sports medicine.

METHODS

A systematic search of PubMed and EMBASE databases, from inception through 2023, was conducted to identify eligible studies using WSDs within sports medicine. Data extraction was performed of study demographics and sensor specifications. Included studies were categorized by application: athletic training, rehabilitation, and research.

RESULTS

In total, 43 studies met criteria for inclusion in this review. Forms of WSDs include pedometers, accelerometers, encoders (consisting of magnetometers and gyroscopes), force sensors, global positioning system trackers, and inertial measurement units. Outcome metrics include step counts; gait, limb motion, and angular positioning; foot and skin pressure; change of direction and inclination, including analysis of both body parts and athletes on a field; displacement and velocity of body segments and joints; heart rate; plethysmography; sport-specific kinematics; range of motion, symmetry, and alignment; head impact; sleep; throwing biomechanics; and kinetic and spatiotemporal running metrics. WSDs are used in athletic training to assess sport-specific biomechanics and workload with a goal of injury prevention and training optimization, as well as for rehabilitation monitoring and research such as for risk predicting and aiding diagnosis.

CONCLUSIONS

WSDs enable real-time monitoring of human performance across a variety of implementations and settings, allowing collection of metrics otherwise not achievable. WSDs are powerful tools with multiple applications within athletic training, patient rehabilitation, and orthopaedic and sports medicine research.

CLINICAL RELEVANCE

Wearable technology may represent the missing link to quantitatively addressing return to play and previous performance. WSDs are commercially available and portable adjuncts that allow clinicians, trainers, and individual athletes to monitor biomechanical parameters, workload, and recovery status to better contextualize personalized training, injury risk, and rehabilitation.

Exposure to Extended Reality and Artificial Intelligence-Based Manifestations: A Primer on the Future of Hip and Knee Arthroplasty

BACKGROUND

Software-infused services, from robot-assisted and wearable technologies to artificial intelligence (AI)-laden analytics, continue to augment clinical orthopaedics - namely hip and knee arthroplasty. Extended reality (XR) tools, which encompass augmented reality, virtual reality, and mixed reality technology, represent a new frontier for expanding surgical horizons to maximize technical education, expertise, and execution. The purpose of this review is to critically detail and evaluate the recent developments surrounding XR in the field of hip and knee arthroplasty and to address potential future applications as they relate to AI.

METHODS

In this narrative review surrounding XR, we discuss (1) definitions, (2) techniques, (3) studies, (4) current applications, and (5) future directions. We highlight XR subsets (augmented reality, virtual reality, and mixed reality) as they relate to AI in the increasingly digitized ecosystem within hip and knee arthroplasty.

RESULTS

A narrative review of the XR orthopaedic ecosystem with respect to XR developments is summarized with specific emphasis on hip and knee arthroplasty. The XR as a tool for education, preoperative planning, and surgical execution is discussed with future applications dependent upon AI to potentially obviate the need for robotic assistance and preoperative advanced imaging without sacrificing accuracy.

CONCLUSION

In a field where exposure is critical to clinical success, XR represents a novel stand-alone software-infused service that optimizes technical education, execution, and expertise but necessitates integration with AI and previously validated software solutions to offer opportunities that improve surgical precision with or without the use of robotics and computed tomography-based imaging.

The Social Media Presence of Professional Sports Team Physicians Is High Among Major League Soccer, Major League Lacrosse, Major League Rugby, Winter Olympics, and Women's National Basketball Association, But Highest Among MLS Team Physicians

Purpose

To quantify the social media utilization of professional sports team physicians on popular platforms and analyze differences between physician users and physician non-users for smaller major professional sports: Major League Soccer (MLS), Major League Lacrosse (MLL), Major League Rugby (MLR), Winter Olympics (WO) and Women's National Basketball Association (WNBA).

Methods

Physicians for the MLS, MLL, MLR, WO, and WNBA were identified and characterized based on training background, practice setting, years of experience, and geographic location. Social media presence on Facebook, Twitter, LinkedIn, Instagram, and ResearchGate were determined. Differences between social media users and non-users were analyzed via chi-squared tests for nonparametric variables. Secondary analysis consisted of univariate logistic regression to identify associated factors.

Results

86 team physicians were identified. 73.3% of physicians had at least one social media profile. 80.2% of physicians were orthopedic surgeons. Specifically, 22.1% had a professional Facebook page, 24.4% had a professional Twitter page, 58.1% had a LinkedIn profile, 25.6% a ResearchGate profile, and 9.3% an Instagram account. All physicians with a social media presence were fellowship-trained.

Conclusions

Seventy-three percent of team physicians in the MLS, MLL, MLR, WO, or WNBA have social media presence, with over half using LinkedIn. Fellowship-trained physicians were significantly more likely to use social media, and 100% of physicians with social media presence were fellowship trained. MLS and WO team physicians were significantly more likely to use LinkedIn (P = .02). MLS team physicians were significantly more likely to use social media overall (P = .004). No other metric significantly impacted social media presence.

Clinical Relevance

The influence of social media is vast. It is important to explore the extent that sports team physicians utilize social media and how this use may influence patient care.

Antimicrobial consumption in hospitalised COVID-19 patients: a systematic review and meta-analysis

Introduction

Despite COVID-19 being a viral illness, antibiotic use has been more prevalent. In addition, co-infection (3.5%) and secondary infection (14.3%) were relatively low in hospitalised patients with COVID-19. A major concern is the increased risk of antimicrobial resistance (AMR) due to inappropriate antibiotic consumption (1).

Aim

This review aims to evaluate antimicrobial consumption (excluding repurposed drugs such as remdesivir) in hospitals and determine the prevalence of COVID-19 patients who received antibiotic therapy using meta-analysis.

Methods

The review was conducted according to PRISMA guidelines (2). The two investigators independently developed and applied eligibility criteria to examine original articles. Studies were eligible for inclusion if they met the following criteria: (i) original research studies with a minimum sample of 50 patients; (ii) focussed on antibiotic consumption (AMC); (iii) patients with COVID-19 or consumption amid COVID-19 pandemic; (iv) any age group or gender; and (v) reported in the English language. The included articles were retrieved from MEDLINE, CINAHL, WHO COVID-19 databases, including studies published in EMBASE, Scopus, WHO-COVID, and LILACS between December 2019 to July 2021. The modified version of Newcastle-Ottawa Scale (NOS) was used to measure biases in included studies after the consensus by both authors. The random-effects model was used to estimate the pooled prevalence or proportion of AMC among hospitalized COVID-19 patients.

Results

A total of 34 studies conducted among hospitalised COVID-19 patients were included. The extracted studies presented AMC in defined daily doses (DDD) or frequency and percentages. Azithromycin was the most frequently prescribed antibiotic in almost all studies. The meta-analysis that examined overall AMC using data from 25 studies (17 studies from high income countries and eight from low-middle income countires) revealed 69% (95% CI:63%-74%) of hospitalized COVID-19 received at least one course of antibiotics. The sub-group analysis of studies from high income countries (HICs) revealed 59% (95% CI: 51%-66%) consumed antibiotics compared with 89% (95% CI: 82% to 94%) among hospitalised COVID-19 patients in low-middle income countries (LMICs).

Conclusion

This review highlights the trend of antibiotic consumption in hospitalised COVID-19 patients. A significant rise in antibiotic consumption was observed in LMICs and increased antibiotic consumption in the first few months of the COVID-19 pandemic in HIC. The review outcomes emphasised the importance of rational and judicious use of antimicrobial therapy as well as to strenghting the antimicrobial stewardship policies and activities, particularly during a global pandemic. The limitation of the review undertaken was not identified incidence of co-infection and don’t include studies on reported AMC in immunocompromised patients.

References

(1) Rawson TM, Ming D, Ahmad R, Moore LSP, Holmes AH. Antimicrobial use, drug-resistant infections and COVID-19. Nature reviews Microbiology. 2020;18(8):409-10.

(2) Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I, et al. PRISMA for Abstracts: Reporting Systematic Reviews in Journal and Conference Abstracts. PLOS Medicine. 2013;10(4):e1001419.

Are All Hardware Removals Equal?

The objective of this study is to report operative time and associated complications of six types of implants and to determine if surgeons are adequately compensated. Hardware removals were analyzed from 2014-2019. Implants were flexible nails, intramedullary rigid nails, long plates, screw(s), single guided-growth plates, and multiple guided-growth plates. Patient demographics, operative time, blood loss, complications, and relative value units (RVU)/min were collected. RVU/min was used to maximize rate. In total, 392 patients were analyzed. Long plate removals took significantly longer than screw removal, therefore RVU/min was significantly lower (p < 0.001). Long plate removals also took significantly longer, and RVU/min was significantly lower compared to guided-growth plate removal (p < 0.001). Intramedullary nails took significantly longer compared to flexible nails, nearly double the RVU/min (p = 0.02). The results from this study indicate that the RVU/ minute for these six different types of implant removals are not equal. Surgeons can use this data to set up their schedule to ensure maximum utilization. (Journal of Surgical Orthopaedic Advances 30(1):020-023, 2021).

Use and validation of a survey tool to measure the perceived effectiveness of insulin prescribing safety interventions in UK hospitals

AIMS

To describe the use and validation of a survey tool to elicit the opinion of hospital pharmacists and medicines safety officers in the UK regarding the perceived effectiveness of strategies to improve insulin prescribing safety in hospitals.

METHODS

One respondent from each participating organization completed the survey on behalf of the main acute hospital in their trust (n = 92). A five-point Likert scale was used to determine opinion on how effective 22 different interventions were at promoting insulin safety at the respondent's trust. The tool, the Perception of Effectiveness of Prescribing Safety Interventions for Insulin (PEPSII) questionnaire, underwent content validity testing. The reliability was estimated using Cronbach's alpha (α).

RESULTS

The PEPSII questionnaire demonstrated good reliability (α = 0.867). Outreach team review and mandatory insulin education were the highest-scoring interventions; the insulin passport was amongst the lowest scoring interventions. Most interventions were considered more effective by trusts using them compared to those who didn't, except for self-administration policies, electronic prescribing and the insulin passport.

CONCLUSIONS

The perceived effectiveness of a variety of insulin prescribing safety strategies in UK hospitals was described by leveraging a purposely developed survey tool. The results describe current levels of support for recommended interventions, and may facilitate the direction of both local and national insulin prescribing safety improvement efforts.

Strategies to reduce insulin prescribing errors in UK hospitals: results from a national survey

AIM

To describe insulin prescribing practice in National Health Service hospitals in the UK and the current use of interventions and strategies to reduce insulin prescribing errors.

METHODS

We sent a cross-sectional questionnaire to chief pharmacists in all National Health Service hospital trusts in the UK in January 2019. Questions concerned the use and functionality of electronic and paper systems used to prescribe subcutaneous insulin, along with features and interventions designed to reduce insulin prescribing errors.

RESULTS

Ninety-five hospital trusts responded (54%). Electronic prescribing of insulin was reported in 40% of hospitals, most of which were teaching hospitals in England. We found a wide variation in the functionality of both electronic prescribing and paper-based systems to enable the safe prescribing of insulin for inpatients. The availability of specialist diabetes pharmacists to support the safe prescribing of insulin was low (29%), but was positively associated with the use of a greater number of insulin prescribing error reduction strategies (P=0.002). The use of specific interventions to improve insulin prescribing quality (e.g. self-administration policies) varied greatly between respondent hospitals.

CONCLUSIONS

There is potential to optimize the functionality of both electronic and paper-based prescribing systems to improve the safe prescribing of insulin in hospitals in the UK. The wide variation in the use of insulin error reduction strategies may be improved by the availability of specialist diabetes pharmacists who can support the implementation of insulin-prescribing interventions.

Exploration of a New Source of Sustainable Nanomaterial from the Koh-e-Suleiman Mountain Range of Pakistan for Industrial Applications

The present study aimed to explore a new source of montmorillonite and to develop an extraction and purification protocol for its isolation from raw clay samples acquired from the Koh-e-Suleiman mountain range in Pakistan. The process involved the collection of raw clay from the source, identification and quantification of montmorillonite. Granulometric extraction and purification protocols increased the montmorillonite content from 21.8-25.1% in the raw clay to 90.1-93.9% after small-scale extraction and 85.33-89.33% on a larger scale. A techno-economic analysis highlighted the practicality and economic benefits of large-scale extraction for industrial applications. This study highlights the existence of a substantial new source of this valuable clay which is currently used across multiple industries including construction, pottery making, pharmaceuticals, cosmetics and engineering. It is intuitively expected that the large-scale extraction of the material will improve the economic condition of the region by providing employment opportunities to locals and may be a valuable resource for export.

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

AIM

To conduct a systematic review of literature to identify interventions that are effective in improving insulin prescribing for people with diabetes in the hospital setting.

METHODS

Computerized bibliographic databases were searched for studies published in English that described the effectiveness of interventions to improve insulin prescribing within the hospital setting. Studies were eligible for inclusion if they reported data that compared insulin prescribing practice after an intervention or compared with a control group. Studies were not excluded on the basis of publication date, geographical location or risk of bias assessment.

RESULTS

We identified 35 studies for inclusion in the review, including two cluster randomized controlled trials, two cohort studies, and 31 uncontrolled before-after studies. Studies reported a variety of interventions that aimed to increase insulin prescribing accuracy or completeness or decrease the use of discouraged subcutaneous sliding scale insulin regimens. Differences in definition of insulin prescribing error, terminology and common practice based on geographical location was evident, and quality issues with respect to study design and reporting somewhat limited the interpretation of conclusions.

CONCLUSIONS

Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels. Future studies in insulin prescribing errors would benefit from the use of standardized approaches, terminology and outcome measures to enable greater comparison.

Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq

This study aimed to assess the impact of the Baby-Friendly Hospital Initiative on WHO-defined breastfeeding indicators in Shaqlawa district in Kurdistan region of Iraq. A household survey was carried out on a purposive non-probability sample of 200 mothers with a child aged < 30 months. Mothers were interviewed using a structured form to determine demographic data and feeding practices of the most recent child. The rate of early initiation of breastfeeding was 38.1%, exclusive breastfeeding was 15.4% and continued breastfeeding was 61.0% and 39.5% at 1 and 2 years of age respectively. A significant relationship was found between delivery at the Baby- Friendly accredited hospital and early initiation of breastfeeding but not with exclusive or continued breastfeeding. While continued breastfeeding at 1 year and 2 year was good, early initiation and exclusive breastfeeding indicators were not at an acceptable level, which indicates an ineffective role for the Baby-Friendly Hospital Initiative.

Anxiety symptoms and the risk of diabetes mellitus in Australian women: evidence from 21-year follow-up

OBJECTIVES

This study aimed to explore the association between transitions in anxiety symptoms and the risk of diabetes in women, using longitudinal data.

STUDY DESIGN

This longitudinal study measured diabetes, and transitions in anxiety symptoms, using validated instruments.

METHODS

Data obtained by the Mater-University of Queensland Study of Pregnancy were analysed. Anxiety was measured using the Delusion Symptoms States Inventory (DSSI). To examine possible transitions over different time periods, anxiety was grouped into four categories and assessed at different phases over a 21-year period.

RESULTS

Three hundred and one women reported diabetes 21 years after the index pregnancy. Almost half of the women who reported anxiety symptoms continued to report these at a subsequent follow-up (FU) phase. About 1 in 10 women who had not reported anxiety symptoms at 5-year FU did so at the subsequent 14-year FU. In prospective analyses, we did not find significant association of diabetes with negative transition (no anxiety to anxiety at subsequent phase) or with positive history of anxiety symptom, but an increasing risk was evident. Women with persistent symptoms had a 1.85-fold greater risk of diabetes (95% CI: 1.18-2.90). The cross-sectional analysis did not produce significant results.

CONCLUSIONS

Despite some limitations, this study provides insight into the long-term association between events of anxiety and the risk of diabetes across the reproductive life of women. However, the evidence is not strong enough to support a direct effect of anxiety in causing diabetes.

Ethnomedicinal plants of Kathua district, J&K, India

ETHNOPHARMACOLOGICAL RELEVANCE

Natural products, especially those derived from plants, continue to provide new and important leads in the drug discovery process. The first step in drug discovery is to document material traditionally used to treat an ailment. Documentation of such knowledge will lead to its conservation and facilitate future research on medicinal plant safety and efficacy to validate traditional use. The present study was undertaken with an aim to document the ethnomedicinal plants of Kathua district.

MATERIAL AND METHODS

The data were quantitatively analysed using indices like use-value (UV), informant consensus factor (ICF) and fidelity level (Fl).

RESULTS

A total of 112 informants (78 males and 34 females) were interviewed. They were using a total of 197 plants from 87 families and 174 genera for the ethnomedicinal purposes. The most dominant families were Fabaceae, Asteraceae and Lamiaceae. The most important plants of the study site on the basis of use-value were Mentha longifolia, Curcuma domestica, Zingiber officinale, Ocimum tenuiflorum, Adiantum capillus-veneris, Viola odorata, Mentha arvensis and Acorus calamus. The diabetes treatment had the maximum consensus (0.96 ICF) among the informants. Other important categories with high ICF values were gastrointestinal disorders and respiratory disorders. Total 23 species recorded 100% Fl. Medicinal plants with high Fl were Brassica rapa, Plumbago zeylanica, Punica granatum, Catharanthus rosea, Tinospora cordifolia, Acacia catechu, Aegle marmelos, Abrus precatorius, Oxalis corniculata, Nicotiana plumbaginifolia, Achillea millefolium, Tamarindus indica, Taxus baccata and Butea monosperma.

CONCLUSION

The plants with high UV and Fl like M. longifolia, C. domestica, Z. officinale, O. tenuiflorum, A. capillus-veneris, A. calamus, B. rapa, P. zeylanica, C. rosea, T. cordifolia, A. catechu, O. corniculata, N. plumbaginifolia, A. millefolium, T. indica, T. baccata and B. monosperma should be analysed for pharmacological components and discovery of new drugs.

Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients

BACKGROUND

Gut-focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided.

AIM

To review the effect of hypnotherapy in a large cohort of refractory IBS patients.

METHODS

One thousand IBS patients fulfilling Rome II criteria, mean age 51.6 years (range 17-91 years), 80% female, receiving 12 sessions of hypnotherapy over 3 months, were studied. The primary outcome was a 50 point reduction in the IBS Symptom Severity Score. The fall in scores for Noncolonic Symptoms, Quality of Life and Anxiety or Depression, were secondary outcomes. The Federal Drug Administration's recommended outcome of a 30% or more reduction in abdominal pain was also recorded.

RESULTS

Overall, 76% met the primary outcome which was higher in females (females: 80%, males: 62%, P < 0.001) and those with anxiety (anxious: 79%, non-anxious: 71%, P = 0.010). The mean reduction in other scores was: IBS Symptom Severity Score, 129 points (P < 0.001), Noncolonic Symptom Score, 65 (P < 0.001) and Quality of Life Score, 66 (P < 0.001). Sixty-seven per cent reported a 30% or more reduction in abdominal pain scores. Pain days fell from 18 to 9 per month. Patients with anxiety and depression fell from 63% to 34% and 25% to 12% respectively (P < 0.001). Outcome was unaffected by bowel habit subtype.

CONCLUSION

These results provide further evidence that gut-focused hypnotherapy is an effective intervention for refractory IBS.

The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes

OBJECTIVES

To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes.

METHODS

A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbach's α.

RESULTS

The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOL's PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01-2.02).

CONCLUSIONS

This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

Understanding of and attitudes toward epilepsy among the urban Chinese population in Malaysia

INTRODUCTION

People with epilepsy are socially discriminated against on the grounds of widespread negative public attitudes, misunderstandings and defensive behaviour. The primary purpose of this study was to evaluate the public understanding of and attitudes toward epilepsy among the Chinese population in Malaysia.

METHODS

A validated, self-administered questionnaire comprising 23 questions was utilised to evaluate the understanding of and attitudes toward epilepsy among randomly approached respondents from the Chinese population living in the urban areas of Penang, Klang Valley, Kuala Lumpur and Sibu in Malaysia.

RESULTS

Out of 1,000 people approached, 697 (69.7 percent) respondents agreed to participate in the study. When asked whether people with epilepsy are slow learners and have intellectual functioning below normal, 448 (64.3 percent) respondents answered 'no'. This positive answer was mainly provided by female (35.6 percent) as compared to male (28.6 percent) respondents. Moreover, more than half responded positively to the following statements: people with epilepsy should not be isolated from the normal population; epileptics can perform daily activities; epileptics can receive academic education; and epileptics can become useful members of society. In addition, significant associations were discovered between the education level of the respondents and several statements, including whether epileptics are as intelligent as everyone else (p-value is 0.009), whether epilepsy can be treated with drugs (p-value is 0.037) and whether epileptics can be as successful as other people in their chosen career (p-value is 0.009). Positive responses were mainly acquired from those with secondary education and above. A large number of the respondents felt that people with epilepsy should not be employed as lorry drivers, firefighters, doctors and army personnel.

CONCLUSION

The general Chinese population in the urban areas of Malaysia had, at the time of the investigation, a relatively high level of understanding and positive attitudes toward certain aspects of epilepsy, although a minority of the study population demonstrated prejudice and discriminatory behaviours toward people with epilepsy.

Antiepileptic drug utilisation and seizure outcome among paediatric patients in a Malaysian public hospital

INTRODUCTION

The primary purpose of this study was to evaluate the utilisation pattern and seizure outcome of newer and older antiepileptic drugs in paediatric clinical practice in a Malaysian hospital setting.

METHODS

Over a two-month period, all paediatric epilepsy patients from Penang General Hospital, Malaysia who were diagnosed according to the classification of the International League Against Epilepsy were followed up prospectively, and the patients' information was gathered with the help of a validated data collection form. This included demographic characteristics, monotherapy and polytherapy of antiepileptic drugs, as well as the number of seizures experienced.

RESULTS

Partial seizures, including complex and simple partial seizures (47.2 percent), followed by generalised seizures (40 percent), were the most common seizure types found in this study. An average of 1.51 antiepileptic drugs per patient was prescribed, with 54.3 percent of the patients on monotherapy and 45.7 percent on polytherapy. Overall, sodium valproate was the most frequently prescribed antiepileptic drug (36.8 percent), followed by carbamazepine (30.2 percent) and lamotrigine (10.4 percent). Carbamazepine was the most frequently prescribed monotherapy (28.6 percent), followed by sodium valproate (17.1 percent). The newer antiepileptic drugs were also found to be used as monotherapy in 7.2 percent of the cases. Moreover, a significant difference was observed between the older and newer antiepileptic drugs in terms of the number of seizures experienced (p=0.027). Most (75 percent) of the seizure-free patients were on carbamazepine monotherapy.

CONCLUSION

Monotherapy was the most frequently used remedy in all forms of epilepsy. Overall, sodium valproate was the most commonly used drug, while carbamazepine was found to be more frequently used as monotherapy. There was a significant difference found between the older and newer antiepileptic drugs, with 87.5 percent of seizure-free patients on older antiepileptic drugs.

Structure-function of the cytochrome b6f complex

The structure and function of the cytochrome b6f complex is considered in the context of recent crystal structures of the complex as an eight subunit, 220 kDa symmetric dimeric complex obtained from the thermophilic cyanobacterium, Mastigocladus laminosus, and the green alga, Chlamydomonas reinhardtii. A major problem confronted in crystallization of the cyanobacterial complex, proteolysis of three of the subunits, is discussed along with initial efforts to identify the protease. The evolution of these cytochrome complexes is illustrated by conservation of the hydrophobic heme-binding transmembrane domain of the cyt b polypeptide between b6f and bc1 complexes, and the rubredoxin-like membrane proximal domain of the Rieske [2Fe-2S] protein. Pathways of coupled electron and proton transfer are discussed in the framework of a modified Q cycle, in which the heme c(n), not found in the bc1 complex, but electronically tightly coupled to the heme b(n) of the b6f complex, is included. Crystal structures of the cyanobacterial complex with the quinone analogue inhibitors, NQNO or tridecyl-stigmatellin, show the latter to be ligands of heme c(n), implicating heme c(n) as an n-side plastoquinone reductase. Existing questions include (a) the details of the shuttle of: (i) the [2Fe-2S] protein between the membrane-bound PQH2 electron/H+ donor and the cytochrome f acceptor to complete the p-side electron transfer circuit; (ii) PQ/PQH2 between n- and p-sides of the complex across the intermonomer quinone exchange cavity, through the narrow portal connecting the cavity with the p-side [2Fe-2S] niche; (b) the role of the n-side of the b6f complex and heme c(n) in regulation of the relative rates of noncyclic and cyclic electron transfer. The likely presence of cyclic electron transport in the b6f complex, and of heme c(n) in the firmicute bc complex suggests the concept that hemes b(n)-c(n) define a branch point in bc complexes that can support electron transport pathways that differ in detail from the Q cycle supported by the bc1 complex.

Structure-function of the cytochrome b6f complex

The structure and function of the cytochrome b6f complex is considered in the context of recent crystal structures of the complex as an eight subunit, 220 kDa symmetric dimeric complex obtained from the thermophilic cyanobacterium, Mastigocladus laminosus, and the green alga, Chlamydomonas reinhardtii. A major problem confronted in crystallization of the cyanobacterial complex, proteolysis of three of the subunits, is discussed along with initial efforts to identify the protease. The evolution of these cytochrome complexes is illustrated by conservation of the hydrophobic heme-binding transmembrane domain of the cyt b polypeptide between b6f and bc1 complexes, and the rubredoxin-like membrane proximal domain of the Rieske [2Fe-2S] protein. Pathways of coupled electron and proton transfer are discussed in the framework of a modified Q cycle, in which the heme c(n), not found in the bc1 complex, but electronically tightly coupled to the heme b(n) of the b6f complex, is included. Crystal structures of the cyanobacterial complex with the quinone analogue inhibitors, NQNO or tridecyl-stigmatellin, show the latter to be ligands of heme c(n), implicating heme c(n) as an n-side plastoquinone reductase. Existing questions include (a) the details of the shuttle of: (i) the [2Fe-2S] protein between the membrane-bound PQH2 electron/H+ donor and the cytochrome f acceptor to complete the p-side electron transfer circuit; (ii) PQ/PQH2 between n- and p-sides of the complex across the intermonomer quinone exchange cavity, through the narrow portal connecting the cavity with the p-side [2Fe-2S] niche; (b) the role of the n-side of the b6f complex and heme c(n) in regulation of the relative rates of noncyclic and cyclic electron transfer. The likely presence of cyclic electron transport in the b6f complex, and of heme c(n) in the firmicute bc complex suggests the concept that hemes b(n)-c(n) define a branch point in bc complexes that can support electron transport pathways that differ in detail from the Q cycle supported by the bc1 complex.

Comparison of ketorolac with morphine for intra-operative analgesia in patients undergoing total abdominal hysterectomy

OBJECTIVE

To compare ketorolac 0.35 mg x kg(-1) with morphine 0.1 mg x kg(-1) for hemodynamic stability, efficacy of analgesia and incidence of side effects in patients undergoing elective total abdominal hysterectomy.

METHODS

Fifty ASA I and II patients, were enrolled in a prospective, randomized and double blind study. They were divided in two equal groups. Group K received Inj. Ketorolac 0.35 mg x kg(-1) while group M received Inj. Morphine 0.1 mg x kg(-1) 5 minutes before induction of anaesthesia. Hemodynamic responses to laryngoscopy, endotracheal intubation, and surgical incision were noted.

RESULTS

Data was entered and analysis was done using SPSS version 10.0. Student-t test and comparison of proportions were done where required. ANOVA was done and a p-value of <0.05 was considered statistically significant. There was a significant rise in heart rate, systolic, diastolic and mean arterial pressure in ketorolac group (K) as compared to baseline values at points of endotracheal intubation and surgical incision. Patients in Morphine group (M) showed a significant increase in heart rate only. There was no statistically significant difference between the two groups for supplemental analgesia requirement intraoperatively and postoperatively. Complications seen with group K were increased surgical wound bleeding in 2 patients (8%), nausea and vomiting in 4 patients (16%) while in group M there was nausea and vomiting in 5 patients (20%), and respiratory depression in 1 patient (4%).

CONCLUSION

Although hemodynamic stability at points of painful stimulation was lower in patients given ketorolac as compared to morphine, Ketorolac has a place in the intraoperative pain relief in Pakistan and other developing countries where availability of powerful narcotics is erratic.

Male complications of female genital mutilation

Female genital mutilation (FGM) is known to cause a wide range of immediate and long-term complications for women subjected to the practice. Male complications due to FGM have, however, not been described before. The objectives of this study were to explore male complications and attitudes with regard to FGM. A village in the Gezira Scheme along the Blue Nile in Sudan constituted the basis of the study. Interviews were carried out according to a pre-tested questionnaire, using structured questions with open-answer possibilities. Married men of the youngest parental generation and grandfathers were randomly selected from up-to-date election lists. All respondents except one agreed to be interviewed. A total of 59 men were interviewed, 29 young men and 30 grandfathers. Male complications resulting from FGM, such as difficulty in penetration, wounds/infections on the penis and psychological problems were described by a majority of the men. Most men were also aware of the female complications. More young than old respondents would have accepted a woman without FGM to become their daughter-in-law (p < 0.03). A majority of the young men would have preferred to marry a woman without FGM. This proportion was significantly higher than among the grandfathers (p < 0.01). Female genital mutilation can no longer be considered to be only an issue for women. The acknowledged male complications and attitudes described may open new possibilities to counteract the practice of FGM.

A community based study on the change of practice of female genital mutilation in a Sudanese village

OBJECTIVE

To investigate the practice of female genital mutilation (FGM), among young and old parents.

METHODS

One hundred and twenty young parents and grandparents in a rural area in central Sudan were randomly selected for interviews carried out according to structured questionnaires with open answer possibilities.

RESULTS

All female respondents had undergone FGM. Of the young respondents, 44% had decided not to let their daughters undergo FGM. Young fathers were more involved in the decision process than previously known, especially when decisions were taken not to perform FGM. Tradition and social pressure were the main motives for performing FGM. Sexuality was an important aspect, mentioned both as motives for and against FGM. Religious belief and education level significantly affected to what extent FGM was practiced.

CONCLUSION

This is the first community based study of FGM indicating a significant shift in practice between generations, young parents starting to question the value of FGM.

Results of arthroscopic treatment of symptomatic loss of extension following anterior cruciate ligament reconstruction

Symptomatic loss of knee extension is an important cause of postoperative morbidity following anterior cruciate ligament reconstruction. In a series of 342 consecutive reconstructions performed by the senior author, 17 knees in 16 patients had symptomatic extension deficits (>5 degrees) refractory to a minimum of 4 months of intensive physical therapy that required arthroscopic debridement. Thirteen knees in 12 patients were available for evaluation at a mean follow-up of 3.9+/-1.7 years and form the treatment group. Twenty-six knees in 26 patients who underwent reconstruction but did not develop arthrofibrosis were matched to the treatment group and served as controls. At a mean of 12+/-8 months following reconstruction, patients in the treatment group underwent examination under anesthesia, arthroscopic debridement, revision notchplasty as necessary, and controlled manipulation. Postoperatively, patients were assigned to a closely supervised rehabilitation protocol emphasizing restoration of knee extension. At final evaluation, knee extension deficits had improved from a preoperative mean of 10 degrees (SD 5 degrees) to 3 degrees (SD 4 degrees) (P<.001). Multiple functional rating scales also were used to evaluate the treatment and control groups. With the numbers available, there was no statistically significant difference in function at final evaluation between the treatment and control groups. The best treatment for loss of knee extension is preventive. Complications are avoided by careful patient selection, appropriate timing of surgery, attention to operative detail, and aggressive rehabilitation. However, patients reaching a plateau in rehabilitation with significant residual extension deficits, patellofemoral symptoms, or both predictably benefit from arthroscopic debridement.

What's new in shoulder surgery

The purpose of this update on shoulder surgery is to discuss, in summary fashion, topics presented at selected orthopaedic meetings during the time-period of August 1999 to July 2000. Sources for this article were presentations and symposia at meetings of the American Orthopaedic Society for Sports Medicine (Specialty Day, Orlando, Florida, March 2000, and the Twenty-sixth Annual Meeting, Sun Valley, Idaho, June 2000), the Arthroscopy Association of North America (Specialty Day, Orlando, Florida, March 2000, and the Nineteenth Annual Meeting, Miami, Florida, April 2000), the American Academy of Orthopaedic Surgeons (Sixty-seventh Annual Meeting, Orlando, Florida, March 2000), the American Shoulder and Elbow Surgeons (Specialty Day, Orlando, Florida, March 2000, and the Sixteenth Annual Meeting, Philadelphia, Pennsylvania, October 1999), and the American Orthopaedic Association (113th Annual Meeting, Hot Springs, Virginia, June 2000).

Actions of the anticonvulsant remacemide metabolite AR-R12495AA on afferent-evoked spinal synaptic transmission in vitro and on models of acute and chronic inflammation in the rat

The effects of the anticonvulsant remacemide [(+/-)-2-amino-N-(1-methyl-1,2-diphenylethyl)-acetamide hydrochloride] and its metabolite AR-R12495AA [(+/-)-1-methyl-1, 2-diphenylethylamine-monohydrochloride] on primary afferent synaptic transmission were assessed in the young rat spinal cord in vitro. Stimulation of dorsal roots at A- and C-afferent intensity elicited a dorsal root-evoked ventral root potential (DR-VRP) with a slowly decaying phase. Repetitive stimuli (2 Hz) produced summation of slow potentials and a cumulative ventral root depolarization (CVRD), a form of wind-up. Remacemide and AR-R12495AA antagonized the DR-VRP slow peak t(1/2) decay and slow phase total duration at drug concentration of > or =25 microM. AR-R12495AA was approximately 2-fold more potent than remacemide. The most potent action was against the slow phase duration with IC(50) values of 157 and 60 microM for remacemide and AR-R12495AA, respectively. Both drugs at concentrations of > or =100 microM attenuated the DR-VRP fast peak amplitude (IC(50) = 253 and 142 microM, respectively). The amplitude of CVRD was reduced by remacemide and AR-R12495AA (IC(50) = 195 and 111 microM, respectively). MK-801 reduced DR-VRP fast peak amplitude (IC(50) = 58 microM), slow peak t(1/2) decay (IC(50) = 60 microM), slow phase duration (IC(50) = 50 microM), and CVRD amplitude (IC(50) = 91 microM). In behavioral studies, AR-R12495AA (i.p.) reduced the mechanical hyperalgesia and paw swelling that followed hind paw injection of carrageenan or Freund's complete adjuvant. These electrophysiological and behavioral data indicate further studies should be conducted on the efficacy of remacemide and AR-R12495AA as putative analgesics.

The anticonvulsant remacemide and its metabolite AR-R12495AA attenuate spinal synaptic transmission and carrageenan-induced inflammation in the young rat

The effects of the anticonvulsants remacemide [(+/-)-2-amino-N-(1-methyl-1,2-diphenylethyl)-acetamide hydrochloride] and its des -glycinated metabolite AR-R12495AA [(+/-)-1-methyl-1,2-diphenylethylamine- monohydrochloride] on primary afferent-induced synaptic transmission and frequency-dependent summation of synaptic potentials were assessed in the young rat spinal cord in vitro. Behavioural studies in the rat determined the effects of these anticonvulsant compounds in the carrageenan model of inflammation. Recordings of the extracellular dorsal root-evoked ventral root potential (DR-VRP) revealed a significant reduction of the duration and t(1)-(2)decay of the long latency, slow DR-VRP by remacemide (50 and 100 microM) and AR-R12495AA (25, 50 and 100 mM). The short-latency, fast monosynaptic DR-VRP peak was reduced by only the highest concentration of AR-R12495AA (100 microM). In intracellular dorsal root-evoked excitatory postsynaptic potentials (DR-EPSPs) of single ventral horn neurons, AR-R12495AA (100 microM) attenuated the time course of the long-latency (slow) EPSP. Frequency-dependent (0.5-2.0 Hz) summation of dorsal root-evoked synaptic events (recorded extracellularly as the cumulative ventral root depolarization (CVRD), and intracellularly as wind-up) was attenuated by remacemide (100 microM) and AR-R12495AA (50 and 100 microM). Pre-treatment with intra-peritoneal injection of 75 mg/kg of remacemide or AR-R12495AA caused a significant reduction of carrageenan-induced mechanical hyperalgesia and oedema. These electrophysiological and behavioural data provide evidence that remacemide and AR-R12495AA may also possess analgesic and anti-inflammatory activity.

Excitation of Oscillations in the Magnetic Network on the Sun

We examine the excitation of oscillations in the magnetic network of the Sun through the footpoint motion of photospheric magnetic flux tubes located in intergranular lanes. The motion is derived from a time series of high-resolution G-band and continuum filtergrams using an object-tracking technique. We model the response of the flux tube to the footpoint motion in terms of the Klein-Gordon equation, which is solved analytically as an initial value problem for transverse (kink) waves. We compute the wave energy flux in upward-propagating transverse waves. In general we find that the injection of energy into the chromosphere occurs in short-duration pulses, which would lead to a time variability in chromospheric emission that is incompatible with observations. Therefore, we consider the effects of turbulent convective flows on flux tubes in intergranular lanes. The turbulent flows are simulated by adding high-frequency motions (periods 5-50 s) with an amplitude of 1 km s(-1). The latter are simulated by adding random velocity fluctuations to the observationally determined velocities. In this case, we find that the energy flux is much less intermittent and can in principle carry adequate energy for chromospheric heating.

Relationship between vertical ground reaction force and speed during walking, slow jogging, and running

OBJECTIVE: To obtain descriptive information between vertical ground reaction force (GRF)-time histories and gait speed, running style, and gender. DESIGN: GRF-time history measurements were obtained from male and female subjects during walking, slow jogging, jogging and running on an indoor platform. BACKGROUND: Previous studies have established GRF descriptor variables for male subjects running at speeds from 3 to 6 m s(-1), but very little descriptive data exists for slower or faster running, nor have previous studies reported GRF descriptors separately for female subjects. METHODS: GRF-time histories were recorded for 13 male and 10 female recreational athletes during walking and slow jogging at speeds between 1.5 and 3.0 m s(-1), and running at speeds between 3.5 and 6.0 m s(-1). Vertical GRF-time data for trials with speeds within 0.2 m s(-1) of the prescribed speed were analysed to determine thrust maximum GRF (F(z)) and loading rate (G(z)). RESULTS: In both male and female subjects, F(z) increased linearly during walking and running from 1.2 BW to approximately 2.5 BW at 6.0 m s(-1), remaining constant during forward lean sprinting at higher speeds. F(z) was linearly correlated to G(z), the latter ranging from 8 to 30 BW s(-1) over this speed range. Slow jogging was associated with a > 50% higher F(z) and G(z) in comparison to walking or fast running. CONCLUSIONS: Similar GRF descriptor data and velocity relationships were obtained for male and female subjects. Impact forces were greatest when the subjects adopted a higher, less fixed centre of gravity during slow jogging. RELEVANCE: These results suggest that vertical GRF norms can be established for male and female subjects alike, and that slow or fast running with a lower, fixed centre of gravity decreases impact forces.

Increased baseline sway contributes to increased losses of balance in older people following triazolam

OBJECTIVE

Although it has been stated frequently that older people are more sensitive to benzodiazepines, the relative roles of impaired baseline performance, impaired elimination, and altered responsiveness have not been defined. We evaluated postural sway and plasma triazolam concentrations after administration of placebo and triazolam 0.375 mg in both young and older healthy subjects.

DESIGN

Double-blind placebo-controlled trial.

PARTICIPANTS

Nine young and nine older healthy men.

INTERVENTION

All subjects received triazolam 0.375 mg or placebo on different study days, which were separated by at least 48 hours.

MEASUREMENTS

Postural sway, visual analog scale of drowsiness, and plasma triazolam levels.

RESULTS

The older subjects swayed more during triazolam than did the younger subjects, and this resulted in an increased number of losses of balance. This difference appeared to be caused by greater baseline sway in the older subjects rather than higher concentrations or increased responsiveness. A subset of older people had a much greater number of losses of balance during triazolam than did the rest of the subjects, and these individuals could be identified from their baseline sway.

CONCLUSIONS

In this study, the increase in drug effect seen in the older subjects was of similar magnitude to that of the young, but it resulted in greater postural sway after drug administration than was seen in the young. The higher postural sway and the corresponding increased instability seen in the older subjects may put these older persons at increased risk of drug-related falls. This study also suggests that it should be possible to develop techniques that will identify individuals at particular risk of drug-induced postural instability.

Effect of chlorpromazine as a sensitizer of rat brain on radiation-induced AMP and adenosine metabolism

The role of AMP and adenosine was investigated in the radiosensitization of normal brain tissues by chlorpromazine. Their metabolism was evaluated by estimating the levels of 5'-nucleotidase and adenosine deaminase activity in the brains of rats treated with chlorpromazine alone or chlorpromazine and irradiation. The extent of lipid peroxidation, measured in terms of the lipid peroxidase enzyme formed, increased with chlorpromazine treatment and irradiation. Chlorpromazine treatment was found to decrease AMP and adenosine metabolism, as shown by a marked reduction in the level of 5'-nucleotidase and ADA activity which was accompanied by a marked curtailment in the DNA, RNA and protein contents of the brain. Chlorpromazine was also found to increase the radiation-induced activity of acid phosphatase, indicating its action on the lysosomal activity of the brain cells. In the present study a low dose of chlorpromazine, i.e. 17 mg/kg body weight, was found to be more effective than a high dose of 34 mg/kg. The results of this study suggest that chlorpromazine probably sensitizes normal brain tissues to radiation by inhibiting AMP and adenosine metabolism via a hydroxy-radical induced decrease in DNA, RNA and protein metabolism with a concomitant increase in lysosomal activity.

Effect of prochlorperazine as a sensitizer of rat skin on radiation-induced AMP metabolism

The role of AMP was investigated in radiosensitization by the use of prochlorperazine in normal rat skin. AMP metabolism was evaluated by estimating the level of activities of 5' nucleotidase vis-à-vis protein, DNA and RNA contents in prochlorperazine-treated plus irradiated skin. To study radiation-induced changes in the skin, the extent of lipid peroxidation was measured in terms of enzyme lipid peroxidase. After irradiation, lipid peroxidase activity was observed to increase in prochlorperazine-treated rat skin. Subsequently the level of 5' nucleotidase was found to decrease in drug-treated plus irradiation skin. Similarly, the suppression in the levels of DNA, RNA and protein contents increased when the rat skins was irradiated in the presence of sensitizer prochlorperazine. The cytological examination, which revealed the extent of the lesions occurring in the normal rat skin, and the biochemical examination demonstrated increased cellular lethality in prochlorperazine-sensitized skin after irradiation. The results suggest that prochlorperazine probably sensitizes the normal skin tissues to radiation by inhibiting AMP metabolism via hydroxy-radical-induced decrease in DNA, RNA and protein metabolism.

Triazolam in cirrhosis: pharmacokinetics and pharmacodynamics

Although it is frequently stated that patients with cirrhosis are more sensitive to benzodiazepines, the relative roles of impaired elimination and altered responsiveness have not been clarified. We evaluated the pharmacokinetics, pharmacodynamics, and sensitivity to triazolam in six patients with clinically stable cirrhosis and six age-matched control subjects. Our findings show that there were no significant differences between the patients with cirrhosis and the control subjects in any of the pharmacokinetic parameters. Drug effect, measured as postural sway, was also similar in the patients with cirrhosis and control subjects; therefore the ratio of effect area under the curve to concentration area under the curve, a measure of sensitivity, did not differ significantly between the patients with cirrhosis and the control subjects. Because triazolam is metabolized by P4503A, we hypothesized that the effects of cirrhosis on drug metabolism may differ with respect to the specific P450 responsible for the oxidation of this drug. These effects may differ because of the relative sparing of a specific P450 and because of an extrahepatic site of metabolism.

Thoracoscopic management of malignant pleural effusion

The results of thoracoscopic biopsy and talc pleurodesis in the management of malignant pleural effusions, is analysed. The study population consisted of 213 patients. Pre-operative cytology was positive in only 27% of patients; the diagnostic yield using thoracoscopic biopsy was 91.5%. (Sensitivity 99%; specificity 100%; positive predicted value 100%; negative predicted value 88%). Talc pleurodesis at thoracoscopy produced symptomatic improvement in 93% of patients. Post-operative complications occurred in 3.7% and there was a 2.3% mortality. Recurrent effusion was not a significant clinical problem. Thoracoscopy enhances the accuracy of diagnosis of pleural effusions; simultaneous talc pleurodesis has a high therapeutic success.

Dose-related effect of triazolam on postural sway

Measurement of clinically relevant benzodiazepine drug effects at hypnotic and anxiolytic doses has been difficult because most measures are subjective, difficult to interpret, or relate to anesthetic doses. A potentially useful measure of drug effect is postural sway, which is a manifestation of the corrective mechanisms associated with the maintenance of upright posture. Postural sway was measured over 8 hours, with a biomechanics force platform, in six healthy male volunteers who received triazolam, 0.125, 0.250, or 0.375 mg, or placebo in a randomized double-blind study. Our results show a dose-dependent increase in postural sway measured as the elliptical area or the 95% confidence ellipse for the area covered by the subjects' sway. After triazolam, 0.250 and 0.375 mg, the area under the sway-time curve and peak effect increased significantly compared with placebo (p less than 0.05). The number of losses of balance when subjects stood on one foot also showed a significant increase with increased dose (p less than 0.05). The rate of loss of balance was positively correlated with the extent of postural sway (r = 0.802; p less than 0.001). The extent of sway when the subjects were drug free predicted this increase in a subject's postural sway with triazolam. Thus at hypnotic or anxiolytic doses of triazolam, computer-assisted force platform measures of sway provide a clinically relevant measure of drug effect. Measurement of drug-induced postural sway may be useful in persons at risk for falls, such as the elderly.

[The effect of low doses of x-rays on the biochemical processes in the brain and on urinary metabolites in fasted rats]

The effect of mild doses of X-rays (three fractions, each of 100 R) on energy metabolism of the brain of starved rats has been investigated. It is inferred that X-radiation may cause serious detrimental changes of enzymes involved in glucose metabolism (glucose-6-phosphate dehydrogenase and fructose diphosphate aldolase) and in peroxidation (of catalase and lipid peroxidase), and of the acetylcholine activity which is determined by the cholinesterase level. Dynamics of changes in the protein and nucleic acid content of the brain has been studied. It has been shown that the level of 4-HIAA and 3M4HMA in the brain increases after irradiation of starved and normally fed rats.

Effect of loss of balance on biomechanics platform measures of sway: influence of stance and a method for adjustment

This paper describes a method for adjusting biomechanics platform measures of sway for loss of balance. Area and velocity measures of sway were determined in forty-seven elderly women, in double and single leg stance, first with their eyes open, then closed. Subjects were rarely able to complete 10 s trials during single leg stances. Therefore, a method was developed for eliminating data associated with loss of balance. Monitoring changes in vertical force and velocity by computer, those points exceeding trial specific thresholds associated with loss of balance were truncated. In double leg stances, loss of balance increased area measures by 0.3%, but did not effect velocity measures. In contrast, the loss of balance increased area measures by 0-3%, but did not effect velocity measures. In contrast, the loss of balance experienced by most subjects in single leg stance exaggerated area measures by 16-38%, and velocity measures by up to 10%. In double leg stances the correlations between unadjusted area measures and area measures adjusted for loss of balance ranged from 0.98 to 1.00. In single leg stances, the correlations for the area measures ranged from 0.69 to 0.89. The correlations between adjusted and unadjusted velocity measures were 1.00 and 0.93 for the double and single leg stances respectively. Although the question of which sway measure is best remains unanswered, this study provides useful data for future research. First, it demonstrates a method for modifying area representations of the center of pressure excursions for the effects of loss of balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole body X-irradiation and impact of dietary factors on brain and testes of albino rats

The study was undertaken to investigate the radioprotective effect of protein diet on the irradiated brain and testes. The study indicated that the less availability of protein in the diet caused a marked reduction in the protein and nucleic acid (DNA and RNA) contents of brain after irradiation. Further, the protein deficiency in diet brought about an increased deamination of protein in the brain of irradiated rats. It was noted that in response to irradiation the testes of protein deficient diet fed rats got adversely affected as compared to high protein diet fed animals. This paper gives evidence that feeding of protein enriched diet provides protection against ionizing radiation.

Chronic effect of datura (seed) extract on the brain of albino rats

The effect of chronic treatment with datura (seed) extract was studied to investigate its effect on the energy metabolism and peroxidative activities in the brain of rats. Datura treatment was found to cause an increase in the activity of brain lipid peroxidase and catalase, while it caused a decrease in the activity of fructose diphosphate aldolase and glucose 6-phosphate dehydrogenase enzyme. A marked reduction was noted in the protein, DNA and RNA contents of datura administered rats.

Effect of a mild dose of X-irradiation on rats under stress

This investigation was apt at studying the effect of a mild dose of X-rays on the normal and shock administered rats. Administration of stress brought about a marked depression in the contents of DNA, RNA and protein in the brain. On the other hand, total body exposure to X-rays was found to increase the levels of DNA, RNA and protein in the brain. Thus, the use of a mild dose of X-rays in stressed animals seems to be stimulatory to the diminished levels of DNA, RNA and protein in the brain. There were rising levels of 5-hydroxy indol acetic acid and Vinyl mandelic acid in the urine of stress administered rats and the enhanced levels of these urinary metabolites appeared to be refractory to the application of X-rays.

Effect of two graded doses of whole-body X-irradiation and radioprotection by the use of S-phenethyl formamidino 4(N-ethyl isothioamide) morpholine dihydrochloride

The protection offered by a newly synthesized compound (S-phenethyl-formamidino-4(N-ethyl isothioamide) morpholine dihydrochloride) against radiation effects on DNA, RNA and protein biosynthetic processes in the brain, and on metabolites of 5-HT and nor-adrenalin, i.e., 5-HIAA and VMA, in the urine, including the radiobiological damage to thyroid and testes, was evaluated. The use of the compound prior to irradiation prevented radiation-induced changes in the thyroid and testes. The radiation-induced alterations in the pattern of DNA, RNA, protein in the brain, and in 5-HIAA and VMA in urine could be averted by treatment with this compound prior to each dose of X-irradiation.