Strength training for partially paralysed muscles in people with recent spinal cord injury: a within-participant randomised controlled trial.

STUDY DESIGN: Within-participant randomised controlled trial. OBJECTIVES: To determine whether strength training combined with usual care increases strength in partially paralysed muscles of people with recent spinal cord injury (SCI) more than usual care alone. SETTINGS: SCI units in Australia and India. METHODS: Thirty people with recent SCI undergoing inpatient rehabilitation participated in this 12-week trial. One of the following muscle groups was selected as the target muscle group for each participant: the elbow flexors, elbow extensors, knee flexors or knee extensors. The target muscle on one side of the body was randomly allocated to the experimental group and the same muscle on the other side of the body was allocated to the control group. Strength training was administered to the experimental muscle but not to the control muscle. Participants were assessed at baseline and 12 weeks later. The primary outcome was maximal isometric muscle strength, and the secondary outcomes were spasticity, fatigue and participants' perception of function and strength. RESULTS: There were no dropouts, and participants received 98% of the training sessions. The mean (95% confidence interval (CI)) between-group difference for isometric strength was 4.3 Nm (1.9-6.8) with a clinically meaningful treatment effect of 2.7 Nm. The mean (95% CI) between-group difference for spasticity was 0.03/5 points (-0.25 to 0.32). CONCLUSION: Strength training increases strength in partially paralysed muscles of people with recent SCI, although it is not clear whether the size of the treatment effect is clinically meaningful. Strength training has no deleterious effects on spasticity.

Deep brain stimulation can suppress pathological synchronisation in parkinsonian patients.

BACKGROUND: Although deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a highly effective therapeutic intervention in severe Parkinson's disease, its mechanism of action remains unclear. One possibility is that DBS suppresses local pathologically synchronised oscillatory activity. METHODS: To explore this, the authors recorded from DBS electrodes implanted in the STN of 16 patients with Parkinson's disease during simultaneous stimulation (pulse width 60 µs; frequency 130 Hz) of the same target using a specially designed amplifier. The authors analysed data from 25 sides. RESULTS: The authors found that DBS progressively suppressed peaks in local field potential activity at frequencies between 11 and 30 Hz as voltage was increased beyond a stimulation threshold of 1.5 V. Median peak power had fallen to 54% of baseline values by a stimulation intensity of 3.0 V. CONCLUSION: The findings suggest that DBS can suppress pathological 11-30 Hz activity in the vicinity of stimulation in patients with Parkinson's disease. This suppression occurs at stimulation voltages that are clinically effective.

Quantitative determination of airborne respirable non-fibrous alpha-silicon carbide by x-ray powder diffractometry.

OBJECTIVES: The purpose of the present investigation was to establish a method for the determination of airborne respirable non-fibrous silicon carbide (SiC). The main application is within the industrial production of SiC. METHODS: Due to the complex airborne aerosol mixture of crystalline compounds in the SiC industry, X-ray powder diffractometry was selected as the most appropriate method. Without any international standard material for the respirable fraction of non-fibrous SiC, pure and suitable products from three SiC plants in Norway were selected. These products have a median particle diameter in the range 4.4-5.1 mum. The method is based on thin sample technique, with the dust deposited on a polycarbonate filter. Absorption correction is done by standard procedures with the use of a silver filter, situated below the polycarbonate filter. RESULTS: The diffraction line used for quantitative determination was selected carefully. This was done to avoid interferences from quartz, cristobalite, and graphite, which all are airborne components present in the atmosphere during the industrial process. The instrumental limit of detection for the method is 12 microg. CONCLUSIONS: This method has been used to determine airborne non-fibrous SiC in a comprehensive ongoing project in the Norwegian SiC industry for further epidemiological studies. The method is fully applicable for compliance work.

Exposure to fibres, crystalline silica, silicon carbide and sulphur dioxide in the norwegian silicon carbide industry.

OBJECTIVES: The aim of this study was to assess personal exposure to fibres, crystalline silica, silicon carbide (SiC) and sulphur dioxide in the Norwegian SiC industry. METHODS: Approximately 720 fibre samples, 720 respirable dust samples and 1400 total dust samples were collected from randomly chosen workers from the furnace, processing and maintenance departments in all three Norwegian SiC plants. The respirable dust samples were analysed for quartz, cristobalite and non-fibrous SiC content. Approximately 240 sulphur dioxide samples were collected from workers in the furnace department. RESULTS: The sorting operators from all plants, control room and cleaning operators in Plant A and charger, charger/mix and payloader operators in Plant C had a geometric mean (GM) of fibre exposure above the Norwegian occupational exposure limit (OEL) (0.1 fibre cm(-3)). The cleaner operators in Plant A had the highest GM exposure to respirable quartz (20 mug m(-3)). The charger/mix operators in Plant C had the highest GM exposure to respirable cristobalite (38 mug m(-3)) and the refinery crusher operators in Plant A had the highest GM exposure to non-fibrous SiC (0.65 mg m(-3)). Exposure to the crystalline silica and non-fibrous SiC was generally low and between 0.4 and 2.1% of the measurements exceeded the OELs. The cleaner operators in Plant A had the highest GM exposure to respirable dust (1.3 mg m(-3)) and total dust (21 mg m(-3)). GM exposures for respirable dust above the Norwegian SiC industry-specific OEL of 0.5 mg m(-3) were also found for refinery crusher operators in all plants and mix, charger, charger/mix and sorting operators in Plant C. Only 4% of the total dust measurements exceeded the OEL for nuisance dust of (10 mg m(-3)). Exposure to sulphur dioxide was generally low. However, peaks in the range of 10-100 p.p.m. were observed for control room and crane operators in Plants A and B and for charger and charger/mix operators in Plant C. CONCLUSION: Workers in the SiC industry are exposed to a mixture of several agents including SiC fibres, quartz, cristobalite, non-fibrous SiC and sulphur dioxide. Exposure levels were generally below the current Norwegian OELs; however, high exposure to fibres and respirable dust still occurs in the furnace department.

Airborne fibres in the norwegian silicon carbide industry.

Morphology of silicon carbide (SiC) fibres from the Norwegian SiC industry has been studied by scanning electron microscopy (SEM). The fibres are an unwanted side-product in SiC production. They represent a probable cause of the observed increased occurrence of lung diseases among SiC workers. The main aim of this work is to give a detailed description of the morphological variation of the fibres. Furthermore, it is important to study the occurrence of various morphological types with respect to job types and process parameters. SiC fibres accounted for >90% of all fibres observed. Eight categories of SiC fibres are described based on their morphology. The most frequent fibre category had a smooth surface and accounted for more than half of the observed SiC fibres. The diameter distributions of the eight fibre types were significantly different except for two of the categories. More than 99% of the SiC fibres observed were <3 microm in diameter, satisfying one WHO criterion for health relevant fibres. The aspect ratio and diameter of health-relevant fibres generally followed a lognormal distribution for different fibre categories, whereas fibre length did not. The proportions of SiC fibres (all categories) did not differ significantly between the plants. The proportions differed between plants for two SiC fibre categories including the most dominant type. For two SiC fibre categories and the SiC cleavage fragments differences were observed between job groups. Two other fibre categories were correlated with type of SiC produced (i.e. black or green SiC) and sawdust added to the raw material mix.

Hazardous peak concentrations of hydrogen sulfide gas related to the sewage purification process.

The concentration of hydrogen sulfide in the atmosphere of a sewage purification plant in Norway was studied. Continuous measurements over several 3-week periods showed that the concentrations generally were lower than 2 ppm, but peak concentrations over 100 ppm were discovered. Rapid onset and decline characterized these peak concentrations, which occurred at regular intervals. Through evaluation of the time pattern of these peaks compared with plant operations, a specific process was identified as the likely causative factor of the spikes. Through simple remedial actions the hydrogen sulfide concentration associated with this activity was reduced from above 100 ppm to less than 2 ppm. Olfactory fatigue to hydrogen sulfide and strong offensive odors from other compounds in the sewage makes smell ineffective for signaling high concentrations. Peak concentrations may therefore pass unnoticed unless detected with continuous measuring equipment. The risk for exposure may be reduced by enclosing processes and through the use of spot extraction ventilation in areas with compacted anaerobic waste material.

Changes in Na+, K(+)-adenosinetriphosphatase, citrate synthase and K+ in sheep skeletal muscle during immobilization and remobilization.

The K+ balance and muscle activity seem to interact in a complex way with regard to regulating the muscle density of Na(+)-K+ pumps. The effect of immobilization was examined in ten sheep that had low muscle K+ content. Three additional sheep served as untreated controls. After being brought from pasture to sheep stalls one hindlimb was immobilized in a plaster splint for 9 weeks, and in five of the animals remobilization was carried out for a further 9 weeks. The weight bearing of the leg in plaster was recorded by a force plate. Open muscle biopsies from the vastus lateralis muscle were obtained before the study, after 9 weeks of immobilization, and after another 9 weeks of remobilization. The Na(+)-K+ pump density was measured as [3H]-ouabain binding to intact tissue, and citrate synthase activity was measured in tissue homogenate. The tissue content of K+ was measured in fat-free dried tissue. Muscle K+ content increased linearly by almost 70% through the 18-week period independent of intervention. Immobilization reduced thigh circumference by 8% (P < 0.05). A slight decrease in the area of type I fibres at 9 weeks and a slight increase at 18-weeks was found. The [3H]-ouabain binding was reduced by 39% and 22% in the immobilized and control legs, respectively, whereas citrate synthase activity was reduced by about 30% in both legs after 9 weeks of immobilization. During remobilization both the [3H]-ouabain binding and the citrate synthase activity increased to the same level as in the control animals. The plaster cast significantly reduced mass bearing of the immobilized leg, and a corresponding reduction in muscle activity must be assumed to have occurred in both legs as judged from citrate synthase activity. We concluded from this study that the reduction in the [3H]-ouabain binding during immobilization independent of an increase in muscle K+ content points to muscle activity as a strong stimulus for control of Na(+)-K+ pump density.

Predicting garment pattern dimensions from photographic and anthropometric data.

Traditional linear measurements (lengths and circumferences taken over the body surface with a tape measure) were compared with measurements of frontal and lateral view photographs for usefulness in determining pattern dimensions for the upper torso of the female body form. The statistical regression models developed indicated that, while linear measurements provided slightly more accuracy in predicting a few of the pattern dimensions, the photographic measurements were more accurate in predicting others, particularly pattern angles. Photographic measurements hold promise as an alternative to the more intrusive linear measurements for predicting pattern dimensions.

Dental amalgam and mercury.

The mercury concentrations in blood (HgB) and urine (HgU) samples, and in exhaled air (HgAir) were measured in 147 individuals from an urban Norwegian population, using cold vapour atomic absorption spectrometry. The study aimed to estimate the mercury exposure from the dental restorations, by correlating the data to the presence of amalgam restorations. Mean values were HgB = 24.8 nmol/l, HgU = 17.5 nmol/l and HgAir = 0.8 micrograms/m3. HgU correlated with HgAir, and both HgU and HgAir with the number of amalgam restorations, amalgam restored surfaces and amalgam restored occlusal surfaces. HgB showed poor correlation to HgU and HgAir and the presence of amalgam restorations. A differentiation of the mercury absorption due to exposure from dental amalgams and from the dietary intake, necessitates measurements of both organic and inorganic mercury in the plasma, and in the erythrocytes. The results suggest that individuals with many amalgam restorations, i.e., more than 36 restored surfaces, absorb 10-12 micrograms Hg/day.

Multivariate classification of histochemically stained human skeletal muscle fibres by the SIMCA method.

The SIMCA (soft independent modelling of class analogy) method of pattern recognition has been used to classify four muscle fibre types: I, IIA, IIB and IIC. The samples were histochemically stained human skeletal sections from biopsy material. Disjoint (separate) class modelling gave information about variables, i.e., the combinations of alkaline, acidic and Ca2+-containing preincubation procedures with appropriate discrimination power, and showed satisfactory separation of the classes (fibre types). Two serial stained muscle sections represent a minimum for a proper classification of the four fibre groups. A comparison of biopsy samples from two different persons showed significant variation in the data structure between similar fibre types, probably caused by intermuscle variations. It is suggested that the introduction of computer-assisted classification by the application of such multivariate analytical techniques both facilitates the classification of muscle fibres and improves the precision and reliability of fibre typing.

Occurrence of airborne silicon carbide fibers during industrial production of silicon carbide.

Airborne dust from the production of silicon carbide has been analyzed for particle morphology and composition. Fibers of alpha silicon carbide were identified by scanning electron microscopy (SEM) combined with energy dispersive X-ray spectrometry (EDS) and transmission electron microscopy (TEM) with selected area electron diffraction techniques (SAED). Micrographs taken at high magnification revealed several stacking periods along the fiber axis, and one or more of the polytypes 2H, 4H, or 6H could be distinguished. Preliminary investigations applying SEM showed that 80% of the fibers had diameters of less than 0.5 micron and a length greater than 5 micron. Fiber concentrations were examined by the counting of stationary and personal samples in an optical phase contrast microscope. The fiber levels in the three plants investigated were low and less than 1 fiber/cc of air (10(6) fibers/m3). Dust samples from the handling of raw material, including recycled material, contained up to 5 fibers/cc (5 X 10(6) fibers/m3).

In vitro cytotoxicity and quantitative silica analysis of diatomaceous earth products.

Mouse peritoneal macrophages were used to evaluate the relative cytotoxicity of a series of diatomaceous earth products in vitro. The amorphous and crystalline silica content of the products was determined by a combination of infrared spectroscopy and x ray powder diffraction techniques. The cytotoxicities of the high cristobalite content flux calcined materials were similar to that of the standard cristobalite ; both the natural and straight calcined materials had significantly greater activities than the flux calcined materials. Thus within the limitations of the macrophage cytotoxicity test the hypothesis that crystalline content is the only determinant of fibrogenicity of diatomaceous earth is not supported.

X-ray crystallographic and gas chromatographic--mass spectrometric studies on norpropoxyphene.

The crystal structure of norpropoxyphene maleate is presented. The conformation is discussed in relation to similar compounds. A gas chromatographic--mass spectrometric investigation indicates that earlier proposed metabolites may be formed during the gas chromatographic separation.

Crystal structures of synthetic analgetics. V. Dextromoramide.

The molecular and crystal structure of dextromoramide has been determined by X-ray methods. The crystals are orthorhombic, space group P212121 with unit cell dimensions a = 9.720(4) A; b = 12.226(3) A; c = 18.381(3) A. The structure was determined by direct methods and the model refined to an R-value of 0.036 for 1788 observed reflections. The mean e.s.d.'s in bond lengths and angles are 0.004 A and 0.3, respectively. The morpholine moiety is nearly in antiposition relative to the quaternary carbon atom C6, the pertinent angle C6 - C7 - C9 - N2 being - 159.4. This conformation is similar to that previously reported for the bitartrate of the title compound. The pyrrolidine ring has the envelope conformation and the amide group is strictly planar. The conformation of some acyclic analgetics are discussed.

Crystal structures of synthetic analgetics. IV. Dextropropoxyphene.

The molecular and cystal structure of dextropropoxyphene has been determined by X-ray methods. The crystals are monoclinic, space group P21, with unit cell dimensions a=9.257(2) A; b=9.048(3) A; c=12.074(7) A; beta=93.01(4)degrees. The phase problem was solved by direct methods and the model refined to an R-value of 0.038 for 1799 observed reflections. E.s.d's are, in average, 0.004 A and O.3 degrees in interatomic distances and angles, respectively. The propylamine chain in nearly fully extended, the dihedral angel C4-C5-C7-N being -174.2 degrees. The conformation of this side chain is similar to that in the hydrochloride of the title compound. Thus the proposed bioactive conformation is not preferred by propoxyphene in the crystalline state, as was the case for the free base of methadone.