Skeletal evidence for violent trauma from the bronze age Qijia culture (2,300-1,500 BCE), Gansu Province, China.

This research explores how social and environmental factors may have contributed to conflict during the early Bronze Age in Northwest China by analyzing violent trauma on human skeletal remains from a cemetery of the Qijia culture (2300-1500 BCE). The Qijia culture existed during a period of dramatic social, technological, and environmental change, though minimal research has been conducted on how these factors may have contributed to violence within the area of the Qijia and other contemporaneous material cultures. An osteological assessment was conducted on 361 individuals (n = 241 adults, n = 120 non-adults) that were excavated from the Mogou site, Lintan County, Gansu, China. Injuries indicative of violence, including sharp- and blunt-force trauma that was sustained ante- or peri-mortem, were identified, and the patterns of trauma were analysed. Violent injuries were found on 8.58% (n = 31/361) of individuals, primarily adult males. No evidence of trauma was found on infants or children. Cranial trauma was found on 11.8% (n = 23/195) of the adult individuals examined. Of these, 43.5% (n = 10/23) presented with severe peri-mortem craniofacial trauma. The high rate of perimortem injuries and their locations indicate lethal intent. This lethality, in addition to the fact that individuals with trauma were predominantly male, suggest intergroup violence such as raiding, warfare, or feuding. Both social and environmental factors may have contributed to this conflict in the TaoRiver Valley, though future systematic archaeological and paleoenvironmental data will be needed to disentangle the many potential causal factors.

Examining the effect of self-explanation on cognitive integration of basic and clinical sciences in novices.

Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of self-explanation during learning has the potential to promote and support the development of integrated knowledge by encouraging novices to elaborate on the causal relationship between clinical features and basic science mechanisms. To explore the effect of this strategy, we compared diagnostic efficacy of teaching students (n = 71) the clinical features of four musculoskeletal pathologies using either (1) integrated causal basic science descriptions (BaSci group); (2) integrated causal basic science descriptions combined with self-explanation prompts (SE group); (3) basic science mechanisms segregated from the clinical features (SG group). All participants completed a diagnostic accuracy test immediately after learning and 1-week later. The results showed that the BaSci group performed significantly better compared to the SE (p = 0.019) and SG groups (p = 0.004); however, no difference was observed between the SE and SG groups (p = 0.91). We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic conceptual understanding of each disease. These findings suggest that integration strategies need to be carefully structured and applied in ways that support the holistic story created by integrated basic science instruction in order to foster conceptual coherence and to capitalize on the benefits of cognition integration.

Imagen musculoesquelética en la urgencia pediátrica. Lo esencial a través de tres escenarios clínicos / Musculoskeletal imaging in pediatric emergencies: the basics through three clinical scenarios

La patología musculoesquelética pediátrica representa un alto porcentaje de los estudios solicitados al radiólogo de guardia. Al tratarse de huesos y articulaciones inmaduros, en constante crecimiento y remodelación, presentan peculiaridades fisiológicas y anatómicas propias que condicionan la necesidad de un abordaje específico para la edad pediátrica. Mediante tres escenarios clínicos (cojera, fracturas e infecciones osteoarticulares) hemos querido resumir y transmitir los conceptos esenciales de la radiología musculoesquelética en la urgencia pediátrica (AU)

A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children (AU)

The influence of electromagnetic radiation generated by a mobile phone on the skeletal system of rats.

The study was focused on the influence of electromagnetic field generated by mobile phone on the skeletal system of rats, assessed by measuring the macrometric parameters of bones, mechanical properties of long bones, calcium and phosphorus content in bones, and the concentration of osteogenesis (osteocalcin) and bone resorption (NTX, pyridinoline) markers in blood serum. The study was carried out on male rats divided into two groups: experimental group subjected to 28-day cycle of exposures in electromagnetic field of 900 MHz frequency generated by mobile phone and a control, sham-exposed one. The mobile phone-generated electromagnetic field did not influence the macrometric parameters of long bones and L4 vertebra, it altered mechanical properties of bones (stress and energy at maximum bending force, stress at fracture), it decreased the content of calcium in long bones and L4 vertebra, and it altered the concentration of osteogenesis and bone resorption markers in rats. On the basis of obtained results, it was concluded that electromagnetic field generated by 900 MHz mobile phone does not have a direct impact on macrometric parameters of bones; however, it alters the processes of bone mineralization and the intensity of bone turnover processes and thus influences the mechanical strength of bones.

Prevalência de subluxações cervicais e torácicas com relação ao membro dominante superior em atletas amadores de voleibol / Prevalence of cervical and thoracic subluxations in relation to the dominant upper limb in amateur volleyball players

O voleibol exige um ótimo condicionamento físico, força, velocidade, agilidade e flexibilidade de seus participantes. Nele, a repetição de determinados tipos de movimentos e a sobrecarga de treinamento exigida produz um processo de adaptação orgânica do corpo que resulta, muitas vezes, em desequilíbrio muscular. Somado a isso, os gestos específicos e os erros na técnica de execução dos movimentos podem aumentar a prevalência de alterações posturais influenciando o aumento de possibilidades de lesões (JUNIOR, 2004). As alterações posturais, por sua vez, podem ocasionar distúrbios que afetam a coluna vertebral. Objetivo: o propósito do estudo foi detectar as principais subluxações - vertebrais cervicais e torácicas - por meio da análise das rotações do processo espinhoso de cada vértebra e lateralidade do atlas com o membro dominante superior, relacionando com as categorias e com a posição em quadra de atletas de Voleibol. Método: para tanto, realizou-se uma pesquisa descritiva com 145 atletas de categorias de base e adulta que treinam mais de dois dias por semana. Os atletas foram submetidos a uma avaliação quiroprática. Resultados e Discussão: verificou-se que as subluxações mais prevalentes foram das vértebras C1, C7, T4, T8 e T12. Observou-se que a musculatura e a articulação do ombro estão diretamente interligadas com as subluxações encontradas. Atletas ambidestros apresentaram menor percentagem de subluxações e maior equilíbrio rotacional dos processos espinhosos e da lateralidade do atlas. Os demais atletas apresentaram a lateralidade do atlas e as rotações do processo espinhoso das regiões cervical e torácica para o lado direito...

Volleyball requires a great physical fitness, strength, speed, agility and flexibility of its players. In it, the repetition of certain types of movements and the overload of training required may produces an organic process of adaptation of the body that often results in muscle imbalance. Added to this, the specific gestures and errors in technique of the movements may increase the prevalence of postural changes influencing the increased possibilities of injuries. Postural changes, inturn, can lead to disorders affecting the spine. Objective: the purpose of the study was to identify the main subluxations - cervical and thoracic - through the analysis of rotations of the spinous process of each vertebra and laterality of the atlas with the dominant upper limb, in what respect the categories and the position in court of volleyball athletes. Method: it was carried out a descriptive study of 145 athletes from youth teams and adult training more than two days per week. The athletes underwent a chiropractic evaluation. Results and Discussion: it was found that the most prevalent vertebral subluxation are C1, C7, T4, T8 and T12. It was noted that the muscles and the shoulder joint are directly interconnected with the subluxations found. Ambidextrous athletes showed lower percentage of subluxations and higher rotational equilibrium of the spinous processes and the laterality of the atlas. The other athletes showed the laterality of the atlas and the rotations of the spinous process of the cervical and thoracic regions to the right side...

[Bradytrophic tissue. Its histopathological diagnosis and value in trauma surgical and orthopedic expert opinions]. / Bradytrophe Gewebe. Histopathologische Diagnostik und Stellenwert bei unfallchirurgisch-orthopädischen Gutachten.

Expert opinions on the musculoskeletal system are generally required for statutory or private accident insurance purposes in a variety of legal areas and with varying rules of evidence. Since they are also intended for non-medical personnel, terminology needs to be defined and must be comprehensible by all parties. Bradytrophic tissue is the most frequently evaluated aspect of the musculoskeletal system. In this context, the term"degeneration" which was formerly used has been replaced by the term"tissue structure alteration", which takes matrix changes and cellularity into consideration. Thus the significance of histopathological diagnosis of bradytrophic tissue has been put in a new light. Histopathological diagnosis is carried out on the basis of various staining methods, scores and analyses depending on the diagnostic question.

Functional biomarkers of musculoskeletal syndrome (MSS) for early in vivo screening of selective MMP-13 inhibitors.

INTRODUCTION: Long-term administration of non-selective matrix metalloproteinase (MMP) inhibitors, such as marimastat, in humans elicits musculoskeletal syndrome (MSS), a syndrome characterized by joint damage including pain, stiffness, and inflammation. This pathology is a significant obstacle to the clinical development of MMP inhibitors and in pre-clinical models MSS can be verified only after terminal histopathology. Consequently, we devised a longitudinal and functional readout of MSS in conscious rats treated with marimastat that was validated against terminal histological assessment. METHODS: MSS was induced by minipump infusion of marimastat (5-10mg/kg/day). In marimastat-treated or vehicle-control groups, three possible functional biomarkers were assessed: paw volume (PV), landing foot splay separation (LFSS), and rotarod performance (n=6 rats/group for each endpoint). RESULTS: Histologically, fibrosis scores in the synovium and ligament increased from 0 on Day 1 (D1) to 4.6±0.2 and 4.7±0.1, respectively, on D15; growth plate thickness was also elevated from 215.0±6.3µm (D1) to 253.3±8.0µm (D15). While neither PV nor LFSS were correlative with MSS histopathology, marimastat (10mg/kg/day) reduced rotarod performance from 180±0s (D0) to 135±30s (D9) using a constant speed protocol (10rpm, 180s) and from 180±0s (D0) to 96±6s (D6) employing a variable speed protocol (increasing from 5 to 25rpm over 180s). DISCUSSION: Results of the present study demonstrate that rotarod performance can be used as a predictive longitudinal, in vivo functional biomarker of MSS concomitant with histological evidence of joint damage to effectively facilitate compound selection during drug discovery. Moreover, for targets with a mechanistic risk for MSS, the model is also conducive to inclusion in secondary pharmacodynamic studies during lead optimization to identify the best (safest) compounds for advancement into clinical trials.

Terapia de la risa. En el dolor crónico músculo-esquelético / Laughter Therapy for chronic skeletal muscular pain

Se explican los efectos de la introducción de talleres de risoterapia y relajación en una unidad de educación terapéutica y rehabilitación funcional, y se comprueba si su aplicación ayuda a disminuir el dolor, mejorar la movilidad y reducir el estado emocional alterado (ansiedad-depresión) del paciente(AU)

The authors explain the effects introducing workshops for laughter therapy and relaxation to a unit dedicated to therapeutic education and functional rehabilitation; the authors test to see if the application of this therapy hepls to decrease pain, to improve mobility and to reduce na altered emotional state, such as anxiety-depression, common among chronic pain patients(AU)

[Musculoskeletal rehabilitation and bone. Musculoskeletal atrophy, and rehabilitation medicine].

Weightless environments such as prolonged bed rest and spaceflight are associated with dramatic losses of muscle volume and bone mass that hinder patients' or astronauts' health and reintegration into daily life. It is important that the countermeasure is effective for slow twitch fiber, and adds mechanical stress to a bone. So, we developed the hybrid training method (HYB) as a countermeasure of this musculoskeletal atrophy, which uses the contraction produced in a muscle by electrical stimulation of antagonist to resist the volitional contraction of agonist. HYB has several features. These include ; 1) simple device, 2) simultaneous contractions both agonist and antagonist musculature, 3) volitional contraction of deep layers of muscle, 4) longitudinal bone force loads. Several studies reported that, this HYB was tested successfully for increasing muscles strength and hypertrophy in the upper and lower extremities. And, a wearable HYB apparatus with a virtual reality control system was developed. Now, we are developing the hybrid ergometer with virtual reality system, which training can play while playing a game at home.

Chronic tension-type headache with vitamin D deficiency: casual or causal association?

The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.

Neuromuscular stimulation after stroke: from technology to clinical deployment.

Since the early 1960s, electrical or neuromuscular electrical stimulation (NMES) has been used to support the rehabilitation of stroke patients. One of the earliest applications of NMES included the use of external muscle stimulation to correct drop-foot after stroke. During the last few decades various clinical applications have been used for the upper and lower limb. Despite a growing body of literature on the use of NMES, its application in stroke is still limited to a few clinical groups that provide dedicated clinical services. Some explanations for the limited use are the sometimes conflicting clinical evidence, the size of the effects or the complicated use of the technology itself. This review points out three directions for future research. First, we need to expand our knowledge on brain plasticity and the use of different electrical stimulation strategies to modulate the neural system. Second, we foresee an increase in therapies combining different training principles, for example, the combination of NMES and robotics or neuromodulating drugs. Finally, with the ever-increasing pressure on healthcare budgets, it is expected that clinical and economic evidence will become more relevant in transferring these interventions to a wider community.

Compresas húmedo calientes como intervención para reducir el dolor musculoesquelético. Ánalisis de la evidencia / Hot packs like intervention to reduce tnusculoskeletal pain. An analysis of evidence

Introducción: En los Estados Unidos el dolor en niños causa un promedio de 21 millones de días de escuela perdidos y en empleados trabajadores provoca una pérdida de 147 millones de días de trabajo. El dolor produce desordenes musculo esqueléticos y las modalidades terapéuticas se usan comúnmente en su tratamiento. Una de las modalidades más usadas clínicamente son las compresas húmedo calientes previas a tratamientos. No existen artículos que analicen cual es la evidencia disponible sobre la efectividad de las compresas húmedo calientes como intervención para aliviar el dolor. Objetivos: Determinar si existe evidencia científica que avale la efectividad de las compresas húmedo calientes como intervención efectiva en el alivio del dolor. Agrupar la mejor evidencia clínica disponible en relación a la analgesia producida por las compresas húmedo calientes. Evaluar la calidad de los estudios que investigaron los efectos de las compresas húmedo calientes sobre pacientes con dolor. Materiales y métodos: Se buscaron ensayos clínicos aleatorios las bases de datos MEDLINE, Cochrane Library Plus, CINAHL, DARE. A dichos estudios se les aplicó la escala de PEDro para evaluar la validez de los trabajos y posteriormente se clasificó la evidencia según la escala del Centro de Medicina Basada en Evidencias de Oxford. Resultados: Se incluyeron 4 ensayos clínicos aleatorios y una revisión sistemática que cumplieron con los criterios de inclusión y exclusión. Conclusión: Existe evidencia de nivel 1b y recomendación A que las compresas húmedo calientes producen efectos benéficos sobre el dolor de forma tal que potencian una intervención posterior. Aun falta investigación para formular conclusiones adecuadas (AU)

Introduction: The pain in children causes an average of 21 million days of school lost and in hardworking employees in the United States it provoke a loss of 147 million workdays. The pain produces musculoskeletal disorders and the therapeutic modes use themselves commonly in his treatment. One of the most therapeutic modalities used are the hot packs. Do not exist as the available proof on the effectiveness of the hot compresses like intervention to reduce the musculoskeletal pain. Objectives: To determinate if scientific proof that the effectiveness of the hot packs like effective intervention in the relief of the pain exists. To group the best clinical available proof in relation to the analgesia produced by the humid hot compresses. To assess the quality of the studies that the effects of the hot compresses on patients with pain investigated. Materials and methods: The randomized controlled trials were looked into data bases MEDLINE, Cochrane Library Plus, CINAHL, DARE. The aforementioned studies were applied PEDro's scale to evaluate its validity and at a later time the proof according to the scale of Oxford Evidenced-Based Centre was classified. Results: They included 4 randomized controlled trials and one systematic review that abode by the criteria of inclusion and exclusion. Conclusion: Exists evidence of level 1b and recommendation type A that the hot compresses cause beneficial effects on the pain of form to such that they increase the power of a later intervention. Even there is not enough investigation to formulate adequate findings (AU)

Musculoskeletal conditions - what's new from Cochrane and how might this affect your practice?

Australian Family Physician is pleased to introduce a series of articles facilitated by the Cochrane Musculoskeletal Group (CMSG). This series aims to place the findings of recent Cochrane musculoskeletal reviews in a context immediately relevant to general practitioners. Each article will present the results of CMSG reviews relevant to a particular topic, and use common general practice scenarios to show how the results can be applied in practice. The first topic considers the value of calcium supplementation in children.

Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics.

Dense connective tissue sheets, commonly known as fascia, play an important role as force transmitters in human posture and movement regulation. Fascia is usually seen as having a passive role, transmitting mechanical tension which is generated by muscle activity or external forces. However, there is some evidence to suggest that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics. General support for this hypothesis came with the discovery of contractile cells in fascia, from theoretical reflections on the biological advantages of such a capacity, and from the existence of pathological fascial contractures. Further evidence to support this hypothesis is offered by in vitro studies with fascia which have been reported in the literature: the biomechanical demonstration of an autonomous contraction of the human lumbar fascia, and the pharmacological induction of temporary contractions in normal fascia from rats. If verified by future research, the existence of an active fascial contractility could have interesting implications for the understanding of musculoskeletal pathologies with an increased or decreased myofascial tonus. It may also offer new insights and a deeper understanding of treatments directed at fascia, such as manual myofascial release therapies or acupuncture. Further research to test this hypothesis is suggested.

O uso do ultra-som terapêutico em clínicas de fisioterapia da cidade de Santa Maria - RS - Brasil / The use of therapeutic ultra-sound in physiotherapeutic clinics of Santa Maria city - RS -Brasil

O ultra- som terapêutico é um aparelho de eletroterapia largamente utilizado como recurso fisioterapêutico no tratamento de diversas patologias do sistema músculo-esquelético. Em virtude disso, elaborou-se um questionário para verificar o emprego deste aparelho em diversas clínicas de fisioterapia de Santa Maria - RS. O questionário, aplicado a 14 clínicas de fisioterapia, constava de ítens como frequência mais utilizada, dosimetria empregada, agentes de acoplamento utilizados, calibragem, incidência anual de danos nos aparelhos e aparelhos submetidos à assistência técnica especializada. Os resultados obtidos foram analisados descritivamente e säo apresentados, neste artigo, sob a forma de figuras.

Rm de los tumores musculoesqueléticos, estado actual y últimos avances / Magnetic resonance in musculoskeletal tumors: state of the art and recent advances

La Resonancia magnética (RM) se ha convertido en la técnica diagnóstica más importante para: 1) la estadificación local de las neoplasias primarias musculoesqueléticas, 2) para monitorizar la respuesta a la quimioterapia y 3) para detectar la recidiva tumoral. La RM es capaz de diagnosticar con exactitud la extensión local del tumor, ayudando a determinar los márgenes tumorales de seguridad durante la cirugía. La RM poscontraste es útil para valorar la presencia o ausencia de necrosis tumoral tras la quimioterapia. Si la RM demuestra ausencia de necrosis tumoral (típicamente menos de un 90 por ciento de necrosis en el tejido tumoral) se considera que la respuesta a la quimioterapia es pobre y que el tratamiento es ineficaz, siendo necesario cambiar el protocolo quimioterápico. Los estudios dinámicos de RM tras la administración de contraste paramagnético i.v. en bolo son particularmente útiles para valorar la respuesta a la quimioterapia. Hasta el momento actual el cálculo de los valores de la pendiente de las curvas de realce por contraste-tiempo se realizaba mediante análisis del ROI (región de interés). Sin embargo, los nuevos ordenadores son capaces de generar la 'imagen del primer paso de contraste' o 'imagen de la tasa de realce' y calcular la tasa de realce tisular midiendo cada uno de los puntos de la imagen y utilizando un algoritmo lineal, lo cual facilita la interpretación. Estas 'imágenes del primer paso de contraste' o 'imágenes de la tasa de realce' pueden también ser útiles para diferenciar el edema perineoplásico de la lesión tumoral y para detectar áreas de tumor residual o recidiva tumoral después de la cirugía y/o radioterapia. La RM de difusión es una nueva técnica que es potencialmente capaz de detectar y cuantificar la cantidad de necrosis tumoral tras la quimioterapia o radioterapia (AU)

Reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is a syndrome characterized by pain in one or more extremities, usually associated with vasomotor changes. Its occurrence in childhood has long been thought to be rare. We describe six cases of pediatric reflex sympathetic dystrophy and suggest that this syndrome could be underdiagnosed in children and adolescents. Psychologic problems frequently play a role in this disorder, which often can be treated conservatively. We also point out that the diagnosis is mainly clinical. An early diagnosis can avoid unnecessary tests and potentially can improve response to treatment, and prognosis.

Biopsies of the musculoskeletal system.

Percutaneous biopsies of musculoskeletal lesions are a safe, economical, and reliable method of obtaining a diagnosis. Most of these biopsies are done under CT guidance, but fluoroscopy is an alternative. Conditions that can be discovered through percutaneous biopsies include metastases, primary benign tumors, infection, and metabolic disease. Experience with invasive procedures and with imaging equipment are the requirements for a physician interested in performing these biopsies.

Comparing psychotic and affective disorders by musculoskeletal structural examination.

Groups of hospitalized patients with psychotic and affective disorders (N = 60) underwent musculoskeletal structural examination. Psychotic and affective disorders each tend to affect a different portion of the musculoskeletal system, with psychotic patients exhibiting increased musculoskeletal dysfunction in the lower extremities and affective-disorders patients exhibiting increased cervical and thoracic dysfunction. At the clinical level, the structural examination may be used to correlate psychiatric disorders with dysfunctional regions of the musculoskeletal system.