Time-Dependent Changes of Extremity Volume and Tissue Alterations in Swollen Arms Caused by Taxanes.

Background: We aimed to determine the course of arm swelling caused by the use of taxanes and to identify valid predictors of persistent swelling. Methods and Results: A total of 15 patients with unilateral arm swelling that developed during the course, or within 3 months after termination, of postoperative taxane-based chemotherapy were included in the present study. The patients attended follow-up appointments every 3-6 months for 24 months after their initial visit. Their arm circumference was measured at each follow-up appointment, while ultrasonography of the skin and subcutaneous tissues was performed at the 0-, 6-, 12-, and 24-month follow-ups. Of the 15 patients, 12 (80%) saw their taxane-induced arm swelling resolved within a median of 12 months (range, 3-29 months) after their final taxane administration. Of the 12 patients whose swelling resolved, 9 did not use compression sleeves; however, their course of resolution did not differ from the other 3 patients who regularly used compression sleeves. In the three patients with persistent swelling, the excess subcutaneous thickness in the medial upper arm (median, 283%) was significantly greater than that in the patients whose swelling resolved (120%; p < 0.05) during their initial visits. Conclusions: Of the 15 patients included in the present study, 80% saw their taxane-induced arm swelling resolve within a median of 12 months after their final taxane administration, independent of the use of compression therapy. Persistent swelling may be predicted during the initial visit based on subcutaneous thickening of the medial upper arm.

Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery.

Background: Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked. Methods: This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test. Results: Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (p = 0.003, p = 0.003, p = 0.006, p = 0.044, and p = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12). Conclusions: Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.

Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study.

BACKGROUND: Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. PURPOSE: This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. METHODS: One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. RESULTS: No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. CONCLUSION: The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

Investigation of the pressure value while performing biceps tenodesis for superior capsuler reconstruction.

BACKGROUND: To compare the histopathological results of biceps tenodesis (BT) performed with normal, low, and high pressures for superior capsule reconstruction (SCR) in rabbits with massive rotator cuff tears. MATERIALS AND METHODS: Thirty rabbits were divided into three groups. Rabbits 1-10 underwent SCR with BT at the same pressure (Group 1), value measured in the groove; 50% lower (Group 2); 50% higher (Group 3). After the 4-week follow-up, shoulder were en-bloc excised and histopathological evaluation was performed with modified Bonar's scale. Results were compared between the groups, statistically. RESULTS: Extracellular matrix were significantly lower in group 2 compared to the other groups (p < 0.05). Cellularity levels were significantly lower in group 2 compared to the other groups (p < 0.05). Group 2 had no difference between the sides (p > 0.05). Group 2 had lower vascularity levels compared to the other groups (p = 0.01). DICSUSSION: When the biceps tendon was in the bicipital groove and in a more mobile state with lower pressure exposure. BT performed with a tension that creates less pressure than the biceps in the groove is more successful in SCR.

"Like not having an arm": a qualitative study of the impact of visitor restrictions on cancer care during the COVID-19 pandemic.

PURPOSE: Visitor restriction policies to prevent the spread of COVID-19 among patients and clinicians were widespread during the pandemic, resulting in the exclusion of caregivers at key points of cancer care and treatment decision-making. The aim of this study was to explore how visitor restrictions impacted cancer treatment decision-making and care from patient and physician perspectives. METHODS: Sixty-seven interviews, including 48 cancer patients and 19 cancer and palliative care physicians from four academic cancer centers in the USA between August 2020 and July 2021. RESULTS: Visitor restrictions that prevented caregivers from participating in clinic appointments and perioperative hospital care created challenges in cancer care that spanned three domains: practical, social, and informational. We identified eight themes that characterized challenges within the three domains across all three groups, and that these challenges had negative emotional and psychological consequences for both groups. Physicians perceived that patients' negative experiences due to lack of support through the physical presence of caregivers may have worsened patient outcomes. CONCLUSIONS: Our data demonstrate the tripartite structure of the therapeutic relationship in cancer care with caregivers providing critical support in the decision-making and care process to both patients and physicians. Caregiver absences led to practical, psychosocial, and informational burdens on both groups, and likely increased the risk of burnout among physicians. Our findings suggest that the quality of cancer care can be enhanced by engaging caregivers and promoting their physical presence during clinical encounters.

Changes in Dynamic Mean Ankle Moment Arm in Unimpaired Walking Across Speeds, Ramps, and Stairs.

Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint-effectively, how "forefoot-dominated" or "hindfoot-dominated" a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at "slow," "normal," and "fast" self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their "normal" speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices.

Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage.

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

Associations between Neck Circumference, Mid-Upper Arm Circumference, Wrist Circumference, and High Blood Pressure among Lithuanian Children and Adolescents: A Cross-Sectional Study.

(1) Background: High blood pressure (HBP) and obesity are significant and growing public health issues worldwide. Our study aimed to evaluate the associations of neck circumference (NC), mid-upper arm circumference (MUAC), and wrist circumference (WrC) with HBP among Lithuanian children and adolescents aged 7-17 years. (2) Methods: In this cross-sectional study, data on BP and anthropometric measurements were analysed in 3688 children and adolescents aged 7-17 years. Multivariate logistic regression analysis was used to estimate the associations between anthropometric indices and HBP. (3) Results: Overall, the prevalence rates of elevated BP and hypertension were 13.7% and 12.9%, respectively. After adjustment for age, BMI, and WC, statistically significant elevated aORs were observed for associations between greater NC, MUAC, WrC, and HBP in boys (aORs: 2.13, 2.46, and 2.48, respectively) and in girls (aORs: 2.01, 2.36, and 2.09, respectively). Moreover, per-unit increase in NC, MUAC, and WrC was also associated with greater odds of HBP in boys (aORs: 1.20, 1.21, and 1.37, respectively) and in girls (aORs: 1.10, 1.10, and 1.21, respectively). The analysed anthropometric indices presented higher area under the curve values for predicting HBP in boys than in girls. (4) Conclusions: This study suggests that higher NC, MUAC, and WrC are associated with increased odds of HBP in Lithuanian children and adolescents.

Investigator choice of standard therapy versus sequential novel therapy arms in the treatment of relapsed follicular lymphoma (REFRACT): study protocol for a multi-centre, open-label, randomised, phase II platform trial.

BACKGROUND: Relapsed or refractory follicular lymphoma (rrFL) is an incurable disease associated with shorter remissions and survival after each line of standard therapy. Many promising novel, chemotherapy-free therapies are in development, but few are licensed as their role in current treatment pathways is poorly defined. METHODS: The REFRACT trial is an investigator-initiated, UK National Cancer Research Institute, open-label, multi-centre, randomised phase II platform trial aimed at accelerating clinical development of novel therapies by addressing evidence gaps. The first of the three sequential novel therapy arms is epcoritamab plus lenalidomide, to be compared with investigator choice standard therapy (ICT). Patients aged 18 years or older with biopsy proven relapsed or refractory CD20 positive, grade 1-3a follicular lymphoma and assessable disease by PET-CT are eligible. The primary outcome is complete metabolic response by PET-CT at 24 weeks using the Deauville 5-point scale and Lugano 2014 criteria. Secondary outcomes include overall metabolic response, progression-free survival, overall survival, duration of response, and quality of life assessed by EQ-5D-5 L and FACT-Lym. The trial employs an innovative Bayesian design with a target sample size of 284 patients: 95 in the ICT arm and 189 in the novel therapy arms. DISCUSSION: Whilst there are many promising novel drugs in early clinical development for rrFL, understanding the relative efficacy and safety of these agents, and their place in modern treatment pathways, is limited by a lack of randomised trials and dearth of published outcomes for standard regimens to act as historic controls. Therefore, the aim of REFRACT is to provide an efficient platform to evaluate novel agents against standard therapies for rrFL. The adaptive Bayesian power prior methodology design will minimise patient numbers and accelerate trial delivery. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05848765; 08-May-2023. EUDRACT: 2022-000677-75; 10-Feb-2022.

[Rare nerve compression neuropathies] / Seltene Nervenkompressionssyndrome.

UNCOMMON NERVE COMPRESSION SYNDROMES: In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes. Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall. The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon's canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen. In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures. In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton's metatarsalgia.

Reliability, validity and responsiveness of the Kurdish version of the questionnaire Disability of the Arm, Shoulder and Hand in patients with carpal tunnel syndrome.

INTRODUCTION: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire predicts the amount of the patient's inabilities and symptoms to evaluate the impacts of upper limb conditions in the patient's daily-life activities. This study aims to test the psychometric properties of DASH in Kurdish patients with carpal tunnel syndrome. MATERIALS AND METHODS: 93 patients with diagnosed carpal tunnel syndrome subjected to complete the self-report DASH-KU and patient rated wrist\hand evaluation PRWHEKU questionnaire during two consecutive assessments with a 24-hour interval before any intervention. RESULTS: DASH-KU questionnaire had excellent internal consistency (Cronbach's alpha = 0.99) and test-retest reliability (intra-class correlation coefficient =0.99). A strong correlation between the DASH-KU score and the PRWHE tool (r=0.792) demonstrated acceptable construct validity of DASH-KU. Bland-Altman plot showed good agreement between the two assessments of DASH-KU, and no floor (3%) nor ceiling effects (0%) were observed. Factor analysis showed that the DASH-KU scale had a high acceptable adequacy (adequacy index = 0.700) and a significant sphericity (p<0.001). The analysis showed a major factor that accounted for 40% of the observed variance with an eigenvalue of 13.14. In addition, five items model also explained 81.23% of the DASH-KU scale variance. However, the responsiveness of DASH-KU was suboptimum, which can be linked to the short 24-hour interval between measurements. CONCLUSION: The DASH-KU scale is a reliable, valid, and responsive instrument for assessing disabilities in patients with carpal tunnel syndrome.

Unilateral identification of a rare superficial brachioulnoradial artery contributing to the superficial palmar arch and brachial artery continuing as the interosseous artery: a case report.

The occurrence of variations in human arterial branching of the upper limb has been commonly reported in peer-reviewed literature. However, the variability of upper limb arterial patterns may be underappreciated in medical practice, which can result in clinical and surgical errors. Here we report a case of a rare, unilateral arterial variation of the left upper limb of a 76-year-old Caucasian male cadaver, discovered during a routine educational dissection. Observed characteristics of the variation include a high brachial artery bifurcation into a superficial brachioulnoradial artery and brachial artery continuing as the interosseous artery and then a bifurcation of the superficial brachioulnoradial artery into a superficial radial and a superficial ulnar artery, which eventually contribute to the formation of the superficial palmar arch. The anatomical characteristics, prevalence, embryological origin, and clinical significance of the variation are discussed.

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

PURPOSE: Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. METHODS: Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. RESULTS: On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. CONCLUSION: BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

[Expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients (2023 Edition)].

With the widespread application of ultrasound-guided Sedinger puncture techniques and intracardiac electrocardiogram positioning technology, implantable intravenous drug delivery device (IVAP) in the upper arm has been recognized by the majority of medical personnel and cancer patients due to its advantages of hiding scars and completely avoiding the risk of hemothorax and pneumothorax. In order to standardize the clinical application of IVAP via the upper arm approach in cancer patients, improve the success rate of implantation, reduce complications and improve patient satisfaction, the Breast Cancer Expert Committee of the National Cancer Quality Control Center consulted guidelines and the latest evidence-based evidences and established the expert consensus on the whole-course management of implantable venous access port in the upper arm of cancer patients, in order to provide reference for the standard application of IVAP in the upper arm. The consensus mainly introduces the indications, contraindications, preoperative evaluation, implantation site, operation procedure, utilization and maintenance, complications and management, medical staff training and patient education of IVAP in the upper arm, in order to provide reference for clinical staff.

Short-term chemotherapy-related complications and undernutrition in children diagnosed with cancer at Korle Bu Teaching Hospital, Accra, Ghana: A prospective cohort study.

Undernutrition in children with cancer is associated with complications during cancer therapy. The study objective was to determine the association between specific anthropometric parameters and short-term chemotherapy-related complications and mortality. This was a hospital-based, prospective cohort study of children, age ≤12 years, with a new cancer diagnosis at the Paediatric Oncology Unit, Korle Bu Teaching Hospital, Ghana. Socio-demographic information, cancer characteristics and anthropometric measurements were obtained at enrolment. Participants were followed up for twelve weeks from commencement of chemotherapy and selected treatment-related complications such as anaemia and thrombocytopenia requiring transfusions, prolonged neutropenia resulting in treatment delays, febrile neutropenia, mucositis and death were recorded. A total of 133 participants were recruited with a median age of 4.5 years. Eighty-one (60.9%) were diagnosed with solid tumours, 31 (23.3%) had leukaemias and 21 (15.8%) had lymphomas. Of the anthropometric parameters assessed, only arm anthropometry using upper arm muscle area (UAMA) and mid-upper arm circumference (MUAC) were associated with complications. Participants with wasting were more likely to develop anaemia and mucositis. However, the incidence of prolonged neutropenia was significantly higher among participants with average UAMA (p = 0.043) and low average UAMA (p = 0.049) compared to those with low UAMA. Risk of neutropenia was also significantly less among those with wasting by MUAC compared to those well-nourished (p = 0.045). Twenty-three participants (17.3%) died with a greater proportion (11/44; 25%) occurring in those who were wasted using MUAC. These findings underscore the need for nutritional surveillance at diagnosis and during chemotherapy, particularly where co-morbid disease is prevalent.

The control of the arm's equilibrium position.

To generate a force, the brain activates muscles that act like springs to pull the arm toward a new equilibrium position. The equilibrium position (EP) is central to our understanding of the biological control of viscoelastic muscles. Although there is evidence of the EP during the control of limb posture, EPs have not been directly identified when the limb exerts a force against the environment. Here, we asked participants to apply a constant force in one of eight directions against a point-like constraint. This constraint was released abruptly to observe the final position to which the arm converged. Importantly, the same force magnitude was maintained while changing the arm's stiffness by modulating the strength of the hand's power grasp. The final position moved further away from the constraint as the arm became less stiff and was inversely proportional to the arm's stiffness, thereby confirming that the final position was the arm's EP. These results demonstrate how the EP changes with the arm's stiffness to produce a desired force in different directions.NEW & NOTEWORTHY According to numerous theories, the brain controls posture and movement by activating muscles that attract the limb toward a so-called equilibrium position, but the universality of this mechanism has not been shown for different motor behaviors. Here, we show that even when pushing or pulling against the environment, the brain achieves the desired force through an equilibrium position that lies beyond the physical constraint.

Arm muscle synergies enhance hand posture prediction in combination with forearm muscle synergies.

Objective.We analyze and interpret arm and forearm muscle activity in relation with the kinematics of hand pre-shaping during reaching and grasping from the perspective of human synergistic motor control.Approach.Ten subjects performed six tasks involving reaching, grasping and object manipulation. We recorded electromyographic (EMG) signals from arm and forearm muscles with a mix of bipolar electrodes and high-density grids of electrodes. Motion capture was concurrently recorded to estimate hand kinematics. Muscle synergies were extracted separately for arm and forearm muscles, and postural synergies were extracted from hand joint angles. We assessed whether activation coefficients of postural synergies positively correlate with and can be regressed from activation coefficients of muscle synergies. Each type of synergies was clustered across subjects.Main results.We found consistency of the identified synergies across subjects, and we functionally evaluated synergy clusters computed across subjects to identify synergies representative of all subjects. We found a positive correlation between pairs of activation coefficients of muscle and postural synergies with important functional implications. We demonstrated a significant positive contribution in the combination between arm and forearm muscle synergies in estimating hand postural synergies with respect to estimation based on muscle synergies of only one body segment, either arm or forearm (p< 0.01). We found that dimensionality reduction of multi-muscle EMG root mean square (RMS) signals did not significantly affect hand posture estimation, as demonstrated by comparable results with regression of hand angles from EMG RMS signals.Significance.We demonstrated that hand posture prediction improves by combining activity of arm and forearm muscles and we evaluate, for the first time, correlation and regression between activation coefficients of arm muscle and hand postural synergies. Our findings can be beneficial for myoelectric control of hand prosthesis and upper-limb exoskeletons, and for biomarker evaluation during neurorehabilitation.

Did the first description of patients with polymyalgia rheumatica take place in Scotland or in Denmark?

The first description of polymyalgia rheumatica (PMR) is generally attributed to Dr. Bruce. In an 1888 article entitled Senile rheumatic gout, he described five male patients aged from 60 to 74 years whom he had visited at the Strathpeffer spa in Scotland. In 1945, Dr. Holst and Dr. Johansen reported on five female patients examined over several months at the Medical Department of Roskilde County Hospital in Denmark. These patients suffered from hip, upper arms, and neck pain associated with elevated ESR and constitutional manifestations such as low-grade fever or loss of weight. In the same year, Meulengracht, another Danish physician, reported on two patients with shoulder pain and stiffness associated with fever, weight loss, and an increased erythrocyte sedimentation rate. As in the five patients reported by Dr. Holst and Dr. Johansen, a prolonged recovery time was recorded. On reading and comparing these three accounts, we question whether it is correct to attribute the first description of PMR to Dr. Bruce and put forward shifting this accolade to the three Danish physicians.