Incidence, Mechanisms, and Characteristics of Injuries in Pole Dancers: A Prospective Cohort Study.

OBJECTIVE: Pole dancing is a challenging physical activity. Prospective injury studies in pole dancing are lacking. The aim of this study was to describe the incidence, mechanisms, and characteristics of injuries in pole dancers. METHODS: A total of 66 pole dancers from 41 studios across Australia were prospectively followed over 12 months. An intake questionnaire was administered including items on pole dancers' demographics and training characteristics. Exposure was assessed using a daily online training diary. Self-reported injury data were collected via an incident report form and subsequently coded using the Orchard Sports Injury Classification System. Injuries occurring during pole-specific and pole-related activities were included in the analyses. RESULTS: The sample included 63 females and 3 males, mean age 32.3 ± 8.9 years and mean pole training experience 3.5 ± 2.8 years. 25 of 66 participants completed the full study. The 1-year incidence of all new injuries was 8.95/1,000 exposure hours (95% CI 6.94 - 10.96), 7.65/1,000 hrs (95% CI 5.79 - 9.51) for pole-specific injuries and 1.29/1,000 hrs (95% CI 0.53 - 2.06) for pole-related injuries. A total of 103 injuries occurred, 62.1% of which were sudden onset and 37.9% gradual onset. Mechanism of onset included 54.4% acute and 45.6% repetitive in nature. Shoulder (20.4%) and thigh (11.7%, majority ham¬string) were the most reported anatomic injury sites. Non-contact mechanisms accounted for the majority of injuries (57.3%). The most reported primary contributor to injury onset at the shoulder were manoeuvres characterised by loaded internal humeral rotation (33.3%), and at the hamstring were manoeuvres and postures involving front splits (100.0%). CONCLUSION: The findings indicate that pole dancers are at high risk for injuries. Future research is needed to understand the biomechani¬cal demand of manoeuvres and training characteristics of pole dancing (e.g., workload and recovery) to guide the development of preventative interventions, particularly targeted toward the shoulder and hamstring.

Improving endovascular access to the target vessel for thrombus aspiration -Use of the wedge device to overcome anatomic hurdles.

BACKGROUND AND PURPOSE: Aspiration is a successful technique used in thrombectomy for acute stroke. It is contingent upon the appropriate position of the aspiration catheter, so that it is in contact with the thrombus. However, navigating the craniocervical vasculature is challenging is some patients. The wedge microcatheter (MicroVention®) is designed to reduce the gap between the microcatheter and the SofiaPlus 6F catheter for ease of advancement. The purpose of this study is to describe our initial experience with the wedge microcatheter. MATERIALS AND METHODS: A retrospective review of 38 consecutive patients in whom the wedge microcatheter was used during thrombectomy was performed to determine whether the wedge microcatheter was successful in delivering the Sofia catheter to the desired location. RESULTS: We have found this device to be successful in delivering the aspiration catheter to the correct position in 97% (N = 37) of cases. It was used predominantly to pass the origin of branching vessels and also to navigate the tortuous cavernous and petrous segments of the ICA. CONCLUSION: The wedge microcatheter is a successful tool in delivering the aspiration catheter to the desired vessel for revascularisation.

Pelvic vein embolization: an assessment of the readability and quality of online information for patients.

INTRODUCTION: Pelvic congestion syndrome is a controversial topic. Pelvic vein embolization is a minimally invasive treatment for pelvic congestion syndrome. We aimed to assess the quality of information available on the Internet and determine how accessible information provided by the main IR societies was to patients. MATERIALS AND METHODS: The most commonly used term relating to pelvic vein embolization was searched across the five most-used English language search engines, with the first 25 web pages returned by each engine included for analysis. Duplicate web pages, nontext content and web pages behind paywalls were excluded. Web pages were analyzed for quality and readability using validated tools: DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. RESULTS: The most common applicable term was "Pelvic Vein Embolization". Mean DISCERN quality of information provided by websites is "fair". Flesh-Kincaid readability tests and Gunning-Fog Index demonstrated an average "college level" of reading ease. HON code certification was demonstrated in less than one third of web pages. Professional societies and scientific journals demonstrated the highest average JAMA and DISCERN scores, while for-profit organizations and healthcare providers demonstrated the lowest. Only information from 1 of 3 interventional societies was included in the first 25 search engine pages. CONCLUSION: The quality of information available online to patients is "fair" and outside of scientific journals the majority of web pages do not meet the JAMA benchmark criteria. These findings call for the production of high-quality and comprehensible content regarding interventional radiology, where physicians can reliably direct their patients for information.

Machine learning methods to support personalized neuromusculoskeletal modelling.

Many biomedical, orthopaedic, and industrial applications are emerging that will benefit from personalized neuromusculoskeletal models. Applications include refined diagnostics, prediction of treatment trajectories for neuromusculoskeletal diseases, in silico design, development, and testing of medical implants, and human-machine interfaces to support assistive technologies. This review proposes how physics-based simulation, combined with machine learning approaches from big data, can be used to develop high-fidelity personalized representations of the human neuromusculoskeletal system. The core neuromusculoskeletal model features requiring personalization are identified, and big data/machine learning approaches for implementation are presented together with recommendations for further research.

Varicocele Embolization: An Assessment of the Quality and Readability of Online Patient Information.

AIMS AND OBJECTIVES: Varicocele embolization is a growing treatment modality owing to the safety, efficacy, and quick return to work following the procedure. The internet is the most dominant source of information for many. We aimed to assess the quality of information accessible by patients considering treatment. MATERIALS AND METHODS: A list of applicable, commonly used searchable terms was generated. Each term was assessed across the five most-used English language search engines to determine the two most commonly used terms. These two terms were then investigated across each search engine, with the first 25 web pages returned by each engine included for analysis. Duplicate web pages, nontext content such as video or audio, and web pages behind paywalls were excluded. Web pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features including age, rank, author, and publisher were recorded. RESULTS: The most common applicable terms were "Testicular embolization" (378,300 results) and "Varicocele embolization" (375,800 results). Mean DISCERN quality of information provided by websites is "fair"; Adherence to JAMA Benchmark Criteria was 13.5%. Flesh-Kincaid readability tests demonstrated an average "9th grade" reading level. Scientific journals showed the highest quality scores, but were least up to date with an average web page age of 11.2 years. Web pages produced by "for-profit" organizations were the second most current (average age 2.7 years), but displayed the lowest quality of information scores. CONCLUSION: While quality of online information available to patients is "fair," adherence to JAMA benchmark criteria is poor. "For-profit" organization websites are far more numerous and significantly more up-to-date, yet showed significantly lower quality of information scores. Scientific journals were unsurprisingly of higher quality, yet more challenging for the general public to read. These findings call for the production of high-quality and comprehensible content regarding interventional radiology, where physicians can reliably direct their patients for information.

Different visual stimuli affect body reorientation strategies during sidestepping.

Sidestepping in response to unplanned stimuli is a high-risk maneuver for anterior cruciate ligament (ACL) injuries. Yet, differences in body reorientation strategies between high- and low-level soccer players prior to sidestepping in response to quasi-game-realistic vs non-game-realistic stimuli, remain unknown. Fifteen high-level (semi-professional) and 15 low-level (amateur) soccer players responded to a quasi-game-realistic one-defender scenario (1DS) and two-defender scenario (2DS), and non-game-realistic arrow-planned condition (AP) and arrow-unplanned condition (AUNP). The AP, 1DS, 2DS to AUNP represented increasing time constraints to sidestep. Selected biomechanics from the penultimate step to foot-off were assessed using a mixed-model (stimuli × skill) ANOVA (P < 0.05). Step length decreased in the defender scenarios compared with the arrow conditions. Support foot placement increased laterally, away from mid-pelvis, with increasing temporal constraints. Greater trunk lateral flexion in the 1DS, 2DS, and AUNP has been associated with ACL injury onsets. Higher level players pushed off closer to their pelvic midline at initial foot contact in the 2DS especially. Higher level perception of game-realistic visual information could have contributed to this safer neuromuscular strategy that, when understood better, could potentially be trained in lower level players to reduce ACL injury risk associated with dangerous sidestepping postures.

Prescribing joint co-ordinates during model preparation to improve inverse kinematic estimates of elbow joint angles.

To appropriately use inverse kinematic (IK) modelling for the assessment of human motion, a musculoskeletal model must be prepared 1) to match participant segment lengths (scaling) and 2) to align the model׳s virtual markers positions with known, experimentally derived kinematic marker positions (marker registration). The purpose of this study was to investigate whether prescribing joint co-ordinates during the marker registration process (within the modelling framework OpenSim) will improve IK derived elbow kinematics during an overhead sporting task. To test this, the upper limb kinematics of eight cricket bowlers were recorded during two testing sessions, with a different tester each session. The bowling trials were IK modelled twice: once with an upper limb musculoskeletal model prepared with prescribed participant specific co-ordinates during marker registration - MRPC - and once with the same model prepared without prescribed co-ordinates - MR; and by an established direct kinematic (DK) upper limb model. Whilst both skeletal model preparations had strong inter-tester repeatability (MR: Statistical Parametric Mapping (SPM1D)=0% different; MRPC: SPM1D=0% different), when compared with DK model elbow FE waveform estimates, IK estimates using the MRPC model (RMSD=5.2±2.0°, SPM1D=68% different) were in closer agreement than the estimates from the MR model (RMSD=44.5±18.5°, SPM1D=100% different). Results show that prescribing participant specific joint co-ordinates during the marker registration phase of model preparation increases the accuracy and repeatability of IK solutions when modelling overhead sporting tasks in OpenSim.

MRI development and validation of two new predictive methods of glenohumeral joint centre location identification and comparison with established techniques.

Identification of the centre of the glenohumeral joint (GHJ) is essential for three-dimensional (3D) upper limb motion analysis. A number of convenient, yet un-validated methods are routinely used to estimate the GHJ location in preference to the International Society of Biomechanics (ISB) recommended methods. The current study developed a new regression model, and simple 3D offset method for GHJ location estimation, employing easy to administer measures, and compared the estimates with the known GHJ location measured with magnetic resonance imaging (MRI). The accuracy and reliability of the new regression and simple 3D offset techniques were compared with six established predictive methods. Twenty subjects wore a 3D motion analysis marker set that was also visible in MRI. Immediately following imaging, they underwent 3D motion analysis acquisition. The GHJ and anatomical landmark positions of 15 participants were used to determine the new regression and simple 3D generic offset methods. These were compared for accuracy with six established methods using 10 subject's data. A cross validation on 5 participants not used for regression model development was also performed. Finally, 10 participants underwent a further two MRI's and subsequent 3D motion analysis analyses for inter-tester and intra-tester reliability quantification. When compared with any of the other established methods, our newly developed regression model found an average GHJ location closer to the actual MRI location, having an GHJ location error of 13+/-2 mm, and had significantly lower inter-tester reliability error, 6+/-4 mm (p<0.01).

Effects of different technical coordinate system definitions on the three dimensional representation of the glenohumeral joint centre.

This study aimed to find the most appropriate marker location, or combination thereof, for the centre of the humeral head (Wang et al. in J Biomech 31: 899-908, 1998) location representation during humeral motion. Ten male participants underwent three MRI scans in three different humeral postures. Seven technical coordinate systems (TCS) were defined from various combinations of an acromion, distal upper arm and proximal upper arm clusters of markers in a custom Matlab program. The CHH location was transformed between postures and then compared with the original MRI CHH location. The results demonstrated that following the performance of two near 180 degrees humeral elevations, a combined acromion TCS and proximal upper arm TCS produced an average error of 23 +/- 9 mm, and 18 +/- 4 mm, which was significantly smaller (p < 0.01) than any other TCS. A combination of acromion and proximal upper arm TCSs should therefore be used to reference the CHH location when analysing movements incorporating large ranges of shoulder motion.

Use of the HemoCue near patient testing device to measure the concentration of haemoglobin in suction fluid at elective caesarean section.

We have investigated the suitability of the HemoCue photometer to measure the concentration of haemoglobin in suction fluid obtained at elective caesarean section in 30 women. Laboratory analysis was used as a gold standard against which values generated by the HemoCue were compared. We used the method of Bland and Altman to analyse the data. The bias and the limits of agreement were -0.013 and -0.39 to 0.36 mg x dl(-1) respectively, indicating a good level of agreement. Mean (SD) total blood loss calculated using these data, combined with the weight of the swabs, was consistently greater than clinical estimation: 768 (496) ml versus 506 (249) ml respectively (p < 0.001). We have found that the HemoCue near patient testing device may be used to estimate blood loss accurately in the suction fluid obtained at elective Caesarean section.

Transmission of mitochondrial DNA following assisted reproduction and nuclear transfer.

Mitochondria are the organelles responsible for producing the majority of a cell's ATP and also play an essential role in gamete maturation and embryo development. ATP production within the mitochondria is dependent on proteins encoded by both the nuclear and the mitochondrial genomes, therefore co-ordination between the two genomes is vital for cell survival. To assist with this co-ordination, cells normally contain only one type of mitochondrial DNA (mtDNA) termed homoplasmy. Occasionally, however, two or more types of mtDNA are present termed heteroplasmy. This can result from a combination of mutant and wild-type mtDNA molecules or from a combination of wild-type mtDNA variants. As heteroplasmy can result in mitochondrial disease, various mechanisms exist in the natural fertilization process to ensure the maternal-only transmission of mtDNA and the maintenance of homoplasmy in future generations. However, there is now an increasing use of invasive oocyte reconstruction protocols, which tend to bypass mechanisms for the maintenance of homoplasmy, potentially resulting in the transmission of either form of mtDNA heteroplasmy. Indeed, heteroplasmy caused by combinations of wild-type variants has been reported following cytoplasmic transfer (CT) in the human and following nuclear transfer (NT) in various animal species. Other techniques, such as germinal vesicle transfer and pronuclei transfer, have been proposed as methods of preventing transmission of mitochondrial diseases to future generations. However, resulting embryos and offspring may contain mtDNA heteroplasmy, which itself could result in mitochondrial disease. It is therefore essential that uniparental transmission of mtDNA is ensured before these techniques are used therapeutically.

Nitrate respiration in the actinomycete Streptomyces coelicolor.

Streptomyces coelicolor is an obligate aerobic, filamentous soil-dwelling bacterium. Remarkably, the genome of S. coelicolor has three copies of the narGHJI operon that encodes respiratory nitrate reductase. This review summarizes our current views on the requirements for multiple nitrate reductases in S. coelicolor.

Epidural analgesia for acute symphysis pubis dysfunction in the second trimester.

We report a case of severe symphysis pubis dysfunction in a parturient during her second trimester of a twin pregnancy. Symphysis pubis dysfunction produces pain, instability and limitation of mobility and function, of the symphysis pubis during pregnancy and labour. It is often under-treated. We provided lumbar epidural analgesia with intermittent top-ups of bupivacaine 0.1% with fentanyl 2 micrograms/mL for 72 h. This provided initial analgesia, breaking a vicious cycle of pain and muscle spasm. The benefits extended into the remainder of her pregnancy. Subsequently, simple analgesics and physiotherapy allowed control of pain until vaginal delivery 15 weeks later.

Topological analysis of DctQ, the small integral membrane protein of the C4-dicarboxylate TRAP transporter of Rhodobacter capsulatus.

Tripartite ATP-independent periplasmic ('TRAP') transporters are a novel group of bacterial and archaeal secondary solute uptake systems which possess a periplasmic binding protein, but which are unrelated to ATP-binding cassette (ABC) systems. In addition to the binding protein, TRAP transporters contain two integral membrane proteins or domains, one of which is 40-50 kDa with 12 predicted transmembrane (TM) helices, thought to be the solute import protein, while the other is 20-30 kDa and of unknown function. Using a series of plasmid-encoded beta-lactamase fusions, we have determined the topology of DctQ, the smaller integral membrane protein from the high-affinity C4-dicarboxylate transporter of Rhodobacter capsulatus, which to date is the most extensively characterised TRAP transporter. DctQ was predicted by several topology prediction programmes to have four TM helices with the N- and C-termini located in the cytoplasm. The levels of ampicillin resistance conferred by the fusions when expressed in Escherichia coli were found to correlate with this predicted topology. The data have provided a topological model which can be used to test hypotheses concerning the function of the different regions of DctQ and which can be applied to other members of the DctQ family.

Epidural analgesia in labour for a patient with hereditary neuropathy with liability to pressure palsy.

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare but probably under-diagnosed disorder of peripheral nerves in which individuals suffer from repeated motor and sensory neuropathies (pressure palsies) following brief nerve compression or mild trauma. A seemingly trivial insult such as sitting or kneeling may result in a focal neurological deficit lasting for hours to months. Despite the growing recognition of this problem, information regarding the anaesthetic management of labour is sparse. We present a woman with HNPP who was provided with a modified epidural regimen (low concentration bupivacaine and fentanyl) for analgesia in labour and delivery. Labour progressed uneventfully and there were no neurological sequelae following delivery.