Forearm muscle activity is modified bilaterally in unilateral lateral epicondylalgia: A case-control study.

Lateral epicondylalgia (LE) is associated with a reduced wrist extensor muscle activity and altered biomechanics. This study compared the coordination between forearm muscles during gripping in individuals with LE and pain-free controls. Intramuscular electrodes recorded myoelectric activity from extensor carpi radialis brevis/longus (ECRB/ECRL), extensor digitorum communis (EDC), flexor digitorum superficialis/profundus (FDS/FDP), and flexor carpi radialis (FCR), bilaterally, in 15 participants with unilateral LE and 15 pain-free controls. Participants performed a gripping task at 20% maximum force in four arm positions. The contribution of each muscle was expressed as a proportion of the summed electromyography of all muscles. In individuals with LE, ECRB contributed less to total electromyography in the symptomatic arm but not the asymptomatic arm than pain-free controls. The contribution of EDC and FDP to total electromyography was greater in both the symptomatic and asymptomatic arm of the LE group, than pain-free controls. No other differences were observed between groups. Subtle differences in muscle activation were present with differing arm positions. These findings indicate forearm muscle activity is modified in LE. It is unknown whether this is cause or effect. Changes in the asymptomatic side may imply involvement of central mechanisms.

Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey.

BACKGROUND: Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL. METHOD: Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history. RESULTS: A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm- 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001). CONCLUSION: Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.

Stimulation of the local femoral inflammatory response to fracture and intramedullary reaming: a preliminary study of the source of the second hit phenomenon.

We have undertaken a prospective study in patients with a fracture of the femoral shaft requiring intramedullary nailing to test the hypothesis that the femoral canal could be a potential source of the second hit phenomenon. We determined the local femoral intramedullary and peripheral release of interleukin-6 (IL-6) after fracture and subsequent intramedullary reaming. In all patients, the fracture caused a significant increase in the local femoral concentrations of IL-6 compared to a femoral control group. The concentration of IL-6 in the local femoral environment was significantly higher than in the patients own matched blood samples from their peripheral circulation. The magnitude of the local femoral release of IL-6 after femoral fracture was independent of the injury severity score and whether the fracture was closed or open. In patients who underwent intramedullary reaming of the femoral canal a further significant local release of IL-6 was demonstrated, providing evidence that intramedullary reaming can cause a significant local inflammatory reaction.

Patterns of disease progression and outcomes in a randomized trial testing ABVD alone for patients with limited-stage Hodgkin lymphoma.

BACKGROUND: In the National Cancer Institute of Canada Clinical Trials Group/Eastern Cooperative Oncology Group HD.6 trial, progression-free survival was better in patients randomized to therapy that included radiation, compared to doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) alone. We now evaluate patterns of progression and subsequent outcomes of patients with progression. PATIENTS AND METHODS: After a median of 4.2 years, 33 patients have progressed. Two radiation oncologists determined whether sites of progression were confined within radiation fields. Freedom from second progression (FF2P) and freedom from second progression or death (FF2P/D) were compared. RESULTS: Reviewers agreed for the extended (kappa = 0.87) and involved field (kappa = 1.0) analyses. Progression after ABVD alone was more frequently confined within both the extended (20/23 vs. 3/10; P = 0.002) and involved fields (16/23 vs. 2/10; P = 0.02). There was no difference in FF2P between groups [5-year estimate 99% (radiation) versus 96% (ABVD alone)] [hazard ratio (HR) = 3.14, 95% confidence interval (CI) 0.63-15.6; P = 0.14]; the 5-year estimates of FF2P/D were 94% in each group (HR = 1.04, 95% CI 0.41-2.63; P = 0.93). CONCLUSION: Treatment that includes radiation reduces the risk of progressive Hodgkin lymphoma in sites that receive this therapy, but we are unable to detect differences in FF2P or FF2P/D.

Addition of lenalidomide to melphalan in the treatment of newly diagnosed multiple myeloma: the National Cancer Institute of Canada Clinical Trials Group MY.11 trial.

Oral melphalan and prednisone remain an effective and tolerable treatment for patients with multiple myeloma. For approximately 40 years, this combination has been the standard of care for patients not proceeding to stem cell transplant. Within the last 10 years, new agents have been found to be efficacious in the relapsed/refractory setting. Within the last year, two trials of added thalidomide in the newly diagnosed setting have demonstrated outcomes superior to those achieved with melphalan and prednisone alone. This improved outcome comes at the cost of increased toxicity.The National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) has recently developed a randomized phase ii trial (MY.11) that uses a combination of lenalidomide with melphalan for patients with newly diagnosed multiple myeloma. Lenalidomide is a thalidomide analogue and, like thalidomide, is thought to work through immunomodulatory effects. It was shown to have activity in patients with relapsed or refractory disease and, in combination with dexamethasone, is superior to dexamethasone alone. Lenalidomide holds promise as a more effective and potentially less toxic derivative of thalidomide. Experience with lenalidomide in combination with chemotherapy is very limited, and the purpose of MY.11 is to establish tolerability and to gain knowledge about efficacy. The information gained from MY.11 is expected to help inform dosing levels and schedules for a large phase iii trial being developed by the Eastern Cooperative Oncology Group that will include participation by the NCIC CTG.

Chromosomal instability in unirradiated cells induced in vivo by a bystander effect of ionizing radiation.

Using a bone marrow transplantation protocol in which we transplanted a mixture of irradiated and nonirradiated bone marrow cells that were distinguishable by a cytogenetic marker, we have demonstrated chromosomal instability in the progeny of nonirradiated hemopoietic stem cells. This first demonstration of a link between a bystander effect of ionizing radiation and the induction of genomic instability in vivo clearly poses a major challenge to current views of the mechanisms of radiation-induced DNA damage with mechanistic implications for the health consequences of radiation exposure particularly in the context of the induction of malignancy.

Effect of 3,4-diaminopyridine on rat extensor digitorum longus muscle paralyzed by local injection of botulinum neurotoxin.

The actions of the K+ channel blocker, 3,4-diaminopyridine (3,4-DAP), were studied in the rat extensor digitorum longus (EDL) muscle following local inhibition of neuromuscular transmission by botulinum neurotoxin (BoNT). Local paralysis of the EDL muscle was induced by s.c. injections of BoNT serotypes A, B, E or F over the anterior tibialis muscle. One to 14 days later, the rats were anesthetized with urethane, and isometric twitch tensions following stimulation of the peroneal nerve were measured in situ. Muscles were paralyzed within 24 hr of administration of 5 mouse LD50 units (U) of BoNT/A and remained inhibited for the entire 14-day period of observation. Similar levels of inhibition, but of shorter duration, were observed after local injection of 20 U of BoNT/E, 10(4) U of BoNT/B or 20 U of BoNT/F. 3,4-DAP (4 mg/kg, i.v.) potentiated twitch tensions markedly in BoNT/A intoxicated muscle. The increase in tension developed rapidly (halftime = 5.81 +/- 0.6 min), persisted for approximately 1 hr, then decayed slowly with a halftime of 25.2 +/- 4.6 min. Subsequent administration of 3,4-DAP restored tensions to the original maxima, and this procedure could be repeated up to eight times with no decrement. The action of 3,4-DAP was comparable when given 1, 2, 3 or 7 days after BoNT/A and enhanced when administered 14 days after toxin injection. 3,4-DAP was less effective in reversing BoNT/E-induced muscle paralysis and nearly ineffective in antagonizing the paralytic actions of BoNT/B or BoNT/F. The results indicate that 3,4-DAP is of benefit in BoNT/A and BoNT/E intoxication, but is of marginal value after exposure to serotypes B and F.

Pulsatile flow in a catheterised artery.

A model is presented for the physiological problem of a catheter which is inserted in a femoral artery to measure the pressure gradient. As the catheter will modify the pressure distribution in the artery, the pressure gradient which would be recorded by a perfect pressure transducer attached to it would differ from that in the uncatheterised artery. To estimate the magnitude of this error, it is assumed that the rates of flow of blood through the catheterised and the uncatheterised artery are described by the same known periodic function of time.

Styrene migration from general-purpose and high-impact polystyrene into food-simulating solvents.

General-purpose and high-impact polystyrenes (GPPS and HIPS, respectively) are used in many food-contact applications for the packaging of aqueous-based, fatty and dry foods. The correlation of residual styrene concentrations in polystyrene with styrene migration into food-stimulating solvents is of interest in order to predict the potential exposure of consumers to styrene from food-packaging applications. Studies of the migration of styrene into 8% ethanol and cooking oil from a GPPS and a HIPS polymer, each containing three different residual styrene levels, have been completed at temperatures ranging from 70 to 180 degrees F (21 to 82 degrees C). The results showed that the amount of styrene migrating from both polymers into cooking oil was proportional to the square root of the time of exposure, and the total amount of styrene migrating was proportional to the residual levels of styrene in the polymers. The calculated diffusion coefficients were found to be independent of the residual levels of styrene in a given polymer at a given temperature. While the partition equilibrium was not approached when the polymers were exposed to cooking oil, it was observed in the 8%-ethanol exposure studies. The calculated partition coefficients between the polymers and 8% ethanol appeared to be independent of the residual levels of styrene in the polymers at a given temperature. Linear relationships were observed between the logs of the diffusion and partition coefficients and the inverse of the absolute temperature of exposure.

The blood supply of the osteocutaneous free fibular graft.

The use of an osteocutaneous free fibular graft as a single-stage reconstructive procedure for composite tissue loss is increasingly common. Detailed anatomical study in cadavers of the blood supply to the graft demonstrates cutaneous arteries arising from the peroneal artery and then passing along the posterior surface of the lateral intermuscular septum. These vessels pierce the crural fascia and then ramify to supply the skin. Knowledge of the vascular anatomy of the skin overlying the fibula is essential to the success of the graft.

Maximal isometric patellofemoral contact force in patients with anterior knee pain.

We assessed patellofemoral joint function by combining the measurement of maximal isometric extensor torque at the knee with clinical and radiological measurements in order to calculate the patellofemoral contact force. Eighteen volunteers established the normal ranges of results and the reliability of the system. Of the 39 patients with a variety of knee problems, 29 had anterior knee pain, and all had a subsequent arthroscopy. Patients with anterior knee pain and lesions in the patellar cartilage had significantly reduced isometric contact forces, but those with normal patellofemoral cartilage had normal contact forces. Our method may be useful in providing an objective assessment of anterior knee pain and a quantitative means of monitoring its treatment.

Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.

We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming nu non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury. There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united.

A confirmatory study of the relation between self-reported complex partial epileptic signs, peak experiences and paranormal beliefs.

Data obtained from a sample of 102 university students were used to calculate Pearson product moment correlations between measures of complex partial epileptic signs, peak experiences and paranormal beliefs. Significant correlations ranging from .35 to .42 (p < .001) were found between all three measures. Moreover, notable relations were obtained between complex partial epileptic signs and a number of subscales of the paranormal measure including precognition (r = .43), psi beliefs (r = .40), spiritualism (r = .40), extraordinary life forms (r = .26) and superstition (r = .22). The results are consistent with previous research linking temporal lobe signs to paranormal and peak experiences.

Anatomical relationships between selected segmental muscles of the lumbar spine in the context of multi-planar segmental motion: a preliminary investigation.

In the last decade, concepts regarding spinal stability have been redefined. Whereas traditional stability models considered only the integrity of the intervertebral disc and spinal ligaments, mechanisms contributing to spinal stability are now thought to include neural and muscular elements. Lumbar muscles capable of generating intersegmental stiffness are considered necessary for the control of multi-planar segmental spinal motion. The transversus abdominis, psoas, quadratus lumborum and multifidus have each been described functionally as contributing to segmental motion control in the lumbar spine. However, the fundamental anatomy of these muscles has not been fully established nor have their architectural characteristics as a functional group been explored. A dissection of the lumbar spine was undertaken to document the attachments of the deep vertebral muscles and illustrate their group architectural characteristics in the context of multi-planar segmental motion. The transversus abdominis, psoas, quadratus lumborum and multifidus were each noted to have segmental attachment patterns in the lumbar spine. As a group, they surround the lumbar motion segments from the anterolateral aspect of a vertebral body to the spinous process. A hypothetical role for this muscle group in maintaining lumbar spine stability is discussed as are suggestions for future research.

Audit of thromboembolic prophylaxis in hip and knee surgery.

An audit of the departmental policy for thromboembolic prophylaxis was undertaken, examining the use of TED stockings, administration of subcutaneous low-dose heparin and inclusion into a multicentre pulmonary embolism prevention (PEP) trial for fractured neck of the femur. The results showed that despite an established unit policy, only 43% of patients undergoing primary hip replacement and 14% undergoing revision replacement received subcutaneous heparin. All patients undergoing primary and revision total knee replacement received subcutaneous heparin, but 75% of these patients received an incorrect dose. Use of TED stockings in patients who had sustained a fractured neck of the femur, ranged from 0% to 70% depending on the type of fixation. Use of subcutaneous heparin in these patients ranged between 0% and 20% and inclusion into the PEP trial from 0% to 20%. The results of this study were presented to the clinicians working in the orthopaedic department and 3 months later the audit cycle was completed by repeating the study. It was found there was a statistically significant improvement in the administration of subcutaneous heparin and in the wearing of TED stockings in the joint arthroplasty group as well as in the inclusion of hip fracture patients into the PEP trial. This study demonstrates that established protocols are of little value unless audited and that completion of the audit cycle is essential. It does not attempt to show that one prophylactic method is better than another.

Trochanteric non-union in revision total hip arthroplasty: does it matter?

The aims of this study were to assess whether trochanteric non-union is an important factor in revision total hip arthroplasty in terms of postoperative morbidity. We studied prospectively 97 consecutive patients undergoing revision total hip arthroplasty in the years 1992-1996. All operations were performed by one surgeon through a Charnley trans-trochanteric approach. The patients were followed-up over a period of 1-4 years and at 12 months postsurgery were assessed using a modified scoring system devised by D'Aubigne. Anatomical union of the greater trochanter was assessed by an anterior-posterior pelvic radiograph at 12 months to decide if the greater trochanter was united in the correct anatomical position. The trochanteric non-union rate was 18.5% (18 out of 97 patients). There was no significant difference between the patients in terms of pain, function and satisfaction scores at one year between those with trochanteric union and those without. This study suggests that trochanteric non-union post revision total hip arthroplasty is not a cause of increased morbidity.

Incidence and causes of mortality following acute orthopaedic and trauma admissions.

PURPOSE: To analyse the incidence and causes of mortality of orthopaedic and trauma patients. METHODS: Between March 1995 and October 2000, there were 594 (404 females) in-patient deaths (2.8%) with a mean age of 82.14 years (range, 21-102 years) out of 21,122 acute admissions. The cause of death and details of the acute episode were collected from the hospital records, death certificates and postmortem examinations. Data collected were computerised and analysed using the Astute statistical package, University of Leeds. RESULTS: The most common primary diagnosis on admission was fracture neck of femur 392 (69.1%; P = 0.001). In total, 443 (78.1%) patients underwent surgical intervention of their injuries prior to mortality with 21 patients (4.7%) dying on the same day of the operation. The mean number of days between the initial surgical intervention and death was 22.3 days (range, 0-154 days). Of the patients who were treated non-operatively, 124 died due to poor medical condition (4 [3.2%] died within 24 h, 66 [51.6%] died within the first week and the rest died thereafter). In the death certificate, the most common primary cause of death recorded in the group of patients of 64 years of age and below was cancer followed by multi-organ failure. In the age group of 65 years and above, the most common primary cause of mortality was pneumonia followed by heart failure and myocardial infarction. CONCLUSIONS: In orthopaedic and trauma patients below the age of 65 years, the most common cause of death appears to be cancer followed by multiple system organ failure; in the elderly, pneumonia predominates followed by heart failure and myocardial infarction. Proximal femoral fractures accounted for 70% of the deaths.

The Self-Expansiveness Level Form: examination of its validity and relation to the Neo Personality Inventory--Revised.

This study examined the validity of the Self-expansiveness Level Form of Friedman with particular emphasis on the Transpersonal subscale, a measure of transpersonal self-concept, in terms of its basic psychometric properties and its relation to the NEO Personality Inventory--Revised. Support for the basic psychometric properties of the scale in terms of reliability, factorial validity, and concurrent validity was obtained; however, support was limited for convergent validity as correlations between scores on the Transpersonal subscale and measures of theoretically related constructs were low. Correlational analyses involving the Self-expansiveness Level Form and NEO Personality Inventory--Revised indicated that Transpersonal scores were not appreciably associated with the NEO Personality Inventory--Revised domains. Moreover, factor analysis of NEO Personality Inventory--Revised facets and Self-expansiveness Level Form items generated a solution in which the two measures contributed to separate factors. Discussion of the implications and limitations of the findings is included.

Correlations between the Myers-Briggs Type Indicator and the Neo Personality Inventory facets.

Using data obtained from 48 male and 161 female undergraduate students in psychology, correlations between scores on the scales of the Myers-Briggs Type Indicator and the facets of the Neuroticism, Extraversion, and Openness domains of the NEO Personality Inventory were low to moderate.