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PubMed2006

Identification and measurements of strong Brønsted acid site in ultrastable Y (USY) zeolite.

By using the IRMS-TPD method in which IR (infrared) and MS (mass spectroscopy) worked together, acid sites of USY (ultrastable Y) zeolite were studied. A new band of OH playing a role of Brønsted acid was clearly detected on Na2H2-ethylenediaminetetraacetic acid (EDTA)-treated USY at 3595 cm(-1) during an elevation in temperature after the adsorption of ammonia. MS-measured TPD (temperature-programmed desorption) of NH3 and IR-measured TPD of the NH4+ cation coincided well to show that this zeolite consisted of the Brønsted acid sites. The MS-TPD profile at higher temperatures corresponded to the IR-TPD of the 3595-cm(-1) band, and therefore, this OH was identified as a strong acid site. From comparison between IR-TPD of OH and MS-TPD, numbers of three kinds of Brønsted OH (i.e., those in super and sodalite cages of a Y zeolite structure) and created strong Brønsted acid site were quantified. On the other hand, strength of the Brønsted acid site DeltaH was determined individually by a simulation method, where the corrected IR-TPD of OH was simulated based on the proposed equation. Thus, a new strong Brønsted acid site was identified in the EDTA-treated USY, and the amount and strength was measured quantitatively.

Journal Article↗
PubMed1998

Correlation between symptom fatigue and muscular fatigue in multiple sclerosis.

The symptom of fatigue is a frequent complaint in multiple sclerosis (MS) patients. Signs of fatigability have been documented in these patients as well. However, correlation with signs of objective fatigue had not been clarified in MS. The aim of this study was to ascertain the existence of muscular fatigue in multiple sclerosis patients, and to find out if there is a correlation between the subjective symptom of fatigue and muscular fatigue. Fifty MS patients and 50 age and sex matched volunteers were studied using isometric and isotonic tests using the dominant hand. Strength was studied in the baseline condition and also after recovery of either an isotonic (experiment A) or isometric effort (experiment B). Maximum strength, strength in relationship to weight, slope of fatigability in 11 consecutive contractions, and strength and duration of a maximum effort were calculated. Fatigue as a symptom was measured using the Fatigue Severity Scale (FSS) and the Fatigue Descriptive Scale (FDS). Non-parametric techniques were used for the statistical analysis. Patients with MS had less isometric and isotonic strength, but the recovery was the same as recovery in the control group. There was a negative linear correlation between the symptom of fatigue and the baseline strength. In conclusion, this study supports the existence of signs of muscular fatigue in MS patients. However, the recovery after exercise is normal. The correlation between the baseline scores in strength and the symptom of fatigue suggest that the same cause (probably pyramidal deficits) may be involved in both of them. Copyright 1998 Lippincott Williams & Wilkins

Journal Article↗
PubMed1996

Blood donation-related neurologic needle injury: evaluation of 2 years' worth of data from a large blood center.

BACKGROUND: There is little information in the medical literature on t he clinical spectrum of blood donation-related neurologic needle injury and on its frequency in a blood donor population. STUDY DESIGN AND METHODS: Sixty-six cases of blood donation-related neurologic needle injury were identified from nursing reports made during a 2-year collection period involving 419,000 whole blood donations. Telephone follow-up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects. RESULTS: Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow-up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation-related neurologic needle injury was 1 of every 6300 donations. CONCLUSION: While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation-related neurologic needle injury is relatively low.

Adult↗
PubMed2002

Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection--a randomised controlled trial.

Two hundred and thirty women who had undergone surgery for breast cancer were randomised to a prospective study, comparing early (group A) and delayed (group B) shoulder exercise. Preoperatively, group A received instructions and an exercise programme supervised by a physiotherapist, whereas group B received written instructions to use the arm normally but to avoid heavy work. Two weeks after surgery both groups were given identical exercise programmes. Shoulder mobility, hand strength and arm volume were measured preoperatively, 1 month, 6 months and 2 years postoperatively. After 2 years 13.8% of the women had lymphoedema, but there were no significant differences between the groups. Grip strength was slightly decreased during the postoperative period in both groups (n.s.). Postoperatively, all movements in both groups were decreased after 2 weeks and 1 month and shoulder elevation and abduction remained decreased at 2 years. Mobility in group A recovered significantly earlier than in group B.

Clinical Trial↗
PubMedDate not supplied

[Experiences with calcitonin treatment of patients with type I complex regional pain syndrome (CRPS I--Sudeck disease)].

UNLABELLED: PURPOSE/METHODS/PATIENTS: Calcitonin is a common treatment in patients suffering from Complex Regional Pain Syndrome Type 1 (CRPS I), although its effects are being controversially discussed. In a prospective study of 24 patients with CRPS I of the upper limb, we examined the tolerance of daily doses of 0.5 mg human calcitonin administered subcutaneously over 8 weeks. To assess the benefit of this therapy, the patients were clinically examined every second week. The results were compared to a consecutive group of 25 CRPS 1 patients who received only analgetics and physiotherapy. RESULTS: With regard to all examined parameters (spontaneous pain, grip strength, edema, hand function, systematic temperature difference), the patients treated with calcitonin showed an improvement during the observation time. However, a statistically significant difference to the control group was calculated only for the reduction of the edema (P < 0.01). 83% (20/24 patients) of the calcitonin-treated patients suffered from severe, mostly gastroenterological side-effects. Hence therapy had to be discontinued in 3 cases (13%). CONCLUSION: The therapy with calcitonin has the burden of numerous unpleasant side-effects and causes only a slight therapeutic improvement. Thus, calcitonin must only be prescribed with reservations for patients suffering from CRPS I.

Aged↗
PubMed2003

An evaluation of irritant smoke to detect exhalation valve leakage in respirators.

This study evaluated the ability of a qualitative fit-test method (irritant smoke) to detect known exhalation valve leakage. The OSHA protocol for the irritant smoke test mandates the use of a low flow air pump at 200 mL/minute or an aspirator squeeze bulb. Many commercial test kits include an aspirator bulb, which is subject to variation in frequency, depth of squeeze, fatigue rate, and individual hand strength. Previous studies on irritant smoke used a handheld squeeze bulb. This study evaluated the effectiveness of a low flow pump for irritant smoke fit-testing. Twenty subjects wearing North 7600 series full-face respirators equipped with P100 filters were fit-tested with a Portacount Plus to ensure adequate fit. After successful fit was demonstrated, the exhalation valve was replaced with a damaged valve and/or rotated approximately 90 degrees to produce a fit factor below 100. Having induced an exhalation valve leak, the irritant smoke fit-test was performed using the OSHA irritant smoke protocol. To avoid introducing additional unknown leakage, all head movement exercises were replaced with the head straight, normal breathing maneuver. Irritant smoke did not detect 40 percent of respirators with leaking exhalation valves. Sixty percent of the subjects were able to detect the irritant smoke. Test sensitivity was 60 percent, well below the recommended 95 percent criterion. Of the 12 subjects that detected irritant smoke, none detected the smoke in less than a minute; the average detection time was 3 min 5 s. Some subjects were able to suppress the cough reflex. These findings suggest that qualitative fit-testing using irritant smoke with a 200 ml/min continuous flow pump does not have adequate sensitivity to detect fit factors less than 100.

Equipment Failure Analysis↗
PubMed2003

Prospective study of morbidity associated with snakebite envenomation.

BACKGROUND: The morbidity associated with snakebite envenomation has not been well documented. METHOD: Using a standardized questionnaire all patients with snakebite reported to a regional poison center during the year 2001 were followed after hospital discharge by telephone until resolution of symptoms. RESULTS: One hundred and twenty-eight snakebite cases were reported, of which 16 (12.5%) were lost to follow-up and 31 (24.2%) reported no progression of symptoms beyond puncture and were deemed "dry bites." Eighty-one (63.3%) patients were followed for the duration of symptoms. Age ranged from 1 to 86 years with a mean of 32 years. There were 64 males (79%). The snakes were identified as copperhead (n = 57), unidentified venomous (n = 17), timber rattlesnake (n = 6), and cottonmouth (n = 1). All patients were initially evaluated in a hospital emergency department of which 51 were admitted. Nine patients received antivenin. Of the 37 patients who had a job, 33 lost a mean of 14 days of work (SD +/- 18.1). Mean duration of edema was reported as 11.4 days (S.D +/- 12). Recurrent edema frequently occurred with limb activity. Pain was scored on a scale of 1 to 10, with a mean score of 4.8 (SD +/- 2.7). Mean duration of pain was reported as 7.8 days (SD +/- 6.4). Thirty patients required accommodation for ambulation including crutches (n = 11), limp (n = 11), and no shoes or loose shoes (n = 14). Of the 26 patients bitten on the hand or finger, duration of reduced function persisted for a mean of 14.3 days (SD +/- 10.4) and reduction of hand strength persisted for a mean of 22 days (SD +/- 25.5). Five patients had poorly healing wounds at the bite site which persisted from 14 to 77 days with a mean of 45 days (SD +/- 22.8) CONCLUSION: In this study snakebite resulted in significant duration and extent of morbidity in a majority of patients.

Adolescent↗
PubMed1996

Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study.

BACKGROUND: There are no earlier cross-national comparative studies analyzing the functions of the posture control mechanisms and its sensory-motor correlates in elderly subjects. We investigated whether there are differences in balance between elderly subjects living in different geographical areas, and analyzed the sensory-motor associates of balance in men and women separately. METHOD: Using a force platform method, the functioning of the posture control system under three standardized conditions (normal standing, eyes open; normal standing, eyes closed; and tandem standing, eyes open) was studied among samples of 75-year-old residents in three Nordic localities, namely Glostrup in Denmark, Göteborg in Sweden, and Jyväskylä in Finland. The associations of the variables describing performance in each test with other sensory and motor functions were studied using correlation analyses and multivariate regression models. RESULTS: Differences between the populations were observed in both tests with visual control, favoring the participants from Glostrup and Jyväskylä compared with those from Göteborg. However, only minor differences between the subjects from different localities were observed in the test performed with the eyes closed. In all localities there was a primary sex difference in favor of the women which, however, mainly disappeared when body height was taken into the analyses as a covariate. A good performance in the balance tests (body height-adjusted values) was associated with good visual acuity, low vibrotactile thresholds, and high psychomotor speed. Also, isometric muscle strength, especially hand grip and body extension, was positively associated with good performance in the balance tests. Among the women, a poorer balance was observed in women with a smaller body mass. The results of the multivariate analyses showed that among the men, the most important predictors of good performance in the balance tests were low vibrotactile threshold on the foot, high isometric hand grip strength, and low body stature. Among the women, the most important predictors were low body stature, high body mass, high isometric body extension strength, and high psychomotor speed. However, only a small proportion of the variance in balance (about 13% in the men and 11% in the women) could be explained by the help of these factors. CONCLUSIONS: As the same procedure was applied to the analysis of postural balance, some differences between the populations living in different localities could be detected in some of the tests. The better performance of the women in the balance tests may partly be explained by anthropometric factors, especially differences in body height. There may also be differences in sensory-motor associates of balance in elderly men and women. On the basis of the associations observed, it is difficult to explain the differences in balance between the sexes or subjects living in different localities. Within the sexes, only a small proportion (10-13%) of the variation in balance during normal standing with eyes open could be explained by the factors included in the study.

Aged↗
PubMedDate not supplied

Rehabilitation of eosinophilic fasciitis. A case report.

Eosinophilic fasciitis (EF), first described in 1974, is characterized by the sudden onset of painful swelling with induration of the soft tissues and peripheral eosinophilia, often after an episode of intense physical exertion. It rapidly progresses to joint contractures because of inflammation and fibrosis of the fascia. Of the 200 cases reported in the medical literature, most have responded positively to a prolonged course of oral prednisone. Although complete recovery is possible, more frequently signs and symptoms of EF persist. There were no detailed descriptions found in the literature of any rehabilitative interventions in this disease. This case study describes the methods used in a successful, comprehensive rehabilitation treatment of a 21-yr-old man admitted to the Palo Alto VA Medical Center rehabilitation program 8 mo after the onset of symptoms. Previous medication therapy included prednisone and methotrexate. The patient underwent 2 mo of inpatient rehabilitation, which consisted of upper and lower extremity nerve blocks, serial splinting, application of physical modalities, massage, stretching and strengthening exercises and interdisciplinary pain management. Significant improvement was made in the range of motion in all extremities, strength, hand function, level of pain, gait and endurance. Aggressive therapy did not increase eosinophilia. In fact the eosinophil count returned to normal by the time of discharge. A detailed review of the patient's rehabilitation program is presented.

Activities of Daily Living↗
PubMed2000

Orthopaedic manifestations of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is the most prevalent heritable disorder of connective tissue. Musculoskeletal problems include joint pain, swelling and instability, and spinal deformity. This study was undertaken to assess functional orthopaedic problems of patients with Ehlers-Danlos syndrome. Sixty patients with genetically verified Ehlers-Danlos syndrome (range, 8-60 years; mean, 34 years) who attended a National Ehlers-Danlos Syndrome Foundation learning conference were evaluated by questionnaire, clinical examination, and when indicated, radiographs. A database of 250 items per patient was constructed and statistically assessed using analysis of variance. Because of rarity of Types VII and VIII, these two patients were dropped from the analysis. Fifty-eight patients had Ehlers-Danlos syndrome Types I, II, III, or IV and form the study cohort. Among these four types, there were no significant differences in history of joint dislocation, swelling, or types of orthopaedic surgical procedures experienced. Thirty patients with Type III Ehlers-Danlos syndrome reported joint pain more frequently than did patients with Types I, II, or IV. Ambulation was impaired significantly in patients with Type III disorder as a whole, as was functional hand strength and upper extremity function. Back or neck pain was a common (67.2%) report among patients with all types of disease but did not correlate with the presence or absence of spinal deformity. Contrary to most previous reports, the patients in this study showed that Type III Ehlers-Danlos syndrome was the most debilitating form with respect to musculoskeletal function.

Adolescent↗
PubMed1999

The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change.

BACKGROUND AND PURPOSE: To be useful for clinical research, an outcome measure must be feasible to administer and have sound psychometric attributes, including reliability, validity, and sensitivity to change. This study characterizes the psychometric properties of the Stroke Impact Scale (SIS) Version 2.0. METHODS: Version 2.0 of the SIS is a self-report measure that includes 64 items and assesses 8 domains (strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, and participation). Subjects with mild and moderate strokes completed the SIS at 1 month (n=91), at 3 months (n=80), and at 6 months after stroke (n=69). Twenty-five subjects had a replicate administration of the SIS 1 week after the 3-month or 6-month test. We evaluated internal consistency and test-retest reliability. The validity of the SIS domains was examined by comparing the SIS to existing stroke measures and by comparing differences in SIS scores across Rankin scale levels. The mixed model procedure was used to evaluate responsiveness of the SIS domain scores to change. RESULTS: Each of the 8 domains met or approached the standard of 0.9 alpha-coefficient for comparing the same patients across time. The intraclass correlation coefficients for test-retest reliability of SIS domains ranged from 0.70 to 0.92, except for the emotion domain (0.57). When the domains were compared with established outcome measures, the correlations were moderate to strong (0.44 to 0.84). The participation domain was most strongly associated with SF-36 social role function. SIS domain scores discriminated across 4 Rankin levels. SIS domains are responsive to change due to ongoing recovery. Responsiveness to change is affected by stroke severity and time since stroke. CONCLUSIONS: This new, stroke-specific outcome measure is reliable, valid, and sensitive to change. We are optimistic about the utility of measure. More studies are required to evaluate the SIS in larger and more heterogeneous populations and to evaluate the feasibility and validity of proxy responses for the most severely impaired patients.

Aged↗
PubMedDate not supplied

Postoperative therapy after metacarpophalangeal arthroplasty.

A literature review was conducted to determine the most effective postoperative therapy regimens for metacarpophalangeal (MCP) arthroplasty. The main difference between the regimens was the use of passive MCP extension over active extension and splinting in MCP flexion over splinting in extension. One study did not find continuous passive motion to be significantly beneficial for gaining hand strength or MCP motion. No study evaluated the efficacy or suitability of a particular regimen for specific implants or surgical procedures.

Arthritis, Rheumatoid↗
PubMed2000

The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius.

The capacity for physiotherapy to improve the outcome after fracture of the distal radius is unproven. We carried out a randomised controlled trial on 96 patients, comparing conventional physiotherapy with a regime of home exercises. The function of the upper limb was assessed at the time of removal of the plaster cast and at three and six months after injury. Factors which may predict poor outcome in these patients were sought. Grip strength and hand function did not significantly differ between the two groups. Flexion and extension of the wrist were the only movements to improve with physiotherapy at six months (p = 0.001). Predictors of poor functional outcome were malunion and impaired function before the fracture. These patients presented with pain, decreased rotation of the forearm and low functional scores at six weeks. Our study has shown that home exercises are adequate rehabilitation after uncomplicated fracture of the distal radius, and routine referral for a course of physiotherapy should be discouraged. The role of physiotherapy in patients at high risk of a poor outcome requires further investigation.

Aged↗
PubMed2006

Practical problems with aerosol therapy in COPD.

Inhaled aerosol drugs commonly used by patients with chronic obstructive pulmonary disease include short-acting and long-acting bronchodilators, as well as corticosteroids. These agents are available in a variety of inhaler devices, which include metered-dose inhalers (MDI), breath-actuated MDIs, nebulizers, and, currently, 5 different models of dry powder inhaler (DPI). There is evidence to suggest that multiple inhaler types cause confusion among patients and increase errors in patient use. Problems with MDIs include failure to coordinate inhalation with actuation of the MDI, inadequate breath-hold, and inappropriately fast inspiratory flow. Lack of a dose counter makes determining the number of remaining doses in an MDI problematic. Patient misuse of MDIs is compounded by lack of knowledge of correct use among health-care professionals. Several factors often seen with elderly patients have been identified as predictive of incorrect use of MDIs. These include mental-state scores, hand strength, and ideomotor dyspraxia. Holding chambers and spacers are partially intended to reduce the need for inhalation-actuation coordination with MDI use. However, such add-on devices can be subject to incorrect assembly. Possible delays between MDI actuation and inhalation, rapid inspiration, chamber electrostatic charge, and firing multiple puffs into the chamber can all reduce the availability of inhaled drug. Because they are breath-actuated, DPIs remove the need for inhalation-actuation synchrony, but there is evidence that patient errors in use of DPIs may be similar to those with MDIs. One of the biggest problems is loading and priming the DPI for use, and this may be due to the fact that every DPI model in current use is different. Medical personnel's knowledge of correct DPI use has also been shown to be lacking. The optimum inhalation profiles are different for the various DPIs, but, generally, chronic obstructive pulmonary disease patients have been shown to achieve a minimum therapeutic dose, although the inhaled amount may be suboptimal. A limitation of DPIs that have multidose powder reservoirs (eg, the Turbuhaler) is ambient humidity, which can reduce the released dose. Small-volume nebulizers are limited by bulk, treatment time, and variable performance, but are easy for patients to use. Important features identified by patients for an ideal inhaler are ease of use during an attack, dose counter, and general ease of use and learning. A breath-actuated-pMDI, such as the Autohaler, ranked at the top of inhaler preference in a study of 100 patients with airflow obstruction, compared to DPIs and MDIs. Short of a universal simple inhaler, patient and caregiver education remains the best solution to correct patient errors in use.

Administration, Inhalation↗
PubMed1990

Carpal tunnel syndrome among Minnesota dental hygienists.

Because of inherent aspects of clinical practice, dental hygiene practitioners may be at risk for developing carpal tunnel syndrome (CTS). A study was conducted to determine the prevalence of CTS among dental hygienists and its effects on clinical practice. A 33-item questionnaire was mailed to a random sample of 493 dental hygienists. A 90% response rate was achieved. Results revealed that 7% of the respondents had been diagnosed as having CTS. However, 63% had experienced one or more symptoms. Six percent reported that CTS had affected their clinical practice in ways such as limiting the number of days practiced, diminishing their hand strength, or forcing them to leave the profession. The findings suggest a need for dental hygienists to obtain information on CTS symptoms to facilitate early diagnosis and treatment.

Adult↗
PubMed1989

[Age-related dynamics of physical development of schoolchildren with various patterns of motor activity].

The longitudinal survey of schoolchildren's physical development was undertaken for 4 years with the 6-month interval. The schoolchildren of the 4th-7th grades were examined compared to swimmers of the same age (30 boys and 30 girls, 120 children all together). As a result nonuniform increase of growth and weight indicators, those of breast circumference and excursion, vital capacity and hand strength was established. The indicators' increase depended on age, sex, regime of motor activity and time of the year. because of girls' earlier puberty by the age of 12 they went ahead of boys by anthropometric indicators but by the age of 14 boys were again ahead of girls by all the indicators of their physical development. The highest growth of all morphologic indicators in sportsmen and others was established during the period from April till October, i.e., in spring and in summer. Regular swimming lessons promoted not only better physical but also harmonious development of adolescents. At the same time relatively early specialization in swimming hindered girls' puberty, especially at the age of 13. Thus it was necessary to set standards for physical load and to assess body functional capacity taking account not only of actual but also biological age.

Adolescent↗
PubMed1989

[Manual therapy in complex treatment of patients with secondary osteochondrosis after sustained tuberculosis spondylitis].

The treatment results relating to 57 patients with neurological signs of osteochondrosis secondary to sustained tuberculous spondylitis with the pain syndrome prevailing in the clinical picture were studied. The majority of the patients (50) had limited affections of 1 or 2-3 adjoining vertebrae and 7 patients had extended processes (4-6 adjoining vertebrae). The treatment procedure was based on manual therapy: hand strength applied to the vertebral column, joints and muscles for eliminating pain and other neurological signs of the disease. The treatment should be complex and differential in regard to the clinical signs, the disease process and stage, the degree of functional disorders and of the pain syndrome. The manual therapy was the most efficient in patients with osteochondrosis secondary to sustained tuberculous spondylitis or the muscular tonic syndrome and moderate deformations of the vertebral column, as well as in those operated on for the main disease at the early stages.

Adult↗