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[Physical exercise and its effects on the cardiovascular system in elderly subjects].

Physical capacity and exercise tolerance decrease in the elderly because of derangements of the cardiovascular and musculoskeletal systems. It is increasingly apparent that many of these alterations are not necessarily connected to ageing but rather to physical inactivity. Rehabilitation programs adapted to the individual capacities of each patient permit prevention and even reversal of organic and functional deficits of the two systems, which are sometimes at the onset of serious invalidity. The recognition of the usefulness of such programs should lead the practitioner to persuade his elderly patients to sustain a physical activity adapted to their state of health.

Aged↗

The musculoskeletal complications of diabetes.

The musculoskeletal system can be affected by diabetes in a number of ways. Some of the musculoskeletal conditions seen in diabetics are the same as those found in the general (nondiabetic) population, whereas others are unique to diabetes. The hands, shoulders, feet, muscles, and skeleton are some of the frequently affected sites. Although there is often no "cure" for these problems, there are treatments available that can significantly improve function and quality of life for diabetics with rheumatologic problems.

Diabetes Complications↗

Advanced modeling environment for developing and testing FES control systems.

Realistic models of neuromusculoskeletal systems can provide a safe and convenient environment for the design and evaluation of controllers for functional electrical stimulation (FES) prior to clinical trials. We have developed a set of integrated musculoskeletal modeling tools to facilitate the model building process. Simulink models of musculoskeletal systems are created using two software packages developed in our laboratory, Musculoskeletal Modeling in Simulink (MMS) and virtual muscle, in addition to one software package available commercially, SIMM (Musculographics Inc., USA). MMS converts anatomically accurate musculoskeletal models generated by SIMM into Simulink(R) blocks. It also removes run-time constraints on kinetic simulations in SIMM, and allows the development of complex musculoskeletal models without writing a line of code. Virtual muscle builds realistic Simulink models of muscles responding to either natural recruitment or FES. Models of sensorimotor control systems can be developed using various Matlab (Mathworks Inc., USA) toolboxes and integrated easily with these musculoskeletal blocks in the graphical environment of Simulink.

Computer Simulation↗

Health-related quality of life in juvenile-onset systemic lupus erythematosus and its relationship to disease activity and damage.

OBJECTIVE: To assess the health-related quality of life (HRQL) of patients with juvenile-onset systemic lupus erythematosus (JSLE) and its relationship with disease activity and accumulated damage. METHODS: In this cross-sectional study, HRQL was assessed using the Child Health Questionnaire (CHQ), disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and accumulated damage using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). RESULTS: A total of 297 patients were included. The mean +/- SD physical and psychosocial summary scores of the CHQ were 40.2 +/- 15.0 and 44.8 +/- 10.7, respectively. The most impaired CHQ subscales were global health, general health perceptions, and parent impact-emotional. The SLEDAI score was significantly correlated with both the physical summary score (r = -0.29, P < 0.0001) and psychosocial summary score (r = -0.25, P < 0.0001), whereas the SDI score was significantly correlated only with the physical summary score (r = -0.23, P = 0.0001). CONCLUSION: We found that patients with JSLE have significant impairment of their HRQL, particularly in the physical domain. HRQL may be affected by both disease activity and accumulated damage, particularly in the renal, central nervous, and musculoskeletal systems.

Adolescent↗

A comparison of convergent and bi-plane X-ray photogrammetry systems used to detect total joint loosening.

X-ray photogrammetry is an accurate method of measuring structural displacements within the musculoskeletal system. Total joint implant alignment, migration and loosening are important clinical parameters which can be measured by X-ray photogrammetry. The purpose of this paper is to compare two different X-ray photogrammetry systems which are being used to study total joint parameters. The Seattle system uses a convergent geometry and the Cleveland system a bi-plane geometry. The accuracy of the two systems was compared by individually measuring the relative motion produced in an articulated plastic model. The model was designed to simulate the relative motion which can take place between the bone and a loose implant. The displacements of the model components were determined physically and photogrammetrically, and the error in the measurements was calculated for several conditions. Both systems measured relative component motion in the model with a root mean square error of 0.1 mm or less. In clinical use stainless steel markers are implanted in human subjects, and both systems measure distances with a r.m.s. error of 0.2 mm or less. The ease of usage, efficiency and flexibility of the two systems based on actual clinical experience reveals strengths and weaknesses in each which should be recognized when selecting a particular system.

Ankle Joint↗

Three-dimensional magnetic resonance imaging of the interosseous membrane of forearm: a new method using fuzzy reasoning.

We now report newly developed three-dimensional magnetic resonance imaging (3D-MRI) system which is based on semiautomatic tissue extraction from the axial MR images utilizing the fuzzy reasoning calculation method and 3D-image reconstruction with surface rendering. We also studied normal in vivo dynamic changes of the interosseous membrane (IOM) of forearm during rotation using this 3D-MRI. Serial axial MRI of right forearms of five healthy volunteers was obtained in five rotational positions, and extraction and 3D-reconstruction of the radius, ulna, and IOM was made using the system. Extraction results were well with the fuzzy reasoning method. 3D-MRI of the radius and ulna, IOM were reconstructed from these images respectively, and their 3D-shapes were almost identical to the anatomic shape. 3D-MRI showed there were wavy deformities on the IOM in pronation position in the all five subjects and dorsiflexion on the most dorsal portion of the IOM at maximum supination in three forearms. In neutral position, the IOM of all five volunteers was almost flat. From anatomic orientation, these dynamic changes of the IOM mainly occurred at the membranous portion, which is soft, thin, and elastic. Otherwise, the tendinous portion which is a thick and strong complex of 5 to 10 bundles run from proximal one third of the radius to distal one fourth of the ulna, demonstrated minimal dynamic changes on the 3D-MRI. Therefore, the tendinous portion is considered to be taut during rotation to provide stability between the radius and the ulna, while the membranous portion is easy to deform and allowing smooth rotation. Furthermore, because of wide-use, our 3D-MRI system is useful for in vivo analysis of soft tissue kinesiology in normal and abnormal musculoskeletal systems.

Adult↗

[Health effects of occupational exposure among shoe workers. A review].

World-wide epidemiological studies provide evidence that the employment in the shoe production and repair plants is associated with an enhanced risk for cancer (primarily nose and nasal sinuses). According to the majority of authors, it is induced by exposure to leather dust. It is also known that, leather dust particles contain numerous chemicals acquired during the process of leather tanning and finishing (chromium salts, vegetable dye extracts, mineral oils). Some of these compounds exert carcinogenic effect. This paper provides a review of the results of epidemiological studies on health effects of exposure to harmful factors present mainly at the footwear production and repair. These results reveal an enhanced risk for cancer of nose or nasal sinuses induced by leather dust, as well as neoplasms of hematopoietic and lymphatic systems, resulting from exposure to solvents (mostly benzene). Among non-neoplasms, diseases of the musculoskeletal system associated with ergonomic factors, contact dermatics, chronic pulmonary diseases and damage of peripheral nerves in solvent-exposed workers are diagnosed.

Carcinogens↗

A sensorimotor theory of temporal tracking and beat induction.

In this paper, we develop a theory of the neurobiological basis of temporal tracking and beat induction as a form of sensory-guided action. We propose three principal components for the neurological architecture of temporal tracking: (1) the central auditory system, which represents the temporal information in the input signal in the form of a modulation power spectrum; (2) the musculoskeletal system, which carries out the action and (3) a controller, in the form of a parieto-cerebellar-frontal loop, which carries out the synchronisation between input and output by means of an internal model of the musculoskeletal dynamics. The theory is implemented in the form of a computational algorithm which takes sound samples as input and synchronises a simple linear mass-spring-damper system to simulate audio-motor synchronisation. The model may be applied to both the tracking of isochronous click sequences and beat induction in rhythmic music or speech, and also accounts for the approximate Weberian property of timing.

Attention↗

Standardized outcome evaluation after blunt multiple injuries by scoring systems: a clinical follow-up investigation 2 years after injury.

OBJECTIVE: The objective of this study was to evaluate the state of rehabilitation in patients with blunt multiple injuries 2 years after their initial injuries, using several standardized scales and a recently described comprehensive scoring system, by means of a prospective clinical multicenter study. METHODS: Two years after the initial injury, patients with blunt multiple injuries (Injury Severity Score > or = 16) underwent a clinical follow-up in 5 German Level I trauma centers. The reassessment included a complete head-to-toe examination of the musculoskeletal system and a neurologic examination. The following patient-assessed health status scores were used to determine the quality of life: Short-Form 12, Functional Independence Measurement, and Musculoskeletal Function Assessment. Moreover, a comprehensive scoring system developed in our department (Hannover Score for Polytrauma Outcome [HASPOC]) was used that includes provider-report (physician's examination) and self-report (score systems) criteria. RESULTS: Two hundred fifty-four of 312 patients who had been injured between January 1995 and July 1996 were reexamined between January 1, 1997, and July 1, 1998. Among the remaining 58 patients, 9 had died by the time of follow-up, and 49 patients had not accepted the invitation. The mean age of those patients who underwent reexamination was 36 +/- 13 years, the mean Injury Severity Score was 24 +/- 6, and the mean initial Glasgow Coma Scale score was 11 +/- 4 (Abbreviated Injury Scale (AIS) head score of 3.3 +/- 1.1; AIS face, 1.4 +/- 0.1; AIS chest, 3.0 +/- 0.8; AIS abdomen, 1.7 +/- 0.6; and AIS extremities, 3.4 +/- 0.8). The general outcome (Short-Form 12) was as follows: grade I, 9%; grade II, 25%; grade III, 29%; grade IV, 25%; grade V, 6%; and grade VI, 6%. The outcome of the injured extremity demonstrated moderate or severe restrictions according to the Musculoskeletal Function Assessment in 41% of injuries of the lower extremity and in 16% of injuries of the upper extremity. Among patients with injuries to the lower extremity, 52% experienced pain or impaired ability to walk related to an injury of the foot or ankle, 31% indicated pain after a knee or thigh injury, and 27% indicated pain after a femoral or hip injury. The most severe deficits in the range of motion occurred in the foot and the ankle region (13.4% deficit of range of motion < 20% of normal range, p < 0.05 to other injuries). The results of the outcome obtained by self-report correlated with the clinical examination when a scoring system was used that was described recently, the HASPOC. CONCLUSION: In a standardized multicenter reexamination of patients with blunt multiple injuries, the general outcome was usually fair or good. Both the complaints and the objective results of specific extremity areas demonstrated that most limitations were because of injuries below the knee. These results were adequately reflected by a comprehensive scoring system, combining self-report and provider report (HASPOC).

Adult↗

The neuroarticular lesion in the elderly: a condensed literature review.

OBJECTIVE: This condensed literature review was performed to show how inappreciably known are the aging effects of the neuromuscular system, especially the neuroarticular function. To give a needed perspective on the aging process of the musculoskeletal system of a rapidly aging population that is all-important to the chiropractor. DATA SOURCES: An online search of several databases (MEDLINE and MANTIS) provided several guidelines for review. Comparison among the guidelines was made on different aspects: format, focus, significance of aging of the neuroarticular process, and primary diagnostic considerations. For brevity, no tables were cited for comparisons on the aspects covered and supported by the references. DATA SYNTHESIS: Condensed literature review from abstracts and full-length articles were used to establish the review conclusions. RESULTS: The data and information found in this literature search are insufficient to draw primary conclusions about the aging process and the neuroarticular complex. CONCLUSION: It may be simply concluded that there needs to be additional concentrated research in the area of the neuroarticular process and the lesion that occurs at some point in time to a significant majority of individuals. As a large portion of chiropractic patients are elderly, this perspective should be read by all chiropractors. There were several criteria in mind when the project began, especially to improve the chiropractic care of the aged patient, to review and to develop needed data, and to understand the neuroarticular process involvement. This article was to accomplish the understanding and build interest in the degeneration ramifications in the neuroarticular complex of the elderly. This interest may stimulate more attention on the subject with an extensive literature search of the topic and additional research needed.

Age Factors↗

Immune responses in space flight.

Space flight has been shown to have profound effects on immunological parameters of humans, monkeys and rodents. These studies have been carried out by a number of different laboratories. Among the parameters affected are leukocyte blastogenesis, natural killer cell activity, leukocyte subset distribution, cytokine production - including interferons and interleukins, and macrophage maturation and activity. These changes start to occur only after a few days space flight, and some changes continue throughout long-term space flight. Antibody responses have received only very limited study, and total antibody levels have been shown to be increased after long-term space flight. Several factors could be involved in inducing these changes. These factors could include microgravity, lack of load-bearing, stress, acceleration forces, and radiation. The mechanism(s) for space flight-induced changes in immune responses remain(s) to be established. Certainly, there can be direct effects of microgravity, or other factors, on cells that play a fundamental role in immune responses. However, it is now clear that there are interactions between the immune system and other physiological systems that could play a major role. For example, changes occurring in calcium use in the musculoskeletal system induced by microgravity or lack of use could have great impact on the immune system. Most of the changes in immune responses have been observed using samples taken immediately after return from space flight. However, there have been two recent studies that have used in-flight testing. Delayed-type hypersensitivity responses to common recall antigens of astronauts and cosmonauts have been shown to be decreased when tested during space flights. Additionally, natural killer cell and blastogenic activities are inhibited in samples taken from rats during space flight. Therefore, it is now clear that events occurring during space flight itself can affect immune responses. The biological significance of space flight-induced changes in immune parameters remains to be established; however, as duration of flights increases, the potential for difficulties due to impaired immune responses also increases.

Animals↗

[Application of the OWAS method in the study of work postures among quarry manual workers].

BACKGROUND: Previous ergonomic and epidemiologic studies revealed high postural risk (exceeding the N.I.O.S.H. recommended limits) and relevant damage (significant excess of acute and chronic lumbosacral spinal disease) among the labourers in porphyry quarries in the Province of Trento (Italy). METHODS: An analysis of work postures was made with the OWAS (Ovako Working postures Analysing System) method. RESULTS: A high prevalence of work postures that have a harmful effect on the musculoskeletal system was found. Working methods need to be changed as soon as possible. CONCLUSIONS: The use of the OWAS method permits a detailed analysis of working conditions in order to identify and re-design the activities causing ergonomically problematic postures.

Data Interpretation, Statistical↗

[The effect of system restructuring on absenteeism due to sickness in the work place. I. Sickness absenteeism during the period 19989-1994].

The current transformation of property relations and economic restructuring, along with many other factors, influence the health condition of workers. The objective of the study was to illustrate the size of the problem and to identify the major causes of work disability among persons employed in enterprises undergoing those processes during the years 1989-94 against the situation observed in the whole country during the same period. The study was carried out in one of the largest industrial plants undergoing the process of economic restructuring. The group investigated was composed of 8,588 workers (including 62.6% of males). In individual years the number of workers in this group was decreasing, and in 1994 the employment status in the group accounted for 37% in relation to the number of workers employed during the first year under observation. The analysis of work disability was based on the rate of sickness absenteeism calculated as a relationship between the number of days of work disability and the number of working days during that particular period. Due to the application of this method it was feasible to consider both workers employed and persons who left the plant, regardless of their employment duration during a year. The study showed a 20 per cent increase in sickness absenteeism during the period of 1989-94. The highest rate (8.60) was noted in 1994. It was higher by 16% in comparison to the rate for the whole country. The greatest difference between these rates was observed in 1990 (the rate in the group investigated was higher by 46%). As to the causes of work disability, the main differences concerned two categories of illnesses, diseases of the circulatory system, a major cause of sickness absenteeism in the group studied (21%), and diseases of the musculoskeletal system, a major cause of sickness absenteeism in Poland. The change in the relationship between sickness absenteeism and the age during the period of the plant restructuring resulted from the fact that a large number of workers left the job. It was observed that the rate of the sickness absenteeism was almost directly proportional to the percentage of persons leaving the plant in individual years. The study showed that changes in the size and the structure of employment resulting from the plant restructuring influence the level of sickness absenteeism, and the age-related diversification in causes of diseases, and in consequence alter the established regularities.

Absenteeism↗

[Can a tail-suspension model be applied to simulate the reproduction system under weightlessness?].

A tail-suspension model to simulate weightlessness is widely used for studies on physiological changes not only of the musculoskeletal system but also of the cardiovascular system. In the present study, we applied this model to investigate whether or not it is possible for male spermatogenesis to occur, and for female rats to maintain pregnancy in this model. Two male rats were suspended with the right inguinal canal ligated loosely for 14 days, and female rats were suspended after copulation (the day when spermatozoa were identified on a smear from the female rat, was referred to as Day 0 for her in this paper). The duration of suspension was chosen dependent upon events to be confirmed during the course of pregnancy. To demonstrate the effects of suspension on implantation, the first and second groups consisted respectively of non-suspended rats penetrated at the base of the tail in the same way as suspended rats, and rats suspended during the former half of pregnancy (Days 0-12, and 0-14). The third group consisted of rats suspended during the latter half (Days 10-20, 10-21, 10-26, and 10-28), and in the final group a rat suspended throughout pregnancy (Days 0-22) was placed. Histological analysis of the male rat testes showed that the testes on the ligated side were scarcely impaired, while the others became degenerated presenting similar appearances of cryptorchidism. The levels of serum testosterone were lower than the control values. As for the female rats, one animal in the final group was successful in parturition, and implantation appeared to be delayed in the second group. A tail-suspended rat, if it is acclimatized to its environment, could succeed in parturition. By employing this model, we can certainly elucidate some new aspects of mammalian reproduction in space.

Animals↗

[Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice].

METHOD: In an open case observation study involving patients with blunt injuries to the musculoskeletal system, the efficacy and tolerability of high-dose Bromelain POS, a plant-derived enzyme preparation, were investigated. The investigating physician was an orthopedic surgeon who, in addition to the usual therapeutic measures, treated 59 of his patients with the bromelaine preparation. The duration of the application was determined by the nature and severity of the lesion, and varied between one and three weeks. The test criteria were swelling, pain at rest and during movement, and tenderness. These parameters were evaluated on the day of the injury and on five subsequent dates. RESULTS: Treatment with bromelaine resulted in a clear reduction in all four parameters tested. Both swelling and the symptoms of pain had improved appreciably at all evaluation time points as compared with baseline. The tolerability of the preparation was very good, and patient compliance was correspondingly high.

Administration, Oral↗

[Ultrasonic diagnosis of the locomotor system. A review].

The purpose of this overview is to discuss the numerous potential applications of diagnostic ultrasound in the evaluation of diseases affecting the musculoskeletal system. Traumatic and inflammatory conditions of tendons, intraarticular effusions and synovial thickening, derangement of articular cartilage, meniscal tears, rotator-cuff lesions and hip anomalies in neonates can be detected by sonography. In addition, hematomas, abscesses, cysts, soft tissue neoplasms and foreign bodies are readily identified using this technique. Sonography is noninvasive, readily accepted by the patients, relatively inexpensive and widely available. In future, further expansion of its role in the diagnostic work-up of musculoskeletal disorders is to be anticipated.

Bone Diseases↗

Performing arts medicine: the musical athlete.

Musicians and dancers in the performing arts place abnormal stresses on their musculoskeletal systems, resulting in overuse injuries. The purpose of this paper is to address the factors contributing to musculoskeletal injuries sustained by musicians. Recommendations for evaluative procedures, treatment, and education in dealing with the needs of this population are discussed.

Adult↗

Magnetic resonance imaging of musculoskeletal injuries.

Magnetic resonance (MR) imaging has been applied toward the assessment of a wide spectrum of injuries to the musculoskeletal system. This use of MR imaging has been enthusiastically accepted by orthopedic surgeons, and the assessment of musculoskeletal trauma has emerged as one of the most commonly utilized applications of this diagnostic method. This article encompasses the major applications of MR imaging in the assessment of injuries to bone and soft tissue. Emphasis is placed on the most commonly encountered conditions, namely, those that are accidental, exercise-, and sports-related. Technical considerations as they pertain to the design and interpretation of trauma-related musculoskeletal MR imaging are addressed.

Fractures, Bone↗