Which prosthetic foot to prescribe?

Introduction: Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to 'try out' a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to patient related factors which can change from day-to-day and can thus make device comparisons unreliable. To determine whether a device’s mechanical function consistently has a more meaningful impact on gait than patient-related factors, the present study undertook quantitative gait analyses of a trans-tibial amputee walking using two different foot-ankle devices on two occasions over a year apart. If the observed differences present between devices, established using quantitative gait analysis, were in the same direction and of similar magnitude on each of the two occasions, this would indicate that device-related factors were more important than patient-related factors. Methods: One adult male with a unilateral trans-tibial amputation completed repeated walking trials using two different prosthetic foot devices on two separate occasions, 14 months apart. Walking speed and sagittal plane joint kinematics and kinetics for both limbs were assessed on each occasion. Clinically meaningful differences in these biomechanical outcome variables were defined as those with an effect size difference (d) between prosthetic conditions of at least 0.4 (i.e. 'medium' effect size). Results: Eight variables namely, walking speed, prosthetic 'ankle' peak plantar- and dorsi-flexion and peak positive power, and residual knee loading response flexion, peak stance-phase extension and flexion moments and peak negative power, displayed clinically meaningful differences (d > 0.4) between foot devices during the first session. All eight of these showed similar effect size differences during the second session despite the participant being heavier and older. Conclusions: Findings suggest that a prosthetic device's mechanical function consistently has a more meaningful impact on gait than patient-related factors. These findings support the current clinical practice of making decisions regarding prosthetic prescription for an individual, based on a single session evaluation of their gait using two different devices. However, to confirm this conclusion, a case series using the same approach as the present study could be undertaken

Influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training on the plasma cytokine response to maximum sustainable voluntary ventilation

The influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training (IMT) on the cytokine response to maximum sustainable voluntary ventilation (MSVV) is unknown. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1h of (1) passive rest and (2) MSVV, whereby participants undertook volitional hyperpnea at rest that mimicked the breathing and respiratory muscle recruitment patterns commensurate with heavy cycling exercise. Plasma cytokines remained unchanged during passive rest. There was a main effect of time (P < 0.01) for plasma interleukin-1 (IL-1) and interleukin-6 (IL-6) concentrations and a strong trend (P = 0.067) for plasma interleukin-1 receptor antagonist concentration during MSVV. Plasma IL-6 concentration was reduced after IMT by 27 + 18% (main effect of intervention, P = 0.029), whereas there was no change after PLA (P = 0.753). There was no increase in a systemic marker of oxidative stress [DNA damage in peripheral blood mononuclear cells (PBMC)], and diaphragm fatigue was not related to the increases in plasma IL-1 and IL-6 concentrations. A dose-response relationship was observed between respiratory muscle work and minute ventilation and increases in plasma IL-6 concentration. In conclusion, increases in plasma IL-1 and IL-6 concentrations during MSVV were not due to diaphragm fatigue or DNA damage in PBMC. Increases in plasma IL-6 concentration during MSVV are attenuated following IMT, and the plasma IL-6 response is dependent upon the level of respiratory muscle work and minute ventilation

The calculation, thresholds and reporting of inter-limb strength asymmetry: a systematic review

The prevalence of inter-limb strength differences is well documented in the literature however, there are inconsistencies related to measurement and reporting, and the normative values and effects associated with inter-limb asymmetry. Therefore, the aims of this systematic review were to: 1) assess the appropriateness of existing indices for the calculation of asymmetry, 2) interrogate the evidence basis for literature reported thresholds used to define asymmetry and 3) summarise normative levels of inter-limb strength asymmetry and their effects on injury and performance. To conduct this systematic review, scientific databases (PubMed, Scopus, SPORTDiscus and Web of Science) were searched and a total of 3,594 articles were retrieved and assessed for eligibility and article quality. The robustness of each identified asymmetry index was assessed, and the evidence-basis of the identified asymmetry thresholds was appraised retrospectively using the references provided. Fifty-three articles were included in this review. Only four of the twelve identified indices were unaffected by the limitations associated with selecting a reference limb. Eighteen articles applied a threshold to original research to identify “abnormal” asymmetry, fifteen of which utilised a threshold between 10-15%, yet this threshold was not always supported by appropriate evidence. Asymmetry scores ranged between and within populations from approximate symmetry to asymmetries larger than 15%. When reporting the effects of strength asymmetries, increased injury risk and detriments to performance were often associated with larger asymmetry, however the evidence was inconsistent. Limitations of asymmetry indices should be recognised, particularly those that require selection of a reference limb. Failure to reference the origin of the evidence for an asymmetry threshold reinforces doubt over the use of arbitrary thresholds, such as 10-15%. Therefore, an individual approach to defining asymmetry may be necessary to refine robust calculation methods and to establish appropriate thresholds across various samples and methodologies that enable appropriate conclusions to be drawn

Pre-launch calibration of the HIRDLS instrument

Report about the aims for the calibration of the HIRDLS instrument

Spring-mass behavioural adaptations to acute changes in prosthetic blade stiffness during submaximal running in unilateral transtibial prosthesis users

Background: Individuals with lower-limb amputation can use running specific prostheses (RSP) that store and then return elastic energy during stance. However, it is unclear whether varying the stiffness category of the same RSP affects spring-mass behaviour during self-selected, submaximal speed running in individuals with unilateral transtibial amputation. Research question: The current study investigates how varying RSP stiffness affects limb stiffness, running performance, and associated joint kinetics in individuals with a unilateral transtibial amputation. Methods: Kinematic and ground reaction force data were collected from eight males with unilateral transtibial amputation who ran at self-selected submaximal speeds along a 15 m runway in three RSP stiffness conditions; recommended habitual stiffness (HAB) and, following 10-minutes of familiarisation, stiffness categories above (+1) and below (-1) the HAB. Stance-phase centre of mass velocity, contact time, limb stiffness’ and joint/RSP work were computed for each limb across RSP stiffness conditions. Results: With increased RSP stiffness, prosthetic limb stiffness increased, whilst intact limb stiffness decreased slightly (p<0.03). Centre of mass forward velocity during stance-phase (p<0.02) and contact time (p<0.04) were higher in the intact limb and lower in the prosthetic limb but were unaffected by RSP stiffness. Intact limb hip joint positive work increased for both the +1 and -1 conditions but remained unchanged across conditions in the prosthetic limb (p<0.02). Significance: In response to changes in RSP stiffness, there were acute increased mechanical demands on the intact limb, reflecting a reliance on the intact limb during running. However, overall running speed was unaffected, suggesting participants acutely adapted to an RSP of a non-prescribed stiffness

Entomopathogenic Fungi on Hemiberlesia pitysophila

Hemiberlesia pitysophila Takagi is an extremely harmful exotic insect in forest to Pinus species, including Pinus massoniana. Using both morphological taxonomy and molecular phylogenetics, we identified 15 strains of entomogenous fungi, which belong to 9 genera with high diversities. Surprisingly, we found that five strains that were classified as species of Pestalotiopsis, which has been considered plant pathogens and endophytes, were the dominant entomopathogenic fungus of H. pitysophila. Molecular phylogenetic tree established by analyzing sequences of ribosomal DNA internal transcribed spacer showed that entomopathogenic Pestalotiopsis spp. were similar to plant Pestalotiopsis, but not to other pathogens and endophytes of its host plant P. massoniana. We were the first to isolate entomopathogenic Pestalotiopsis spp. from H. pitysophila. Our findings suggest a potential and promising method of H. pitysophila bio-control

Latest Results from the Heidelberg-Moscow Double Beta Decay Experiment

New results for the double beta decay of 76Ge are presented. They are extracted from Data obtained with the HEIDELBERG-MOSCOW, which operates five enriched 76Ge detectors in an extreme low-level environment in the GRAN SASSO. The two neutrino accompanied double beta decay is evaluated for the first time for all five detectors with a statistical significance of 47.7 kg y resulting in a half life of (T_(1/2))^(2nu) = [1.55 +- 0.01 (stat) (+0.19) (-0.15) (syst)] x 10^(21) years. The lower limit on the half-life of the 0nu beta-beta decay obtained with pulse shape analysis is (T_(1/2))^(0_nu) > 1.9 x 10^(25) [3.1 x 10^(25)] years with 90% C.L. (68% C.L.) (with 35.5 kg y). This results in an upper limit of the effective Majorana neutrino mass of 0.35 eV (0.27 eV). No evidence for a Majoron emitting decay mode or for the neutrinoless mode is observed.Comment: 14 pages, revtex, 6 figures, Talk was presented at third International Conference ' Dark Matter in Astro and Particle Physics' - DARK2000, to be publ. in Proc. of DARK2000, Springer (2000). Please look into our HEIDELBERG Non-Accelerator Particle Physics group home page: http://www.mpi-hd.mpg.de/non_acc

Complement-Mediated Virus Infectivity Neutralisation by HLA Antibodies Is Associated with Sterilising Immunity to SIV Challenge in the Macaque Model for HIV/AIDS.

Sterilising immunity is a desired outcome for vaccination against human immunodeficiency virus (HIV) and has been observed in the macaque model using inactivated simian immunodeficiency virus (SIV). This protection was attributed to antibodies specific for cell proteins including human leucocyte antigens (HLA) class I and II incorporated into virions during vaccine and challenge virus preparation. We show here, using HLA bead arrays, that vaccinated macaques protected from virus challenge had higher serum antibody reactivity compared with non-protected animals. Moreover, reactivity was shown to be directed against HLA framework determinants. Previous studies failed to correlate serum antibody mediated virus neutralisation with protection and were confounded by cytotoxic effects. Using a virus entry assay based on TZM-bl cells we now report that, in the presence of complement, serum antibody titres that neutralise virus infectivity were higher in protected animals. We propose that complement-augmented virus neutralisation is a key factor in inducing sterilising immunity and may be difficult to achieve with HIV/SIV Env-based vaccines. Understanding how to overcome the apparent block of inactivated SIV vaccines to elicit anti-envelope protein antibodies that effectively engage the complement system could enable novel anti-HIV antibody vaccines that induce potent, virolytic serological response to be developed

High temperature AlInP X-ray spectrometers

Two custom-made Al0.52In0.48P p+-i-n+ mesa photodiodes with different diameters (217 µm ± 15 µm and 409 µm ± 28 µm) and i layer thicknesses of 6 µm have been electrically characterised over the temperature range 0 °C to 100 °C. Each photodiode was then investigated as a high-temperature-tolerant photon counting X-ray detector by connecting it to a custom-made low-noise charge-sensitive preamplifier and illuminating it with an 55Fe radioisotope X-ray source (Mn Kα = 5.9 keV; Mn Kβ = 6.49 keV). At 100 °C, the best energy resolutions (full width at half maximum at 5.9 keV) achieved using the 217 µm ± 15 µm diameter photodiode and the 409 µm ±28 µm diameter photodiode were 1.31 keV ± 0.04 keV and 1.64 keV ±0.08 keV, respectively. Noise analysis of the system is presented. The dielectric dissipation factor of Al0.52In0.48P was estimated as a function of temperature, up to 100 °C. The results show the performance of the thickest Al0.52In0.48P X-ray detectors so far reported at high temperature. The work has relevance for the development of novel space science instrumentation for use in hot space environments and extreme terrestrial applications

Injectable Poly-l-Lactic Acid: A Novel Sculpting Agent for the Treatment of Dermal Fat Atrophy After Severe Acne

Acne vulgaris affects up to 80% of people 11 to 30 years of age, and scarring can occur for up to 95% of these patients. Scarring may be pitted or hypertrophic in nature, although in most cases it is atrophic. Atrophic acne scarring follows dermal collagen and fat loss after moderate to severe acne infection. Injectable poly-L-acid (PLLA) is a biocompatible, biodegradable, synthetic polymer device that is hypothesized to enhance dermal volume via the endogenous production of fibroblasts and, subsequently, collagen. The gradual improvements in cutaneous volume observed after treatment with injectable PLLA have been noted to last up to 2 years. The case studies presented describe the use of injectable PLLA to correct dermal fat loss in macular atrophic acne scarring of the cheeks. Two female patients underwent three treatment sessions with injectable PLLA over a 12-week period. At each treatment session, the reconstituted product was injected into the deep dermis under the depressed portion of the scar. Both patients were extremely pleased with their results at, respectively, 1- and 4-year follow-up evaluations. Patients experienced minimal swelling and redness after injection and no product-related adverse events such as papule and/or nodule formation. The author believes these data suggest that injectable PLLA is a good treatment option for the correction of macular atropic scarring with thin dermis (off-label use), particularly compared with other injectable fillers currently used for this indication that have shorter durations of effect