Interlimb transfer of unimanual grasping movement in upper limb amputees - A pilot study.

Background. Inter-hemispheric communication is necessary during uni- manual grip of an object (1). The right and left hands share a level of representation in the motor program that is common to both (2). It could be essential to take into consideration bi- hemispheric activity to adapt prosthesis of individuals with upper limb amputation.\ud Objective. To determine the relevance of the inter-hemispheric dependence in the programing and execution of uni-manual grip in individuals with upper limb amputation.\ud Methods. Five adults with amputation of the upper limb above and below the elbow participated in this study. Each participant was seated and asked to grab and lift an instrumented cylinder with the sound hand 15 times (Figure 1). The cylinder enabled to record in real time the apposition axis (AO) passing by the thrum, the centre of the cylinder and the first finger as well as the forces applied during the griping period of 2000 ms. The participants were assessed during the temporary (PP) and definitive (PD) phases of prosthesis fitting the after the amputation. Student t-tests were used to determine the effect of different prosthetic phases on the force and orientation of the griping hand.\ud Results\ud 1. A significant reduction (p<0.01) of the forces applied by the sound hand between the two prosthetic phase for 4/5 of the participants (Figure 2)\ud 2. Some changes in the gripping orientation when the amputated hand was dominant for 2/3 of the participants (Figure 3) 3. No changes in the gripping orientation when the amputated hand was not dominant\ud Conclusion. Grip programming and execution with sound hand:\ud 1. Change between two prosthetic fitting phases\ud 2. Depend on the inter-hemispheric transfer related to the force regardless on the amputated hand.\ud 3. Depend on the inter-hemispheric transfer related to the gripping orientation only when the amputated side is dominant.\ud Adjustments in griping force and orientation of the prosthesis depending on the grip correction of the sound hand might be respectively more necessary regardless of the amputated hand and when the amputated hand is dominant.\ud Because of the variability between participants concerning the side of amputation and manual dominance, other studies will be required to generalise these results

BCG scar formation and test results in two generations

Introduction: Considering that BCG injection in newborns is part of TB control program in Iran many years ago, we aimed to compare prevalence of childhood BCG vaccination scar with previous study and asses influence of household crowding on TST result. Aims: Considering that over time there is likely to reduce the immune response, two groups of subjects were selected among young and middle aged. Methods and Material: This cross sectional study was conducted in Zia Abad of Qazvin (a province of Iran) during year 2008. 261 participants randomly were selected (139 asymptomatic children (12-16 y) and 122 adults (40-50 y)). A questionnaire was used to obtain prior histories of BCG vaccination, known exposure to tuberculosis, prior acquired of TB, symptoms of TB disease and household crowding. BCG vaccine scar was ascertained and all participants were tested with 5TU-PPD. Reactions of 10 mm or more were considered positive. Statistical analysis used: Using student t test, chi square and Fisher's exact test, the collected data was analyzed. Results: BCG scar was observed in 78.4 of participant (91.4 children vs. 78.6 adults) which the difference was significant. Twenty three (16.5) of children and 24 (19.7) of adults had tuberculin reactivity of �10 mm. In children and parent groups, positivity of TST had significant direct association with presence of BCG scar and crowding. Conclusions: Most vaccinated children had a scar. Our results demonstrate that a TST applied after BCG vaccination usually produces a reaction of <10 mm. In addition, there is a significant relationship between the tuberculin reactivity and both presence of BCG scar and crowding among children and adult groups. © 2011, Shiraz E Medical Journal. All right reserved

Population-Based Rates of Revision of Primary Total Hip Arthroplasty: A Systematic Review

Background: Most research on failure leading to revision total hip arthroplasty (THA) is reported from single centers. We searched PubMed between January 2000 and August 2010 to identify population- or community-based studies evaluating ten-year revision risks. We report ten-year revision risk using the Kaplan-Meier method, stratifying by age and fixation technique. Results: Thirteen papers met the inclusion criteria. Cemented prostheses had Kaplan-Meier estimates of revision-free implant survival of ten years ranging from 88 % to 95%; uncemented prostheses had Kaplan-Meier estimates from 80 % to 85%. Estimates ranged from 72 % to 86 % in patients less than 60 years old and from 90 to 96 % in older patients. Conclusion: Data reported from national registries suggest revision risks of 5 to 20 % ten years following primary THA. Revision risks are lower in older THA recipients. Uncemented implants may have higher ten-year rates of revision, regardless of age

Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties

OBJECTIVES: T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. METHODS: In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry. RESULTS: The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05). CONCLUSIONS: Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure. Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52–60. DOI: 10.1302/2046-3758.52.200057

Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines

<p>Abstract</p> <p>Background</p> <p>The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention.</p> <p>Methods</p> <p>An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time.</p> <p>Results</p> <p>Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%.</p> <p>Conclusions</p> <p>MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term.</p

Temperature recording sites in infants, children, and adults

Background: Axilla, mouth, and rectum are the most common sites for thermometric measurement. There is no universally accepted belief about how to predict one of them from others. Methods: In a cross-sectional hospital-based study at two educational hospitals in Qazvin Province, mercury in glass thermometers were used and then calibrated with digital thermometer within ±0.1 °C. The axillary temperature was compared with oral or rectal ones in 50 infants, 100 children, and 100 adults. Results: The mean difference between axillary and rectal temperature in infants was 0.366 °C (± 0.21), while those between oral and axilary in children and adults were 0.667 °C (±0.37) and 0.494°C (±0.3), respectively. Among infants, 98 of the oral and rectal readings were stabilized at 5 and 3 minutes, respectively. In children, 98 of the oral readings were stabilized at five but for axilla, 99 by 6 minutes. For adults, 95 of the oral readings were stabilized at 5 minutes while for axilla, it was 96 by 6 minutes. Conclusion: In less than 3 month old infants, axillary temperature accurately reflects the rectal temperature. Axillary and rectal thermometry in infants should be read after 5 and 3 minutes, while oral temperature in children and adults should be read after 6 and 5 minutes, respectively. © Iranian Red Crescent Medical Journal