Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis

INTRODUCTION Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). RESULTS Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I2 = 83%). CONCLUSIONS The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry

Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM):study protocol

Abstract Background It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. Method A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. Discussion It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. Trial registration This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111–12626523. ANZCTR: ACTRN1262100016984

An efficient hybrid method for 3D to 2D medical image registration

PURPOSE: The purpose of this paper is to present a method for registration of 3D computed tomography to 2D single-plane fluoroscopy knee images to provide 3D motion information for knee joints. This 3D kinematic information has unique utility for examining joint kinematics in conditions such as ligament injury, osteoarthritis and after joint replacement. METHODS: We proposed a non-invasive rigid body image registration method which is based on two different multimodal similarity measures. This hybrid registration method helps to achieve a trade-off among different challenges including, time complexity and accuracy. RESULTS: We performed a number of experiments to evaluate the performance of the proposed method. The experimental results show that the proposed method is as accurate as one of the most recent registration methods while it is several times faster than that method. CONCLUSION: The proposed method is a non-invasive, fast and accurate registration method, which can provide 3D information for knee joint kinematic measurements. This information can be very helpful in improving the accuracy of diagnosis and providing targeted treatment

Vertical stiffness is not related to anterior cruciate ligament elongation in professional rugby union players

Background: Novel research surrounding anterior cruciate ligament (ACL) injury is necessary because ACL injury rates have remained unchanged for several decades. An area of ACL risk mitigation which has not been well researched relates to vertical stiffness. The relationship between increased vertical stiffness and increased ground reaction force suggests that vertical stiffness may be related to ACL injury risk. However, given that increased dynamic knee joint stability has been shown to be associated with vertical stiffness, it is possible that modification of vertical stiffness could help to protect against injury. We aimed to determine whether vertical stiffness is related to measures known to load, or which represent loading of, the ACL. &#13; Methods: This was a cross-sectional observational study of 11 professional Australian rugby players. Knee kinematics and ACL elongation were measured from a 4-dimensional model of a hopping task which simulated the change of direction manoeuvre typically observed when non-contact ACL injury occurs. The model was generated from a CT scan of the participant's knee registered frame by frame to fluoroscopy images of the hopping task. Vertical stiffness was calculated from force plate data. &#13; Results: There was no association found between vertical stiffness and anterior tibial translation (ATT) or ACL elongation (r=−0.05; p=0.89, and r=−0.07; p=0.83, respectively). ATT was related to ACL elongation (r=0.93; p=0.0001).&#13; Conclusions: Vertical stiffness was not associated with ACL loading in this cohort of elite rugby players but a novel method for measuring ACL elongation in vivo was found to have good construct validity

High-Resolution Patterned Cellular Constructs by Droplet-Based 3D Printing

AbstractBioprinting is an emerging technique for the fabrication of living tissues that allows cells to be arranged in predetermined three-dimensional (3D) architectures. However, to date, there are limited examples of bioprinted constructs containing multiple cell types patterned at high-resolution. Here we present a low-cost process that employs 3D printing of aqueous droplets containing mammalian cells to produce robust, patterned constructs in oil, which were reproducibly transferred to culture medium. Human embryonic kidney (HEK) cells and ovine mesenchymal stem cells (oMSCs) were printed at tissue-relevant densities (107 cells mL−1) and a high droplet resolution of 1 nL. High-resolution 3D geometries were printed with features of ≤200 μm; these included an arborised cell junction, a diagonal-plane junction and an osteochondral interface. The printed cells showed high viability (90% on average) and HEK cells within the printed structures were shown to proliferate under culture conditions. Significantly, a five-week tissue engineering study demonstrated that printed oMSCs could be differentiated down the chondrogenic lineage to generate cartilage-like structures containing type II collagen.</jats:p

Lucro líquido do franqueado: um sinal para a escolha de franquia em época de crise

Este artículo aborda desde la perspectiva de la Teoría de Señales la elección de una franquicia por un potencial franquiciado que elige este canal de distribución por primera vez. El objetivo es analizar la relación entre algunas señales enviadas por el franquiciador y la elección de una franquicia por el potencial franquiciado. Concluimos que los efectos de las variables macroeconómicas de España en el periodo 2006-2013 influyeron en los ingresos netos de los franquiciados para que se convirtiera en una señal empleada por éstos a la hora de elegir la franquicia donde abrir un establecimiento.This paper adopts the perspective of Theory of Signals to discuss how someone starting a business as a franchisee for the first time can choose a suitable franchise brand. The aim was to analyze the relationship between certain signals sent by the franchisor and the choice of a franchise brand by the prospective franchisee. Using panel data, we found that the effects of macroeconomic variables in Spain for the 2006-2013 crisis period influenced franchisees' net income, which thus became a relevant signal in their process of choosing a franchise brand to start a business.Sob a perspectiva da Teoria de Sinais, este artigo aborda a seleção de uma franquia por um franqueado que elege esse potencial canal de distribuição pela primeira vez. O objetivo é analisar a relação entre alguns sinais enviados pelo franqueador e a escolha de uma franquia pelo potencial franqueado. Usando a metodologia de dados em painel, os resultados obtidos nos permitiram concluir que os efeitos das variáveis macroeconômicas da Espanha no período de crise econômica (2006-2013) influenciaram as receitas líquidas dos franqueados, tornando-se um sinal para eles elegerem onde abrir um estabelecimento franqueado

What women value in the midwifery continuity of care model: A systematic review with meta-synthesis

© 2018 Introduction: There are a number of qualitative studies indicating women are more satisfied with a continuity model of midwifery care however, their experiences have not been understood to gain an overall picture of what it is they value, appreciate and want in such a model. A metasynthesis was undertaken in order to examine the current qualitative literature to gain a deeper understanding of the woman's perspective as a consumer of maternity care in a continuity model. Aim: To identify and synthesise research findings presenting childbearing women's perspectives on continuity of midwifery care. Methods: A search using key words was undertaken using the following databases: CINAHL, Cochrane Library, Ovid, Medline, Nursing Reference Centre and Joanna Briggs Institute. Papers were included if they were published since 2006, in English and included qualitative data from the woman's perspective. The selection process followed was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality appraisal was conducted by all authors using the Critical Appraisal Skills Programme (CASP) tool as a screening tool. This allowed for each paper to be appraised to determine risk of bias. Findings: Thirteen quality appraised papers published between 2006 and 2016 were found which included qualitative data and were related to the woman's experience in a continuity model. Six papers were from Australia, three in the United Kingdom, two in New Zealand and one in the United States of America and Denmark. Themes identified included an overarching concept of the relationship which was underpinned by themes of personalised care, trust and empowerment. Conclusions: The midwife–woman relationship is the vehicle through which personalised care, trust and empowerment are achieved in the continuity of midwifery model of care