Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study.

Prospective controlled intervention study. To evaluate a specific segmental muscle training program of the lumbar spine in order to prevent and reduce low back pain in young female teamgym gymnasts. Teamgym is a team sport comprising three events: trampette, tumbling and floor programme. In a recent study, it was found that teamgym gymnasts practice and compete despite suffering from back pain. Specific muscle control exercises of the lumbar spine have shown good results in reducing pain intensity and functional disability levels in patients with low back pain. To our knowledge, this type of training has not been studied in an adolescent athletic population before. Fifty-one gymnasts, with and without LBP, 11-16 years old, from three top-level gymnastics team participated in the study comprising 12 weeks. Every day the gymnasts answered a questionnaire regarding low back pain. After baseline (4 weeks) the intervention group performed a specific segmental muscle training program. Twenty-four gymnasts (47%) reported low back pain during baseline. Nine gymnasts failed to answer the questionnaire every day and the following results are based on 42 gymnasts (intervention group, n = 30, and control group, n=12). Gymnasts in the intervention group reported significantly less number of days with low back pain at completion compared to baseline (P=0.02). Gymnasts in the control group showed no difference in terms of days with low back pain or intensity of low back pain between baseline and completion. Eight gymnasts (out of 15) with LBP in the intervention group became pain free. Specific segmental muscle control exercises of the lumbar spine may be of value in preventing and reducing low back pain in young teamgym gymnasts.

Musculoskeletal disorders among female and male air traffic controllers performing identical and demanding computer work.

Operators with identical, demanding computer work (90 female and 97 male air traffic controllers) were found to have high prevalences of disorders (assessed by questionnaire and physical examination) in neck, shoulders and upper back. In spite of the identical work, the women displayed higher prevalences than the men (e.g. neck diagnoses 21% vs. 4%). Disorders in elbows, wrists and hands were less common, with similar rates in both genders. Generally, the psychosocial work environment (assessed by questionnaire) was found to be good, but with large inter-individual variation. Women experienced lower decision latitude than men, particularly regarding influence and freedom at work, but perceived higher social support. Physically, the work was characterized by relatively low angular velocities of upper arms (measured by inclinometry) and wrists (right: < 1 degrees/s during 19% of time, measuring by goniometry), dynamic muscular activities and high time fractions of rest in the trapezius and forearm extensor muscles (measuring by electromyography). There were only minor differences between the genders.

Precision of measurements of physical workload during standardised manual handling. Part II: Inclinometry of head, upper back, neck and upper arms.

For measuring the physical exposure/workload in studies of work-related musculoskeletal disorders, direct measurements are valuable. However, the between-days and between-subjects variability, as well as the precision of the method per se, are not well known. In a laboratory, six women performed three standardised assembly tasks, all of them repeated on three different days. Triaxial inclinometers were applied to the head, upper back and upper arms. Between-days (within subjects) and between-subjects (within tasks) variance components were derived for the 10th, 50th and 90th percentiles of the angular and the angular velocity distributions, and for the proportion of time spent in predefined angular sectors. For percentiles of the angular distributions, the average between-days variability was 3.4 degrees , and the between-subjects variability 4.0 degrees . For proportion of time spent in angular sectors, the variability depended on the percentage of time spent in the sector; the relative variability was scattered and large, on average 103% between days and 56% between subjects. For the angular velocity percentiles, the average between-days variability was 7.9%, and the average between-subjects variability was 22%. The contribution of the measurement procedure per se to the between-days variability, i.e., the imprecision of the method, was small: less than 2 degrees for angles and 3% for angular velocity.

Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain.

The present aim was to compare the effects of stabilizing training with those of manual treatment in patients with sub-acute or chronic low-back pain (LBP). Forty-seven patients were randomized to a stabilizing training group (ST group) or a manual treatment group (MT group). The patients underwent a 6-week treatment programme on a weekly basis. Pain, health and functional disability level at the start of treatment, after treatment, and at 3- and 12-month follow-ups were assessed. In the ST group all assessed variables improved significantly (P<0.05) after the treatment period and were maintained long term. After the treatment period there was a significant difference between the groups in assessed function (P<0.05). More individuals in the ST group had improved than in the MT group. At the 3-month follow-up significantly more improved individuals were evident in the ST group regarding pain, general health and functional disability levels. In the long term, significantly more (P<0.05) patients in the MT group reported recurrent treatment periods. The study did not indicate any clear short-term differences between the groups in the accessed outcome measures. In the long term, however, stabilizing training seemed to be more effective than manual treatment in terms of improvement of individuals and the reduced need for recurrent treatment periods.

Fluoride concentrations in saliva and dental plaque in young children after intake of fluoridated milk.

This study determined fluoride (F) concentrations in whole saliva and dental plaque after intake of fluoridated milk using a randomised crossover experimental design. Eighteen healthy children (6-8 years) were subjected to each of four different 3-day drinking regimens: (a) 200 ml F-free tap water; (b) 200 ml tap water with 1.0 mg F; (c) 200 ml standard milk, and (d) 200 ml standard milk with 1.0 mg F. A washout period of 7 days was organised between the different drinking regimens. All children used F-free toothpaste prior to and during the trial and were instructed to avoid F-rich food and drinks. F concentration in unstimulated whole saliva was determined at baseline and after 15 and 120 min and in plaque samples at baseline and after 2 h. The mean baseline values ranged from 0.01 to 0.02 mg F/l in saliva and between 10.4 and 14.2 mg F/l in dental plaque. A statistically significant (p < 0.05) increase of F was disclosed in saliva 15 min after drinking F-containing milk and water (0.052 and 0.058 mg F/l, respectively). After 2 h, the salivary F(-) concentrations were back to baseline values. In the plaque, however, a statistically significant (p < 0.01) twofold increase was found at 2 h after the intake of fluoridated milk and water, respectively. The results indicate that consumption of fluoridated milk contributes to a F storing process with significantly elevated F concentrations in dental plaque up to 2 h after intake. Further studies are required to determine the 'therapeutic concentration' of F in dental plaque after intake of fluoridated milk.

Masked monosomy 7 in myelodysplastic syndromes is uncommon and of undetermined clinical significance.

Masked monosomy 7, i.e. detected by FISH but not by conventional cytogenetics, has been reported in varying frequency in MDS. To establish the prevalence and possible clinical significance of the aberration, we studied the 123 previously karyotyped MDS patients using FISH and a DNA probe specific for chromosome 7. Metaphase cytogenetics revealed ten patients (8%) with monosomy 7 (6 RAEB and 4 RAEB-t). FISH confirmed this result and detected four more cases (4%) with masked monosomy 7 (3 RA and 1 RARS). Thus, masked monosomy 7 is less common than has been suggested, and does not seem to carry the same prognostic weight as monosomy 7 diagnosed by metaphase cytogenetics.

Back muscle fatigue in healthy men and women studied by electromyography spectral parameters and subjective ratings.

To obtain reference data for future studies of patients with low back pain, back muscle fatigue was studied by surface electromyography at L1 and L5 lumbar levels in 55 healthy subjects exerting 80% of maximal voluntary contraction of the back extensors in a sitting position. Reference data were the initial value and rate of decrease (slope) of the median frequency during the contraction. The aim was also to study the effects of contraction time, gender differences, electrode locations and correlations with torque, age and subjective ratings. Initial median frequency was 52 Hz +/- 7.5, with no difference between electrode locations; steeper slopes were found at L5 level (-0.44%/s +/- 0.25) than at L1 (-0.36%/s +/- 0.26). No right-left differences and no gender differences were found for these parameters. A correlation was observed between slope and initial median frequency, higher for men (r approximately -0.7) than for women (r approximately -0.5). Intersubject coefficient of variation for the slope was smallest for the longest (45 seconds) recording time (60-70%), but still much higher than for the initial median frequency (14%). The torque and the subjective ratings of fatigue showed no correlation with the electromyography variables. We conclude that the same reference values can be used for men and women. Owing to the large intersubject range of the slope, the clinical use of this variable may, however, be impeded.

Isolation and characterization of hematopoietic progenitor/stem cells in 5q-deleted myelodysplastic syndromes: evidence for involvement at the hematopoietic stem cell level.

Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal disorders characterized by ineffective hematopoiesis and frequent progression to acute myeloid leukemia. Within MDS, 5q- syndrome constitutes a distinct clinical entity characterized by an isolated deletion of the long arm of chromosome 5 (5q-), a relatively good prognosis, and infrequent transformation to acute leukemia. The cell of origin in 5q- syndrome as well as in other 5q-deleted MDS patients has not been established, but evidence for involvement of multiple myeloid (but not lymphoid) lineages has suggested that a myeloid-restricted progenitor rather than a pluripotent (lympho-myeloid) stem cell might be the primary target in most patients. Although in 9 patients no evidence of peripheral blood T-cell and only 1 case of B-cell involvement was found, the data herein support that 5q deletions occur in hematopoietic stem cells (HSCs) with a combined lympho-myeloid potential. First, in all investigated patients a minimum of 94% of cells in the minor CD34(+)CD38(-) HSC compartment were 5q deleted as determined by fluorescence in situ hybridization. Second, in 3 of 5 patients 5q aberrations were detected in a large fraction (25% to 90%) of purified CD34(+)CD19(+) pro-B cells. Furthermore, extensive functional characterization with regard to responsiveness to early-acting cytokines, long-term culture-initiating cells, and nonobese diabetic/severe combined immunodeficiency repopulating cells supported that MDS HSCs in 5q-deleted patients are CD34(+)CD38(-), but inefficient at reconstituting hematopoiesis.

Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine.

Passive intervertebral motion of the cervical spine was assessed independently by two physical therapists. The therapists had equal backgrounds concerning education and clinical experience. Sixty-one patients seeking care for cervical problems at a private clinic were included in the study where three segments of the cervical spine and the mobility of the first rib were graded as stiff or not stiff. Data were analysed by percentage agreement and kappa coefficient which indicates inter-examiner reliability greater than expected by chance. Results demonstrated inter-examiner reliability of between 70 and 87% and kappa coefficients ranging between 0.28 and 0.43 considered to be only 'fair to moderate'.

Gain of chromosome 7, which marks the progression from indolent to aggressive follicle centre lymphomas, is restricted to the B-lymphoid cell lineage: a study by FISH in combination with morphology and immunocytochemistry.

In a previous fluorescent in situ hybridization (FISH) study of patients with high-grade follicle centre lymphomas (FLCs), we often found additional copies of chromosome 7 in bone marrow (BM) cell nuclei even though obvious malignant tumour cells could not always be morphologically identified in the corresponding cell smears. This raised the question whether the gains of chromosome 7 are really confined to B-lymphoid tumour cells or whether other cell lineages are also of clonal origin. In the present investigation we employed FISH in combination with immunomarkers and morphological studies on BM smears and lymph node imprints from seven patients with high-grade FCLs and diffuse large B-cell lymphomas (DLBCLs). Three out of seven BM samples were found to contain clonal CD20-positive B-lymphoid cells (range 0.4-96% of the cells) and no extra copies of chromosome 7 were detected in the myelomonocytoid or erythroid cells or in the CD3-positive T lymphocytes. All seven patients showed additional copies of chromosome 7 in the lymph nodes and, again, this cytogenetic abnormality was also restricted to the CD20-positive cells (range 0.7-80% of the cells). Thus the present findings confirm that high-grade B-cell lymphomas with or without BM engagement involve the CD20-positive B-lymphoid cells exclusively and not the T lymphocytes, erythroid or myelomonocytoid cell lineages. These findings may indicate that anti-CD20 immunotherapy could be of value in high-grade B-cell lymphomas.

Reliability of EMG spectral parameters in repeated measurements of back muscle fatigue.

The change in median frequency of the power spectrum of the electromyographic (EMG) signal may be used as a measure of muscle fatigue. The reliability of the median frequency parameters was investigated for EMG-recording sites at L1 and L5 right and left on the erector spinae. The reliability of subjective fatigue ratings of the back muscles (Borg CR-10 scale) and of maximal trunk extension torque (MVC) was also investigated. Eleven subjects with healthy backs performed a 45-s isometric trunk extension at 80% of MVC twice a day, on three different days. Two-factor analysis of variance was made to obtain the different variances from which the standard error of measurement (SEM) and the intra class correlation coefficient (ICC) were calculated. The SEM within-day was somewhat lower than that between-days. Both were about the same at all four electrode sites. The 95% confidence interval for the studied variables was for the initial median frequency +/- 10 Hz, for the slope +/- 0.4-0.5%/s, for the MVC +/- 36 Nm and for the Borg ratings +/- 1.6. We conclude that, with the presently used method, changes or differences within these limits should be regarded as normal variability. The slope may be of limited value because of its large variability. Whether the low intraclass correlation coefficient for the EMG parameters in the presently studied test group implies a low potential in discriminating subjects with back pain can not be decisively concluded.

Neutrophil dysplasia is not a specific feature of the abnormal chromosomal clone in myelodysplastic syndromes.

In order to study if dysplastic cells are part of the abnormal chromosomal clone in myelodysplastic syndromes (MDS) we used fluorescence in situ hybridization in combination with standard May-Grünwald-Giemsa morphology (MGG/FISH) to investigate the penetration of chromosomal abnormalities into dysplastic neutrophil granulocytes in five MDS patients with documented monosomy 7 or trisomy 8 in the bone marrow at diagnosis. Neutrophil dysplasia was defined as neutrophil granulocytes with extreme hypogranulation or with nuclear abnormalities of the pelgeroid type. In one patient all dysplastic cells were derived from the abnormal chromosomal clone, while in the other four cases only 6-43% of the hypogranulated neutrophils and 33-40% of the pelgeroid granulocytes exhibited the chromosomal marker. The results suggest that neutrophil dysplasia is not a specific feature of the abnormal chromosomal clone in MDS. It is not clear, however, if the disomic dysplastic cells were derived from a parallel MDS clone with a normal karyotype, or represent residual non-clonal, normal hematopoietic cells.

Trisomy 12 and lymphoplasmacytoid lymphocytes in chronic leukemic B-cell disorders.

BACKGROUND AND OBJECTIVE: Although the finding of trisomy 12 in B-cell malignancies has been extensively documented especially in B-CLL, little is known about the clonal involvement of different tissues and there are few sequential studies documenting the development of trisomy 12 during the course of the disease. The aim of this study was, therefore, to: 1) ascertain the prevalence of trisomy 12 by FISH; 2) correlate the findings of trisomy 12 with hematologic and clinical features; 3) study the trisomy 12 positive clone during the course of the disease, and 4) compare findings of trisomy 12 in different tissues. DESIGN AND METHODS: This a study of an unselected population of 118 patients with CLL or other B-cell disorders in leukemic phase from a defined geographic area. Trisomy 12 was detected by FISH. RESULTS: Trisomy 12 was found in 18 patients (15%). The aberration was significantly more common in morphologically atypical CLL (aCLL) (24%) and CLL/PL (67%) compared to typical CLL (2%) (p < 0.001). aCLL cases had predominantly lymphocytes with lymphoplasmacytoid features. Sequential studies of peripheral blood showed an increase in the proportion of trisomic cells during the observation time, mostly associated with disease progression. None of the initially trisomy 12 negative patients acquired the aberration during follow-up. The percentage of lymphocytes exhibiting trisomy 12 was significantly (p < 0.05) higher in the bone marrow than in peripheral blood. INTERPRETATION AND CONCLUSIONS: Trisomy 12 might define a distinct disease entity with atypical lymphocytes in chronic leukemic B-cell disorders.

Gain of chromosome 7 marks the progression from indolent to aggressive follicle centre lymphoma and is a common finding in patients with diffuse large B-cell lymphoma: a study by FISH.

Gain of chromosome 7 represents one of the most frequent cytogenetic findings in B-cell lymphomas with a follicular growth pattern. We used fluorescence in situ hybridization (FISH) and a probe specifying chromosome 7 on lymph node imprints and/or bone marrow (BM) and peripheral blood (PB) smears from six consecutive patients with follicle centre lymphomas (FCLs) grade I or II (low-grade lymphomas), four patients with FCLs grade III and 11 patients with diffuse large B-cell lymphomas (DLBCLs) (high-grade lymphomas). We found gains of chromosome 7 in 14/18 successfully analysed cases (i.e. 2/6 FCLs grade I-II, 3/3 FLCs grade III and in 9/9 DLBCLs) using lymph node imprints. Moreover, the FISH technique demonstrated gains of chromosome 7 in 1/4 BM and 0/4 PB samples from FCLs grade I-II, in 2/4 BM and 2/4 PB specimens from FCLs grade III and in 4/9 BM and 2/9 PB samples from the DLBCLs. In contrast, morphologically recognizable lymphoma cells were seen in only 1/4 BM and 0/4 PB samples from the FCLs grade III and in 1/11 BM and 1/11 PB samples from the DLBCLs. We conclude that: (i) gain of chromosome 7 marks the progression from indolent to aggressive FCL and would appear to be a common finding in patients with FCLs grade III and in DLBCLs, (ii) clonal lymphoid cells occur frequently in BM and PB in high-grade lymphomas, making traditional staging by cytomorphology uncertain, and (iii) using gains of chromosome 7 as a marker of lymphoma cells, FISH is a useful method to detect minimal residual disease in FCLs grade III and DLBCLs.

Differences in cell lineage involvement between MDS-AML and de novo AML studied by fluorescence in situ hybridization in combination with morphology.

We have employed fluorescence in situ hybridization (FISH) in combination with standard morphology (MGG/FISH) to identify the clonal involvement of different bone marrow cell lineages in 20 AML patients (14 MDS-AML, 6 de novo AML). Even though the number of cells belonging to the abnormal clone varied between individual cases, the percentage of clonal blasts was similar in MDS-AML and de novo AML patients. The erythropoietic cells appeared to be part of the abnormal clone in 13 of 14 patients with MDS-AML, but only in 1 of 6 with de novo AML. Similarly, clonal granulocytes were detected in 13 of 14 patients with MDS-AML, compared to 2 of 6 with de novo AML. Lymphocytes consistently displayed normal, diploid karyotype. The results suggest that it is possible to distinguish between MDS-AML and de novo AML by the use of MGG/FISH; in de novo AML the abnormal chromosomal clone is generally confined to the immature myeloid cells, while in MDS-AML mature granulocytes and erythroid cells are of clonal origin. It is, however, not possible to conclude that MDS-AML is a "multipotent" type of leukaemia, since it cannot be ruled out that the chromosomally aberrant erythroid cells and granulocytes represent surviving cells from the original MDS clone.

Fluorescence in situ hybridization in combination with morphology detects minimal residual disease in remission and heralds relapse in acute leukaemia.

Fluorescence in situ hybridization in combination with morphology (MGG/FISH) was used to detect minimal residual disease (MRD) in complete remission (CR) in 12 cases of acute leukaemia (six MDS-AML, five de novo AML, one pre-B ALL) with numerical chromosomal aberrations at diagnosis. Residual leukaemic cells could be detected in the remission bone marrows by MGG/FISH in five patients, whereas the other seven showed no abnormalities. All five patients with signs of MRD at CR relapsed in the bone marrow with 2-9 months, in contrast to two of seven with a normal finding by MGG/FISH at CR. In both these patients a second MGG/FISH analysis showed that a subpopulation of leukaemic blasts had reappeared, 4 and 5 months prior to the leukaemia becoming clinically overt. One patient suffered a CNS relapse, but without any evidence of bone marrow involvement. The remaining four patients with no evidence of MRD at CR were still in haematological remission at follow-up after 4, 11, 12 and 13 months, respectively. We conclude that MGG/FISH seems to be a clinically useful method to detect MRD in acute leukaemia and to predict relapses, particularly when repeat studies are performed during CR.

Classical morphology, esterase cytochemistry, and interphase cytogenetics of peripheral blood and bone marrow smears.

We used peripheral blood (PB) and bone marrow (BM) smears in the development of two methods based on cytomorphology and esterase cytochemistry in combination with fluorescence in situ hybridization (FISH). The first method involves photodocumentation of May-Grünewald-Giemsa (MGG)-stained cells, followed by destaining in methanol-acetic acid, fixation in paraformaldehyde, and digestion with protease and RNAse before FISH using alpha-satellite probes that specify chromosomes X, 7, 8, and 17. On average, two hybridization signals were seen in 94.5% of disomic BM cells. The hybridization sensitivity was found to vary, however, both among morphologically defined hematopoietic cell lineages and among differentation levels within a lineage. In the second method, an esterase staining technique was followed by the same treatment as for MGG-stained cells. The esterases and FISH signals could be simultaneously visualized and the method was found suitable for rapid screening of in situ signals in cytochemically defined granulocytes and lymphocytes but not in monocytes. The combined methods proved very useful in elucidating the clinical significance of chromosomal abnormalities seen in two cases of leukemia.

Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms.

Thirty patients with unilateral patello-femoral symptoms and a hypotrophic vastus medialis muscle were treated with transcutaneous electrical stimulation of the vastus medialis obliquus and stretching of the lateral thigh muscles twice daily for 10 weeks. Before and after treatment the position of the patella at fixed knee flexion angles and the area of the vastus medialis and vastus lateralis muscles were studied by computed tomography. Isokinetic quadriceps torque was registered with a Cybex II Dynamometer. An evaluation with a functional knee score was carried out. The healthy contralateral leg served as control in all the examinations. Clinically two-thirds of the patients had improved after 10 weeks of treatment and this improvement remained at follow-up 3.5 years later. The area of the vastus medialis and the quadriceps torque of the treated leg increased significantly, while the area of the vastus lateralis and the position of patella did not change. We conclude that transcutaneous electrical muscle stimulation of the vastus medialis and stretching of the lateral thigh muscles might be of benefit in patients with patello-femoral symptoms and a hypotrophic vastus medialis. An improvement after 10 weeks of treatment seems to predict a good long-term result.

The hip joint: forces needed for distraction and appearance of the vacuum phenomenon.

Joint traction and other mobilization techniques are commonly used in physical therapy for patients with osteoarthrosis. The aim of this study has been to: (a) measure the separation of the joint surfaces in the normal hip joint during application of different forces; (b) investigate whether or not the degree of separation was influenced by the position of the joint; (c) compare hip joint laxity in men and women; (d) find the traction force needed to cause the appearance of vacuum phenomena. To achieve a separation in the hip joint, a traction force of at least 400 N must be applied. The distraction was greater in the loose packed position than in the close packed position at equal force and in both males and females. Vacuum phenomena appeared at between 400 and 600 N of traction, varying with joint position.

Increase in myoglobin content and decrease in oxidative enzyme activities by leg muscle immobilization in man.

Biopsies from m. quadriceps femoris from the operated leg of nine patients were taken before, and 6 weeks after, knee surgery. During the whole postoperative period the operated leg was immobilized with the knee in 40-50 degrees of flexion. Myoglobin (MYO) and the enzymes citrate synthase (CS), creatine kinase (CK) and its isozymes MB (CK-MB) and mitochondrial CK (CK-MIT), aspartate aminotransferase (ASAT), phosphofructokinase (PFK) and lactate dehydrogenase (LD) were determined on the biopsies. Citrate synthase, ASAT, CK, CK-MB, CK-MIT and LD activities were decreased (12-30%) after the postoperative leg immobilization period. Phosphofructokinase did not change, while MYO content was increased (16%). In conclusion, a different control of the synthesis of oxidative enzymes and MYO is suggested, as the induced changes following immobilization were in opposite directions. The function of the increased MYO content may be to facilitate the oxygen extraction.