Bladder trigone sparing radiotherapy in prostate cancer treatment.

INTRODUCTION: Evidence suggests the bladder trigone to be a potential organ at risk (OAR) in predicting acute and late genitourinary (GU) side effects when treating prostate cancer with radiotherapy. METHODS: A search of MEDLINE, Cinahl, EMBASE, PubMed, the Cochrane Database of Systematic Reviews and OpenGrey was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified. A systematic literature review was carried out assessing the quality of this evidence. All evidence that prospectively or retrospectively reviewed radiotherapy or modelled radiotherapy dose to the bladder trigone were included. The search was conducted on the 8th July 2021 with 32 studies included in this review. This was repeated 10th June 2023 and two additional studies were identified. Any evidence published since this date have not been included and are a limitation of this review. RESULTS: MRI imaging is recommended to assist in delineating the trigone which has been shown to have a high amount of inter-observer variability and the use of specific training may reduce this. Across all radiotherapy treatment modalities, trigone dose contributed to GU acute and late toxicity symptoms. Trigone motion is relative to prostate motion but further research is required to confirm if the prostate can be used as a reliable surrogate for trigone position. The dose tolerance given for specific trigone related toxicities is debated within the literature, and on analysis the authors of this review suggest bladder trigone dose limits: Dmean < 45.8 Gy, V61.0Gy < 40%, V59.8Gy < 25%, V42.5Gy-V41.0Gy < 91% and V47.4Gy-V43.2Gy < 91% with α/ß of 3 Gy to reduce acute and late GU toxicities. CONCLUSION: There is evidence to support further research into bladder trigone sparing radiotherapy to improve patient outcomes. IMPLICATION FOR PRACTICE: Using the bladder trigone as an organ at risk is possible and the authors are currently seeking funding for a feasibility trial to further investigate this.

Technical note: Understanding the effect of COVID-19 on particle pollution using a low-cost sensor network.

The 2020 coronavirus pandemic and the following quarantine measures have led to significant changes in daily life worldwide. Preliminary research indicates that air quality has improved in many urban areas as a result of these measures. This study takes a neighborhood-scale approach to quantifying this change in pollution. Using data from a network of citizen-hosted, low-cost particulate matter (PM) sensors, called Air Quality & yoU (AQ&U), we obtained high-spatial resolution measurements compared to the relatively sparse state monitoring stations. We compared monthly average estimated PM2.5 concentrations from February 11 to May 11, 2019 at 71 unique locations in Salt Lake County, UT, USA with the same (71) sensors' measurements during the same timeframe in 2020. A paired t-test showed significant reductions (71.1% and 21.3%) in estimated monthly PM2.5 concentrations from 2019 to 2020 for the periods from March 11-April 10 and April 11-May 10, respectively. The March time period corresponded to the most stringent COVID-19 related restrictions in this region. Significant decreases in PM2.5 were also reported by state monitoring sites during March (p < 0.001 compared to the previous 5-year average). While we observed decreases in PM2.5 concentrations across the valley in 2020, it is important to note that the PM2.5 concentrations did not improve equally in all locations. We observed the greatest reductions at lower elevation, more urbanized areas, likely because of the already low levels of PM2.5 at the higher elevation, more residential areas, which were generally below 2 µg/m3 in both 2019 and 2020. Although many of measurements during March and April were near or below the estimated detection limit of the low-cost PM sensors and the federal equivalent measurements, every low-cost sensor (51) showed a reduction in PM2.5 concentration in March of 2020 compared to 2019. These results suggest that the air quality improvement seen after March 11, 2020 is due to quarantine measures reducing traffic and decreasing pollutant emissions in the region.

Persistent pollutants exceed toxic thresholds in a freshwater top predator decades after legislative control.

Declining emissions of persistent organic pollutants (POPs), subject to international control under the Stockholm convention, are not consistently reflected in biotic samples. To assess spatial and temporal variation in organochlorine pesticides and PCBs in UK freshwaters, we analysed tissues of a sentinel predator, the Eurasian otter, Lutra lutra between 1992 and 2009. Past declines in otter populations have been linked to POPs and it is unclear whether otter recovery is hampered in any areas by their persistence. PCBs, DDT (and derivatives), dieldrin and HCB were detected in over 80% of 755 otter livers sampled. Concentrations of ∑PCB, ∑DDT and dieldrin in otter livers declined across the UK, but there was no significant time trend for ∑PCB-TEQ (WHO toxic equivalency, Van den Berg et al., 2006) or HCB. In general, higher concentrations were found in the midlands and eastern regions, and lowest concentrations in western regions. Concentrations of PCBs and HCB in otters increased near the coast, potentially reflecting higher pollutant levels in estuarine systems. Decades after legislative controls, concentrations of these legacy pollutants still pose a risk to otters and other freshwater predators, with spatially widespread exceedance of thresholds above which reproduction or survival has been reduced in related species.

Spatial and seasonal factors are key determinants in the aggregation of helminths in their definitive hosts: Pseudamphistomum truncatum in otters (Lutra lutra).

Parasites are typically aggregated within their host populations. The most heavily infected hosts are frequently cited as targets for optimal disease control. Yet a heavily infected individual is not necessarily highly infective and does not automatically contribute a higher proportion of infective parasitic stages than a host with fewer parasites. Here, Pseudamphistomum truncatum (Opisthorchiida) parasitic infection within the definitive otter host (Lutra lutra) is used as a model system. The hypothesis tested is that variation in parasite abundance, aggregation and egg production (fecundity, as a proxy of host infectivity) can be explained by abiotic (season and region) or biotic (host age, sex and body condition) factors. Parasite abundance was affected most strongly by the biotic factors of age and body condition, such that adults and otters with a higher condition index had heavier infections than sub-adults or those with a lower condition index, whilst there were no significant differences in parasite abundance among the seasons, regions (ecological regions defined by river catchment boundaries) or host sexes. Conversely, parasite aggregation was affected most strongly by the abiotic factors of season and region, which were supported by four different measures of parasite aggregation (the corrected moment estimate k, Taylor's Power Law, the Index of Discrepancy D, and Boulinier's J). Pseudamphistomum truncatum was highly aggregated within otters, with aggregation stronger in the Midlands (England) and Wales than in the southwestern region of the United Kingdom. Overall, more parasites were found in fewer hosts during the summer, which coincides with the summer peak in parasite fecundity. Combined, these data suggest that (i) few otters carry the majority of P. truncatum parasites and that there are more infective stages (eggs) produced during summer; and (ii) abiotic factors are most influential when describing parasite aggregation whilst biotic factors have a greater role in defining parasite abundance. Together, parasite abundance, aggregation and fecundity can help predict which hosts make the largest contribution to the spread of infectious diseases.

A bioactive metallurgical grade porous silicon-polytetrafluoroethylene sheet for guided bone regeneration applications.

The properties of porous silicon make it a promising material for a host of applications including drug delivery, molecular and cell-based biosensing, and tissue engineering. Porous silicon has previously shown its potential for the controlled release of pharmacological agents and in assisting bone healing. Hydroxyapatite, the principle constituent of bone, allows osteointegration in vivo, due to its chemical and physical similarities to bone. Synthetic hydroxyapatite is currently applied as a surface coating to medical devices and prosthetics, encouraging bone in-growth at their surface and improving osseointegration. This paper examines the potential for the use of an economically produced porous silicon particulate-polytetrafluoroethylene sheet for use as a guided bone regeneration device in periodontal and orthopaedic applications. The particulate sheet is comprised of a series of microparticles in a polytetrafluoroethylene matrix and is shown to produce a stable hydroxyapatite on its surface under simulated physiological conditions. The microstructure of the material is examined both before and after simulated body fluid experiments for a period of 1, 7, 14 and 30 days using Scanning Electron Microscopy. The composition is examined using a combination of Energy Dispersive X-ray Spectroscopy, Thin film X-ray diffraction, Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy and the uptake/release of constituents at the fluid-solid interface is explored using Inductively Coupled Plasma-Optical Emission Spectroscopy. Microstructural and compositional analysis reveals progressive growth of crystalline, 'bone-like' apatite on the surface of the material, indicating the likelihood of close bony apposition in vivo.

Assessment of lopinavir pharmacokinetics with respect to developmental changes in infants and the impact on weight band-based dosing.

Improved antiretroviral therapies are needed for the treatment of HIV-infected infants, given the rapid progression of the disease and drug resistance resulting from perinatal exposure to antiretrovirals. We examined longitudinal pharmacokinetics (PK) data from a clinical trial of lopinavir/ritonavir (LPV/r) in HIV-infected infants in whom therapy was initiated at less than 6 months of age. A population PK analysis was performed using NONMEM to characterize changes in lopinavir (LPV) PK relating to maturational changes in infants, and to assess dosing requirements in this population. We also investigated the relationship between LPV PK and viral dynamic response. Age and ritonavir concentrations were the only covariates found to be significant. Population PK of LPV was characterized by high apparent clearance (CL/F) in young infants, which decreased with increasing age. Although younger infants had lower LPV concentrations, the viral dynamics did not correlate with initial LPV exposure. Monte Carlo simulations demonstrated that WHO weight band-based dosing recommendations predicted therapeutic LPV concentrations and provided drug exposure levels comparable to those resulting from US Food and Drug Administration (FDA)-suggested dosing regimens.

Development of a comprehensive musculoskeletal model of the shoulder and elbow.

The Delft Shoulder and Elbow Model (DSEM), a musculoskeletal model of the shoulder and elbow has been extensively developed since its introduction in 1994. Extensions cover both model structures and anatomical data focusing on the addition of an elbow part and muscle architecture parameters. The model was also extended with a new inverse-dynamics optimization cost function and combined inverse-forward-dynamics models. This study is an update on the developments of the model over the last decade including a qualitative validation of the different simulation architectures available in the DSEM. To validate the model, a dynamic forward flexion motion was performed by one subject, of which the motion data and surface EMG-signals of 12 superficial muscles were measured. Patterns of the model-predicted relative muscle forces were compared with their normalized EMG-signals. Results showed relatively good agreement between forces and EMG (mean correlation coefficient of 0.66). However, for some cases, no force was predicted while EMG activity had been measured (false-negatives). The DSEM has been used and has the potential to be used in a variety of clinical and biomechanical applications.

Relapse or worsening of nephrotic syndrome in idiopathic membranous nephropathy can occur even though the glomerular immune deposits have been eradicated.

BACKGROUND: Relapse or worsening of nephrotic syndrome (NS) in idiopathic membranous nephropathy (IMN) is generally assumed to be due to recurrent disease. Here we document that often that may not be the case. SUBJECTS AND METHODS: This is a prospective study of 7 consecutive IMN patients whose renal status improved, then worsened after completing a course of immunosuppressive therapy. Each underwent detailed testing and repeat kidney biopsy. RESULTS: In 4 patients (group A), the biopsy showed recurrent IMN (fresh subepithelial deposits). Immunosuppressive therapy was begun. In the other 3 patients (group B), the biopsy showed that the deposits had been eradicated. However, the glomerular basement membrane (GBM) was thickened and vacuolated. Immunosuppressive therapy was withheld. Groups A and B were comparable except that group B had very high intakes of salt and protein, based on 24-hour urine testing. Reducing their high salt intake sharply lowered proteinuria to the subnephrotic range and serum creatinine stabilized. CONCLUSION: This work is the first to demonstrate that relapse/worsening of NS can occur in IMN even though the GBM deposits have been eradicated. High salt and protein intake in combination with thickened and vacuolated GBM appears to be the mechanism.

Continuous neuronal ensemble control of simulated arm reaching by a human with tetraplegia.

Functional electrical stimulation (FES), the coordinated electrical activation of multiple muscles, has been used to restore arm and hand function in people with paralysis. User interfaces for such systems typically derive commands from mechanically unrelated parts of the body with retained volitional control, and are unnatural and unable to simultaneously command the various joints of the arm. Neural interface systems, based on spiking intracortical signals recorded from the arm area of motor cortex, have shown the ability to control computer cursors, robotic arms and individual muscles in intact non-human primates. Such neural interface systems may thus offer a more natural source of commands for restoring dexterous movements via FES. However, the ability to use decoded neural signals to control the complex mechanical dynamics of a reanimated human limb, rather than the kinematics of a computer mouse, has not been demonstrated. This study demonstrates the ability of an individual with long-standing tetraplegia to use cortical neuron recordings to command the real-time movements of a simulated dynamic arm. This virtual arm replicates the dynamics associated with arm mass and muscle contractile properties, as well as those of an FES feedback controller that converts user commands into the required muscle activation patterns. An individual with long-standing tetraplegia was thus able to control a virtual, two-joint, dynamic arm in real time using commands derived from an existing human intracortical interface technology. These results show the feasibility of combining such an intracortical interface with existing FES systems to provide a high-performance, natural system for restoring arm and hand function in individuals with extensive paralysis.

The effect of elbow angle and external moment on load sharing of elbow muscles.

To study elbow muscle load sharing we investigated the effect of external flexion-extension (FE) and pronation-supination (PS) moments and elbow angle on muscle activation and oxygen consumption (V O(2)). Two data sets were obtained. First, (n=6) electromyography (EMG) of elbow flexors (long and short heads of biceps brachii, brachioradialis, brachialis) and extensors (long and short heads of triceps brachii and anconeus) was recorded in all combinations of FE and PS moments at three force levels and four elbow angles (50 degrees , 70 degrees , 90 degrees and 110 degrees ). Second, (n=4) EMG and V O(2) of three muscles (both heads of biceps and lateral head of triceps) were measured simultaneously during a subset of the above conditions. Joint angle and therefore both moment arm and muscle length influenced both EMG amplitude and the load sharing between muscles. The principles behind load sharing, however, were difficult to quantify, since it was impossible to distinguish between all individual aspects that affect muscle activity. We found a linear relationship between EMG and V O(2), while joint angle had no major effect. Although in general subjects showed comparable muscle activation patterns, there were also considerable inter-individual differences, which might be explained by the use of different optimisation strategies or differences in morphology.

A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis.

OBJECTIVE: To determine the effects of feeding a diet supplemented with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. DESIGN: Randomized, controlled, multisite clinical trial. ANIMALS: 131 client-owned dogs with stable chronic osteoarthritis examined at 33 privately owned veterinary hospitals in the United States. PROCEDURES: In all dogs, the dosage of carprofen was standardized over a 3-week period to approximately 4.4 mg/kg/d (2 mg/lb/d), PO. Dogs were then randomly assigned to receive a food supplemented with fish oil omega-3 fatty acids or a control food with low omega-3 fatty acid content, and 3, 6, 9, and 12 weeks later, investigators made decisions regarding increasing or decreasing the carprofen dosage on the basis of investigator assessments of 5 clinical signs and owner assessments of 15 signs. RESULTS: Linear regression analysis indicated that over the 12-week study period, carprofen dosage decreased significantly faster among dogs fed the supplemented diet than among dogs fed the control diet. The distribution of changes in carprofen dosage for dogs in the control group was significantly different from the distribution of changes in carprofen dosage for dogs in the test group. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that in dogs with chronic osteoarthritis receiving carprofen because of signs of pain, feeding a diet supplemented with fish oil omega-3 fatty acids may allow for a reduction in carprofen dosage.

Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs.

OBJECTIVE: To assess the effect of food containing high concentrations of fish oil omega-3 fatty acids and a low omega-6-omega-3 fatty acid ratio on clinical signs of osteoarthritis in dogs. DESIGN: Randomized, double-blinded, controlled clinical trial. ANIMALS: 127 client-owned dogs with osteoarthritis in 1 or more joints from 18 privately owned veterinary clinics. PROCEDURES: Dogs were randomly assigned to be fed for 6 months with a typical commercial food or a test food containing a 31-fold increase in total omega-3 fatty acid content and a 34-fold decrease in omega-6-omega-3 ratio, compared with the control food. Dog owners completed a questionnaire about their dog's arthritic condition, and investigators performed a physical examination and collected samples for a CBC and serum biochemical analyses (including measurement of fatty acids concentration) at the onset of the study and at 6, 12, and 24 weeks afterward. RESULTS: Dogs fed the test food had a significantly higher serum concentration of total omega-3 fatty acids and a significantly lower serum concentration of arachidonic acid at 6, 12, and 24 weeks. According to owners, dogs fed the test food had a significantly improved ability to rise from a resting position and play at 6 weeks and improved ability to walk at 12 and 24 weeks, compared with control dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Ingestion of the test food raised blood concentrations of omega-3 fatty acids and appeared to improve the arthritic condition in pet dogs with osteoarthritis.

Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis.

OBJECTIVE: To evaluate the effects of a food supplemented with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. DESIGN: Randomized, double-blinded, controlled clinical trial. ANIMALS: 38 client-owned dogs with osteoarthritis examined at 2 university veterinary clinics. PROCEDURES: Dogs were randomly assigned to receive a typical commercial food (n = 16) or a test food (22) containing 3.5% fish oil omega-3 fatty acids. On day 0 (before the trial began) and days 45 and 90 after the trial began, investigators conducted orthopedic evaluations and force-plate analyses of the most severely affected limb of each dog, and owners completed questionnaires to characterize their dogs' arthritis signs. RESULTS: The change in mean peak vertical force between days 90 and 0 was significant for the test-food group (5.6%) but not for the control-food group (0.4%). Improvement in peak vertical force values was evident in 82% of the dogs in the test-food group, compared with 38% of the dogs in the control-food group. In addition, according to investigators' subjective evaluations, dogs fed the test food had significant improvements in lameness and weight bearing on day 90, compared with measurements obtained on day 0. CONCLUSIONS AND CLINICAL RELEVANCE: At least in the short term, dietary supplementation with fish oil omega-3 fatty acids resulted in an improvement in weight bearing in dogs with osteoarthritis.

Distribution of Eurasian otter biliary parasites, Pseudamphistomum truncatum and Metorchis albidus (Family Opisthorchiidae), in England and Wales.

Gall bladders from 273 otter carcasses, collected throughout England and Wales, were screened to assess the status of gall bladder parasites in the Eurasian otter, Lutra lutra. The digenean Pseudamphistomum truncatum had previously been found in UK otters collected between 2000 and 2007. The parasite was established in Somerset and Dorset but its distribution elsewhere in the UK was largely unknown. In the current study, P. truncatum was also found to be abundant in south Wales, with occasional cases elsewhere, but appears to be absent from the north of England. Overall, 11.7% of otters were infected with 1-238 P. truncatum. A second digenean, Metorchis albidus, previously unreported in British otters, was found in the biliary system of 6.6% of otters. M. albidus appears well established in Suffolk, Norfolk and north Essex but was recorded elsewhere rarely. Both parasites are associated with pathological damage to the otter gall bladder. The recent discovery of these two non-native parasites provides a unique opportunity to assess their impact on native British fauna.

A prospective randomized clinical trial of the use of fluoroscopy in obtaining femoral arterial access.

BACKGROUND: There is no consensus on the utility of fluoroscopy in obtaining common femoral artery (CFA) access. METHODS: Patients weighing < 136.4 kg (300 lbs) with palpable femoral pulses undergoing coronary angiography were randomized to arterial access with or without the use of fluoroscopy (using the center of the femoral head as the optimal site to enter the artery). RESULTS: 208 patients were enrolled with 110 randomized to the palpation group and 98 were randomized to the palpation +fluoroscopy group. Mean age (+/- SD) was 60 +/- 11 years, 61% were male, 35% had diabetes, and 40% had a body mass index (BMI) > 30 kg/m(2). Clinical characteristics and procedural factors were similar among the two groups with the exception that fewer needle passes were required and access was achieved faster in the palpation group. Arterial puncture over the femoral head occurred in 91% of the palpation group versus 95% of the palpation + fluoroscopy group (p = 0.27). Successful CFA puncture occurred in 85% of the palpation group versus 90% of the palpation + fluoroscopy group (p = 0.49). Cannulation of the external iliac artery occurred in 1 patient in each group, whereas arterial puncture distal to the CFA bifurcation occurred in 16 (15%) of the palpation group and in 9 (9%) of the palpation + fluoroscopy group (p = 0.33). CONCLUSION: In this single-center, randomized trial, the use of fluoroscopy did not increase the probability of arterial puncture over the femoral head or the rate of successful CFA cannulation.

TACI-Ig prevents the development of airway hyperresponsiveness in a murine model of asthma.

BACKGROUND: Increased levels of serum IgE are associated with greater asthma prevalence and disease severity. IgE depletion using an anti-IgE monoclonal antibody has met with success in the treatment of moderate-to-severe and severe persistent allergic asthma. OBJECTIVE: To test whether B cell-targeted therapy is a more effective treatment for airway hyperresponsiveness (AHR) in a murine model compared with IgE-depletion. METHODS: We delivered soluble mTACI-Ig, a receptor for the B cell survival factors BLyS (B Lymphocyte Stimulator) and APRIL (A PRoliferation-Inducing Ligand), or anti-IgE to allergen-sensitized mice before airway challenge with allergen. RESULTS: mTACI-Ig treatment reduced circulating mature B cell levels in the blood, while anti-IgE treatment had no effect on B cell counts. Both mTACI-Ig and anti-IgE decreased the levels of total and allergen-specific IgE in the serum. Histopathologic analysis of lungs showed a reduction in disease severity scores for both treatment groups, but results were more pronounced in mTACI-Ig-treated mice. Neutrophil and eosinophil numbers in the bronchoalveolar lavage (BAL) were significantly reduced following mTACI-Ig treatment, but not after anti-IgE delivery. BLyS and APRIL blockade also resulted in a significant decrease in IL-4 and eotaxin mRNA and IL-4 and KC protein levels in total lung homogenates and BAL fluid, respectively. Finally, mTACI-Ig treatment was more effective than anti-IgE treatment in reducing AHR to inhaled antigen. CONCLUSIONS: Our data demonstrate that delivery of mTACI-Ig is a more effective treatment than anti-IgE mAb in a murine model of AHR.

The relationship between two different mechanical cost functions and muscle oxygen consumption.

Inverse-dynamic models often use cost functions to solve the load-sharing problem. Although it is often assumed that energy is minimised, most cost functions are based on mechanically related measures like muscle force or stress. The aim of this study was to analyse the relationships of two cost functions with experimentally determined data on muscle energy consumption. Four subjects performed isometric contractions generating combinations of elbow flexion/extension and pro/supination moments. Muscle oxygen consumption (VO2) of the m. biceps breve, m. biceps longum, m. brachioradialis and m. triceps laterale was measured with near infrared spectroscopy. Both cost functions were implemented into an existing inverse-dynamic shoulder and elbow model and the individual cost values per muscle were calculated, normalised and subsequently compared to experimental VO2 values. The minimum stress cost function led to a good correspondence between VO2 and cost for the m. triceps laterale but for the flexor muscles cost was significantly lower. A newly proposed energy-related cost function showed, however, a far better correspondence. The inclusion of a linear term and muscle mass in the new criterion led model results to correspond better to experimental results. The energy-related cost function appeared to be a better measure for muscle energy consumption than the stress cost function and led to more realistic predictions of muscle activation.

Glenohumeral joint loading in tetraplegia during weight relief lifting: a simulation study.

BACKGROUND: The incidence of shoulder complaints in wheelchair users is high and the etiology is poorly understood. The goal of this study was to examine the effect of lesion level and isolated triceps muscle paresis on the internal load on the shoulder by simulation. METHODS: Kinematic and kinetic profiles from four able-bodied subjects and four subjects with tetraplegia were used as input for an inverse dynamics biomechanical model. The model was modified to simulate lesion level and triceps muscle paresis. FINDINGS: The simulations resulted in a significantly higher (+56%) glenohumeral contact force (P=0.037) for tetraplegic profiles than for able-bodied profiles. The model modifications to simulate lesion level only had a minor effect (+7%) on the calculated glenohumeral contact force. More simulations were successful at lower triceps force levels for tetraplegic profiles compared to able-bodied profiles (P=0.012). The muscle forces at the simulated T1 lesion were not significantly higher in tetraplegic profiles compared to able-bodied profiles. INTERPRETATION: The glenohumeral contact force for the tetraplegic profiles is mainly higher due to different task performance. Model modifications only have a minor effect on the calculated glenohumeral contact force. For able-bodied profiles the triceps force seems to be an important factor. The high internal load at the shoulder recommends new techniques of weight relief lifting and proper training of the arm-shoulder muscles in rehabilitation.

A kinematical analysis of the shoulder after arthroplasty during a hair combing task.

BACKGROUND: After shoulder arthroplasty, post-operative Range of Motion is usually compromised. It is, however, unclear to what extent limitations in Range of Motion are related to functional outcome in terms of Activities of Daily Living. METHODS: The upper extremity motions of 13 patients (16 shoulders) and a control group (N = 24) during four Range of Motion tasks and Activities of Daily Living were measured using a six degree-of-freedom electromagnetic tracking device. Based on the results for the Activities of Daily Living task 'hair combing', the patient groups was divided into a group that could perform this task ('Able', N = 8, 10 shoulders) and a group that could not perform the task ('Unable', N = 6, six shoulders). RESULTS: Both patient groups showed considerable limitation in glenohumeral Range of Motion, when compared to controls, but between patient groups only axial rotation Range of Motion was different: the 'Able' group has a larger external rotational Range of Motion, but less internal rotation. During 'combing hair' the Able group appeared to successfully perform the task through a larger clavicular retraction. INTERPRETATION: The ability to perform, or not perform a task appeared to be related to a compensatory movement implementation by means of clavicular retraction. It is concluded that the functional outcome after arthroplasty is limited due to a lack of glenohumeral Range of Motion but that it is possible to compensate for this restriction.

Requirements for upper extremity motions during activities of daily living.

BACKGROUND: Functioning of the upper extremity after implantation of an endoprosthesis remains limited despite the achieved pain relief. Upper extremity kinematics can give insight into function after shoulder arthroplasty. Data on ranges of motion related to the performance of a selection of activities of daily living can aid the clinician in evaluating the outcome of the shoulder and elbow arthroplasties. METHODS: Cross-sectional descriptive study of range of motion and activities of daily living kinematics, conducted on non-impaired subjects. The shoulder and elbow motions of 24 healthy female subjects are measured with an electromagnetic tracking device while performing 8 range of motion tasks and five activities of daily living. The angles of shoulder and elbow are calculated during these tasks. RESULTS: A data set with upper extremity joint angles has been obtained. Large glenohumeral rotations are found for the tasks that require high elevation angles. Large axial rotations of the humerus are found for two of the activities of daily living tasks: the perineal care task and the hair-combing task. Large elbow flexions were seen in the following tasks: combing hair, washing the axilla and eating with a spoon. INTERPRETATION: This study shows a suitable method to describe range of motion and activities of daily living and can serve as a starting point for developing a database on how activities of daily living are performed in a larger population and which joint angles are required to perform these tasks. Results can be used to identify restrictions in upper extremity functioning in patients with shoulder impairments.