Evaluation of a method to quantify posture and scapula position using biplanar radiography.

BACKGROUND: Recent studies have stated the relevance of having new parameters to quantify the position and orientation of the scapula with patients standing upright. Although biplanar radiography can provide 3D reconstructions of the scapula and the spine, it is not yet possible to acquire these images with patients in the same position. METHODS: Two pairs of images were acquired, one for the 3D reconstruction of the spine and ribcage and one for the 3D reconstruction of the scapula. Following 3D reconstructions, scapular alignment was performed in two stages, a coarse alignment based on manual annotations of landmarks on the clavicle and pelvis, and an adjusted alignment. Clinical parameters were computed: protraction, internal rotation, tilt and upward rotation. Reproducibility was assessed on an in vivo dataset of upright biplanar radiographs. Accuracy was assessed using supine cadaveric CT-scans and digitally reconstructed radiographs. FINDINGS: The mean error was less than 2° for all clinical parameters, and the 95 % confidence interval for reproducibility ranged from 2.5° to 5.3°. INTERPRETATION: The confidence intervals were lower than the variability measured between participants for the clinical parameters assessed, which indicates that this method has the potential to detect different patterns in pathological populations.

A central mechanism enhances pain perception of noxious thermal stimulus changes.

Pain perception temporarily exaggerates abrupt thermal stimulus changes revealing a mechanism for nociceptive temporal contrast enhancement (TCE). Although the mechanism is unknown, a non-linear model with perceptual feedback accurately simulates the phenomenon. Here we test if a mechanism in the central nervous system underlies thermal TCE. Our model successfully predicted an optimal stimulus, incorporating a transient temperature offset (step-up/step-down), with maximal TCE, resulting in psychophysically verified large decrements in pain response ("offset-analgesia"; mean analgesia: 85%, n = 20 subjects). Next, this stimulus was delivered using two thermodes, one delivering the longer duration baseline temperature pulse and the other superimposing a short higher temperature pulse. The two stimuli were applied simultaneously either near or far on the same arm, or on opposite arms. Spatial separation across multiple peripheral receptive fields ensures the composite stimulus timecourse is first reconstituted in the central nervous system. Following ipsilateral stimulus cessation on the high temperature thermode, but before cessation of the low temperature stimulus properties of TCE were observed both for individual subjects and in group-mean responses. This demonstrates a central integration mechanism is sufficient to evoke painful thermal TCE, an essential step in transforming transient afferent nociceptive signals into a stable pain perception.

The Emotional Brain as a Predictor and Amplifier of Chronic Pain.

Human neuroimaging studies and complementary animal experiments now identify the gross elements of the brain involved in the chronification of pain. We briefly review these advances in relation to somatic and orofacial persistent pain conditions. First, we emphasize the importance of reverse translational research for understanding chronic pain-that is, the power of deriving hypotheses directly from human brain imaging of clinical conditions that can be invasively and mechanistically studied in animal models. We then review recent findings demonstrating the importance of the emotional brain (i.e., the corticolimbic system) in the modulation of acute pain and in the prediction and amplification of chronic pain, contrasting this evidence with recent findings regarding the role of central sensitization in pain chronification, especially for orofacial pain. We next elaborate on the corticolimbic circuitry and underlying mechanisms that determine the transition to chronic pain. Given this knowledge, we advance a new mechanistic definition of chronic pain and discuss the clinical implications of this new definition as well as novel therapeutic potentials suggested by these advances.

Descending nociceptive inhibition is modulated in a time-dependent manner in a double-hit model of chronic/tonic pain.

Clinical evidences suggest that an imbalance between descending inhibition and facilitation drives the development of chronic pain. However, potential mechanisms promoting the establishment of a persistent pain state and the increased pain vulnerability remain unknown. This preclinical study was designed to evaluate temporal changes in descending pain modulation at specific experimental endpoints (12, 28, 90 and 168 days) using a novel double-hit model of chronic/tonic pain (first hit: chronic constriction injury (CCI) model; second hit: tonic formalin pain in the contralateral hindpaw). Basal activity of bulbo-spinal monoaminergic systems was further assessed through liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) screening of cerebrospinal fluid (CSF). We found that CCI-operated rats exhibited a reduced nociceptive response profile, peaking on day 28, when subjected to tonic pain. This behavioral response was accompanied by a rapid increase in basal CSF serotonin and norepinephrine levels 12 days after neuropathy, followed by a return to sham levels on day 28. These molecular and behavioral adaptive changes in descending pain inhibition seemed to slowly fade over time. We therefore suggest that chronic neuropathic pain produces a transient hyperactivation of bulbo-spinal monoaminergic drive when previously primed using a tonic pain paradigm (i.e., formalin test), translating into inhibition of subsequent nociceptive behaviors. Altogether, we propose that early hyperactivation of descending pain inhibitory mechanisms, and its potential ensuing exhaustion, could be part of the temporal neurophysiological chain of events favoring chronic neuropathic pain establishment.

Influence of prosthetic humeral head size and medial offset on the mechanics of the shoulder with cuff tear arthropathy: a numerical study.

This numerical study assesses the influence of an oversized humeral hemiprosthesis with a larger medial offset on the mechanics of the shoulder with cuff tear arthropathy (CTA). Shoulder elevation in the scapular plane is performed, and a Seebauer Type IIa CTA is simulated: a massive rotator cuff tear, a proximal and static migration of the humeral head, and two contacts with friction (glenohumeral and acromiohumeral). The CTA model without a prosthesis (friction coefficient 0.3) is evaluated first as a reference model. Then, three humeral head prosthetic geometries (friction coefficient 0.15) are evaluated: anatomical head, oversized head, and oversized head with a large medial offset. The function of the middle deltoid (i.e. moment arm, applied force, and strength), the contact forces, and the range of motion are studied. The anatomical head, which reduces friction by half, decreases the middle deltoid force (25%) and the contact forces (glenoid 7%; acromion 25%), and increases the range of motion from 41 to 54°. The oversized head increases the moment arm (15%) and the middle deltoid strength (13%), which further decreases the deltoid force (7%) and the contact forces (glenoid 7%; acromion 17%), and increases the range of motion from 54° to 69°. The oversized head with a large medial offset enhances these effects: the moment arm increases by another 3.1%, the deltoid force decreases by another 5% and the acromiohumeral contact force by another 12%, and the range of motion increases from 69° to 84°. These results suggest that increasing the medial offset and oversizing the hemiprosthetic head improve the function of the deltoid, reduce acromial solicitation, and restore elevation to almost 90°.

Influence of the medial offset of the proximal humerus on the glenohumeral destabilising forces during arm elevation: a numerical sensitivity study.

This study assessed the influence of the medial offset of the proximal humerus on the glenohumeral destabilising forces during arm elevation in the plane of the scapula, using the AnyBody Modeling System. The variability of the medial offset was covered using literature data (minimum, 0 mm; average, 7 mm and maximum, 14 mm). The following parameters were studied: moment arm (MA; middle deltoid), muscle activity and stability ratios. The minimum offset decreased the MA of the middle deltoid ( -11%), increased its activation (+18%) and its superior destabilising action (+40%). The maximum offset had an opposite effect (+9%, -30% and -30%). The stabilising action of the rotator cuff was not affected. Varying the medial offset seems to have an influence on the destabilising action of the middle deltoid. The AnyBody simulation tool appears to be promising in establishing links between shoulder morphology and stability.

Improvements in measuring shoulder joint kinematics.

For many clinical applications it is necessary to non-invasively determine shoulder motion during dynamic movements, and in such cases skin markers are favoured. However, as skin markers may not accurately track the underlying bone motion the methods currently used must be refined. Furthermore, to determine the motion of the shoulder a model is required to relate the obtained marker trajectories to the shoulder kinematics. In Wu et al. (2005) the International Society of Biomechanics (ISB) proposed a shoulder model based on the position of bony landmarks. A limitation of the ISB recommendations is that the reference positions of the shoulder joints are not standardized. The aims of this research project were to develop a method to accurately determine shoulder kinematics using skin markers, and to investigate the effect of introduction of a standardized reference configuration. Fifteen subjects, free from shoulder pathology, performed arm elevations while skin marker trajectories were tracked. Shoulder kinematics were reconstructed using a chain model and extended Kalman filter. The results revealed significant differences between the kinematics obtained with and without introduction of the reference configuration. The curves of joint angle tended towards 0° for 0° of humerus elevation when the reference configuration was introduced. In conclusion, the shoulder kinematics obtained with introduction of the reference configuration were found to be easier to interpret than those obtained without introduction of the reference configuration.

Re-examining the association of os acromiale with supraspinatus and infraspinatus tears.

PURPOSE: To re-evaluate the relationship between os acromiale and rotator cuff tears. METHODS: We retrospectively analyzed 84 magnetic resonance imaging studies of the shoulder. Forty-two subjects with os acromiale (n = 42; 32 men and ten women, age 25-81 years, mean 47.6 years) were compared with age- and gender-matched subjects with no evidence of os acromiale (controls). Arthroscopy data were available in 19 os acromiale and 12 control subjects. Statistical analyses were performed to determine differences between groups regarding rotator cuff tears affecting the supraspinatus and infraspinatus tendons detected by magnetic resonance imaging and arthroscopy. Analysis of os acromiale type, ossicle synchondrosis edema, acromioclavicular joint degenerative changes and step-off deformity at the synchondrosis were tabulated. RESULTS: No statistically significant difference between the os acromiale and control groups was noted, either on magnetic resonance imaging or arthroscopy, with regard to tears of the supraspinatus (P = 1.000 and 0.981, respectively) and infraspinatus (P = 1.000 and 0.667, respectively) tendons. There was a statistically significant increased number of supraspinatus (P = 0.007) and infraspinatus (P = 0.03) tears in a comparison of subjects with os acromiale and step-off deformity (10/42) vs os acromiale without step-off deformity (32/42). CONCLUSION: The presence of os acromiale may not significantly predispose to supraspinatus and infraspinatus tendon tears. However, subjects with step-off deformity of an os acromiale are at greater risk of rotator cuff tears than are similar subjects without such deformity.

Simultaneous determination of dissolved gases and moisture in mineral insulating oils by static headspace gas chromatography with helium photoionization pulsed discharge detection.

This paper presents the development of a static headspace capillary gas chromatographic method (HS-GC) for simultaneously determining dissolved gases (H2, O2, N2, CO, CO2, CH4, C2H6, C2H4, C2H2, C3H8) and moisture from a unique 15-mL mineral oil sample. A headspace sampler device is used to equilibrate the sample species in a two-phase system under controlled temperature and agitation conditions. A portion of the equilibrated species is then automatically split-injected into two chromatographic channels mounted on the same GC for their separation. The hydrocarbons and the lighter gases are separated on the first channel by a GS-Q column coupled with a MolSieve 5-A column via a bypass valve, while the moisture is separated on the second channel using a Stabilwax column. The analytes are detected by using two universal pulsed-discharge helium ionization detectors (PDHID). The performance of the method was established using equilibrated vials containing known amounts of gas mixture, water, and blank oil. The signal is linear over the concentration ranges normally found for samples collected from open-breathing power transformers. Determination sensitivity varies with the nature of the species considered with values as high as 21 500 A x 10(-9) s (microg/ g)(-1) for H2O, 46-216 A x 10(-9) s (microL/L)(-1) for the hydrocarbons and carbon oxides, and as low as 8-21 A x 10(-9) s (microL/L)(-1) for the O2 and N2 permanent gases. The detection limit of the method is between 0.08 and 6 microL/L for the dissolved gases, except for O2, N2, and CO2, where higher values are observed due to air intrusion during sampler operations, and 0.1 microg/g for the dissolved water. Ten consecutive measurements in the low and high levels of the calibration curves have shown a precision better than 12% and 6%, respectively, in all cases. A comparison study between the HS-GC method and the ASTM standard procedures on 31 field samples showed a very good agreement of the results. The advantages of configuring the arrangement with two PDHID over the conventional flame ionization and thermal conductivity detectors were clearly demonstrated.

Bias assessment of current technologies used for the determination of low levels of moisture in mineral oil samples.

The problem in the current debate on the accuracy of Karl Fischer (KF) titrations lies in the fact that coulometry is being compared to volumetry on mineral oil samples for which the true moisture content is unknown. To clarify this point, dehydrated oil samples equilibrated under known temperature and relative humidity conditions and equilibrated oil samples containing known amounts of added moisture were used to assess the accuracy of the determinations. In addition, the measurements were extended to other techniques given that it is unlikely that they would be affected by the same phenomenon causing the KF systematic errors. The samples sent to different laboratories were analyzed by headspace/capillary gas chromatography, gas-phase H2 sensor, oil-phase or gas-phase RH sensors, KF coulometric titration with direct or indirect injection, and KF volumetric titration using a standard or NIST modified procedure. The laboratory comparison showed that with the exception of 4 techniques out of 10 that were tested, the measurements gave results in the expected concentration range. Considering the exceptions, two techniques based on volumetric titration yielded results tainted with an important positive bias for both sample types. This bias, tentatively associated with the high iodine end point concentration used by these systems, was estimated at approximately 22 ppm under the conditions applied by NIST. On the other hand, the two RH sensors showed a marked tendency to underestimate the value of the samples containing high moisture content. In this case, a loss of analyte through wall adsorption during the time required to achieve steady-state conditions in the measuring chamber seems to be at the origin of the negative biases.

Determination of the analytical performance of a headspace capillary gas chromatographic technique and karl Fischer coulometric titration by system calibration using oil samples containing known amounts of moisture.

Over the past few years, concerns have been raised in the literature about the accuracy of the Karl Fischer (KF) method for assessing moisture in transformer mineral oils. To better understand this issue, the performance of a static headspace capillary gas chromatographic (HS-CGC) technique was compared to that of KF coulometric titration by analyzing moisture in samples containing known amounts of water and various samples obtained from the National Institute of Standards and Technology (NIST). Two modes of adding samples into the KF vessel were used: direct injection and indirect injection via an azeotropic distillation of the moisture with toluene. Under the conditions used for direct injection, the oil matrix was totally dissolved in the anolyte, which allowed the moisture to be titrated in a single-phase solution rather than in a suspension. The results have shown that when HS-CGC and combined azeotropic distillation/KF titration are calibrated with moisture-in-oil standards, a linear relation is observed over 0-60 ppm H(2)O with a correlation coefficient better than 0.9994 (95% confidence), with the regression line crossing through zero. A similar relation can also be observed when calibration is achieved by direct KF addition of standards prepared with octanol-1, but in this case an intercept of 4-5 ppm is noted. The amount of moisture determined by curve interpolation in NIST reference materials by the three calibrated systems ranges from 13.0 to 14.8 ppm for RM 8506 and 42.5 to 46.4 ppm for RM 8507, and in any case, the results were as high as those reported in the literature with volumetric KF titration. However, titration of various dehydrated oil and solvent samples showed that direct KF titration is affected by a small bias when samples contain very little moisture. The source of error after correction for the large sample volume used for the determination (8 mL) is about 6 ppm for Voltesso naphthenic oil and 4 ppm for toluene, revealing a matrix effect on the measurement. Finally, the results revealed that HS-CGC is a good technique for measuring moisture in oil samples and that the use of azeotropic vapors for introducing moisture into the titrator almost completely eliminates the matrix effect observed with the oil components. Direct KF injection could also be used provided the system is calibrated with moisture-in-oil standards prepared in the same matrix which is to be used for the determination.

Empathy with a rape victim: the role of similarity of experience.

The purpose of this study was to replicate and extend a prior investigation (Barnett, Tetreault, Esper, & Bristow, 1986) in order to clarify the role of similarity of experience in women's empathy with a rape victim. Women who were identified as having been raped rated themselves as more empathic with, and more similar to, a rape victim patient presented on videotape than did nonrape control subjects who had been matched on level of dispositional empathy. However, no difference was found between the two subject groups in their responses to a videotaped patient whose personal problems were unrelated to the experience of rape. In addition, subjects generally rated the rape victim patient as less emotionally stable than the patient whose personal problems were unrelated to rape. Alternative interpretations of the major finding of this study are discussed.